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INICET May 2026 Mega Recall session with DAMS Faculty — Transcript

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0:01I know it is too early to do a
0:02discussion, but if we don't start right
0:04now,
0:05we won't be able to finish.
0:08So, are you up here?
0:16Those who are live and connected with
0:17me, just reply in the chat.
0:22Can I begin?
0:28Can we start?
0:36Before I ask you about psychiatry, can I
0:38ask you about how was the INI CET paper?
0:46Can I ask you about how was the INI CET
0:48paper?
1:13Yes.
1:15Hello. Good afternoon, everyone. My name
1:18is Dr. Sachin. I'm psychiatry faculty at
1:20AIIMS. And today I'm going to discuss
1:22psychiatry questions. Not that more
1:24number of questions were asked in
1:26psychiatry, but with the help of my
1:28students, I was able to recall them
1:30quickly.
1:31And this is a PDF that I've shared
1:34with which I've written recalled
1:36question by my own hands. When the same
1:39PDF is open in my iPad, so if you make
1:42any changes in this particular question,
1:45I will make the same changes live in my
1:48iPad, and I shall give you the final
1:50questions and the final answers. Thank
1:53you, Dr. Tushar Gautam.
1:55So, before we start the discussion on
1:58INI CET psychiatric questions, may I
2:00just know how was the INI CET paper
2:03according to you?
2:05Uh if I just ask you,
2:07was it good, difficult, easy, average?
2:14What is your answer to that?
2:17Overall INI CET paper according to you
2:20was difficult?
2:22Is my voice clear? Can all of you hear
2:24me properly?
2:27Can all of you hear me properly?
2:41Very tough, average, lengthy, confusing.
2:47Okay, any other comments? Difficult,
2:50bhayanak.
2:52Very very difficult, wow.
2:55But I actually comment on it, okay.
3:04Okay.
3:11Okay, so this was the overall INI CET
3:13paper. And if I ask you psychiatry now,
3:18this was your overall experience of the
3:19INI CET.
3:22If I ask you psychiatry now, then uh
3:26maybe start asking psychiatry.
3:29So, I could recall seven to eight
3:31questions. Somebody said nine questions
3:33of psychiatry.
3:35Don't you think they were focusing more
3:37on, you know,
3:38uh de-addiction, one question on opioid,
3:41one question on Wernicke's line, one
3:44question on nicotine?
3:46What is the first topic that I say that
3:48INI CET favorite topic is de-addiction.
3:52You believe me or not, last Sunday
3:55I was taking a session on nicotine
3:57replacement therapy for psychiatry post
3:59graduates. That session has been posted
4:02on my Instagram channel. When to use
4:04nicotine replacement therapy, when to
4:06use gum, when to use lozenges, and I was
4:10teaching this to psychiatry MD students.
4:13And they asked this question today in
4:17psychiatry for INICET.
4:23I don't know because I was teaching this
4:26part something else.
4:30New drugs was asked. New drug only this
4:32vilazodone, it's a repeat question.
4:37Seeing you after 6 years. Thank you, Dr.
4:39Murphy.
4:42Why everything from surgery is about
4:44colon?
4:45Good question.
4:46I will send this to surgery faculty.
4:53Ah, good question.
4:55I was discussing with the this
4:58psychiatry PG students, not with
5:01psychiatry UG.
5:06Not with UG. I was discussing It was a
5:08webinar on for well
5:11enhancing.
5:13That was unintentional. Okay. So, INICET
5:18May 2026.
5:20Okay.
5:22Good.
5:29Can I start?
5:30Okay. First question. Novel
5:32antidepressant.
5:34Trazodone, vilazodone, blonanserin,
5:36netizolam. First of all, tell me the
5:37question is correct, the options are
5:39correct.
5:54>> First of all, let's start psychiatry
5:55discussion. The question is correct, the
5:57answer is correct.
5:59Okay, not the answer, the options.
6:01Was the question asking novel
6:03antidepressant? Shall I make any changes
6:04in the question language?
6:06All of you will get this PDF from me.
6:10Any changes in question number one?
6:17Any changes required in question number
6:19one?
6:26Are the options correct?
6:31Do we know vilazodone is a spadi?
6:36Did you answer this correct question
6:38correct? It is a repeat question from
6:40previous INICET.
6:42Serotonin partial agonist and reuptake
6:45inhibitor.
6:46Spadi, have you seen the PYQ PDF?
6:50Have you seen the PYQ PDF?
6:56Was this question answerable?
6:59No changes in the options required?
7:02Okay, next question.
7:05Now, this is our nicotine replacement
7:07therapy.
7:08First of all, tell me, did they ask true
7:11statement or did they ask false
7:13statement?
7:16Did they ask true statement or did they
7:18ask false statement?
7:22It is a lamotrigine option according to
7:24students.
7:28Present.
7:31Okay, let's recall nicotine replacement
7:34therapy question.
7:35Uh, did they ask true statement or did
7:38they ask false statement?
7:40True.
7:48Okay. So, gums are better than lozenges
7:50is a false statement. I would like to
7:52tell you lozenges are better than gum.
7:58And it is a true statement that patient
8:00is instructed not to take any
8:02liquid tea, coffee
8:0615 minutes before taking this.
8:16Just tell me is it true statement was
8:18asked or false?
8:27Can anybody recall the other two
8:29options?
8:32Can anyone recall the other two options?
8:43Wernicke line
8:46was in the same
8:48question or in a different question?
9:00Wernicke line was in the same question
9:03or a different question?
9:07It was mentioned gums increase plasma
9:09concentration of
9:10lozenges increase plasma concentration.
9:29Achha, Wernicke line isi question ka
9:31part tha. Okay.
9:37Wernicke line
9:39Hmm. box warning
9:43I'm adding that option.
9:50for cardiovascular side effects.
9:55Varenicline does not have a black box
9:56warning for cardiovascular side effects.
10:00That's a false statement.
10:04To be a option already fourth What's the
10:06answer but I don't
10:08Fourth option but I don't
10:15Varenicline key black box warning to me
10:17a cardiac earlier there's no black box
10:19warning.
10:25Nicotine is absorbed by gastrointestinal
10:28route.
10:33gum patient
10:40Okay, thank you Dr. Cherisha.
10:43Gums are better than lozenges false
10:44statement.
10:46Patient instruction is a true statement
10:48Varenicline false statement.
10:58I nicotine is not delivered by
11:02gastrointestinal route.
11:11There are gums, there are patches, there
11:13are lozenges.
11:21Okay, so according to me the second
11:23option is the most correct.
11:31Uh, Gautam patient is using nicotine
11:33gum, they must avoid tea, coffee for 15
11:35minutes before and during use.
11:43GI route.
11:47According to me, uh, second is the okay.
11:56Can we move on to the next question?
12:07Was this question there? Drug abuser
12:09present with pinpoint pupil
12:12and respiratory depression.
12:16Drug abuser pinpoint pupil and
12:18respiratory depression.
12:35I think opioid overdose was also asked
12:38in
12:39your
12:41INICET
12:4324 November.
12:52Unconscious also.
12:54Okay.
13:13Pralidoxime. Oxime, which oxime?
13:18Flumazenil. Okay.
13:28Pralidoxime. Okay.
13:30Are all of us convinced that the answer
13:32was naloxone? It is an opioid overdose.
13:36Are [snorts] all of us convinced that
13:37the answer was naloxone, opioid
13:39overdose?
13:40Easy question.
13:48Could What was the ans- other options in
13:50this question? Rett syndrome question
13:52was asked. 20-month-old child uh delayed
13:56speech development, breath-holding
13:57spells, hand-wringing movements.
14:12Was this question there on Rett syndrome
14:14room? Have you written somewhere that
14:16Rett is a VIP topic for INI-CET?
14:23Did I mention somewhere Rett was a VIP
14:25topic for INI-CET?
14:33Fragile X. In this also they give an
14:36option whenever they ask a question on
14:38Rett syndrome.
14:41What was the fourth option? Female.
14:47Okay.
14:54Slowly deteriorating
14:56childhood disintegrative disorder was
14:58that option. That is Heller syndrome.
15:12Was breath-holding spells microcephaly
15:15was also given. Okay.
15:22Was
15:22Was mentioned?
15:24Loss of milestones mentioned?
15:30Adjustment disorder question was there.
15:32Nobody recalled it.
15:34Adjustment disorder question.
15:43Oh, that is uh your after divorce.
15:47Uh-huh.
15:49Microcephaly data.
15:54Yeah.
15:57Loss of mention was not mentioned.
16:12Loss of my I'm coming to that chronic
16:14alcoholic wala question. Wait.
16:17Are we convinced with question number
16:19four answer of
16:21Rett syndrome?
16:24Okay, so there was nothing called as
16:26Wernicke's line question, so I will
16:27delete this question.
16:37Was there any question on Korsakoff
16:39syndrome?
16:45Was there any question on Korsakoff
16:47syndrome?
16:58What was the question? True statement or
17:01false statement?
17:08True statement or false statement?
17:41>> Who straight man?
17:43Anterograde amnesia with impaired recent
17:45memory. I think it is a repeat question.
17:57What was the other option?
18:06What was the other option?
18:14I think it is a repeat question PYQ.
18:16Anterograde amnesia with loss of recent
18:18memory.
18:21Same question.
18:31It is a PYQ.
18:35Uh that is the correct answer.
18:36Anterograde amnesia with loss of recent
18:38memory.
18:40Wernicke triad was another option. What
18:41were the remaining option?
18:59Loss of personal identity.
19:12Okay.
19:23Implicit memory. So, you all were able
19:25to do this question. I feel. Let's go to
19:28the next question.
19:35So, this was your confused question.
19:37This year.
19:3945-year-old recently divorced alcoholic
19:43expresses wishes to die. Next best step.
19:50Check the language first.
19:54Check the language of question number
19:56seven first.
20:20Check the language, please.
20:36Antidepressant and weekly OPD. Okay.
20:46Divorce, depressive, alcohol abuse.
20:57Says, "What's the point in living?"
21:12>> What's the point in living? No point to
21:14live.
21:18Reassure and tell it is a transient
21:21phenomenon.
21:25What do you think will you do?
21:27Will you leave the patient having
21:29suicidal thought or will you admit the
21:31patient?
21:35The patient is having suicidal thoughts.
22:08What is the next best treatment?
22:21Next best treatment.
22:24I think we should admit the patient.
22:26Hospitalize.
22:29Admit the patient. Hospitalization.
22:35Suicidal thoughts we cannot leave for,
22:38you know, observation.
22:41Admit her.
22:45Suicidal thoughts. Patient is willing to
22:47die.
22:49Comes under severe depression.
22:51Severe depression, admit the patient.
23:08>> Last question, classical conditioning.
23:11Did you people understand this concept
23:13of classical conditioning? Although the
23:14options recalled were very different.
23:18Before I come to the question on
23:20classical conditioning, uh
23:22can you tell me
23:24>> [snorts]
23:26>> uh was there any question on
23:27fluphenazine?
23:31Was there any question on fluphenazine
23:33or shall I discard this question?
23:38Was there any question on fluphenazine
23:40or shall I discard this question?
23:49No question?
23:52Was there any question on fluphenazine?
23:56If yes, tell me, otherwise I'll discard
23:59it.
24:06What was the question on fluphenazine?
24:17What was the question on fluphenazine?
24:24Fluphenazine.
24:28Penfluridol. Okay, I will remove it.
24:33So, we are back to seven questions.
24:36So, now we are into the last question.
24:39I hope all the other six are clear.
24:42I'm into the last question.
24:44>> [snorts]
24:45>> Do you know the concept of classical
24:47conditioning? The dog and bell
24:48experiment, Pavlov. First, rang the
24:50bell, he gave the food, dog came, dog
24:53salivated. Rang the bell, gave the food,
24:55dog came. In this bell was a
25:00unconditioned stimulus
25:03uh
25:05>> [clears throat]
25:05>> and salivation was an unconditioned
25:08response. Food was an unconditioned
25:10stimulus.
25:11After some time when the food and bell
25:13were coupled, the bell became a
25:17conditioned stimulus.
25:19The bell became a conditioned stimulus.
25:23So, how does this classical conditioning
25:24happens?
25:26First,
25:27it is process.
25:31First, it is unconditioned stimulus,
25:33unconditioned response.
25:35Then when unconditioned stimulus
25:39is coupled,
25:42then eventually a conditioned stimulus
25:48like bell produces a conditioned
25:50response.
25:52Now, I did not understand what was the
25:55uh
26:00options.
26:09If you combine an unconditioned stimulus
26:11like bell with a
26:14unconditioned stimulus like food with a
26:17conditioned stimulus like bell, you will
26:19get a conditioned response.
26:27I did not get the exact options of this
26:30question.
26:33I did not get the exact options of this
26:35question.
27:05>> Nishant, you can type it here in the
27:08YouTube if you have any question.
27:25The option teaser. Okay, Rahul Mangala.
27:36So, we are finally closing at seven
27:38questions. Any other question that you
27:40have recalled related to psychiatry?
28:15Uh did they ask in classical
28:17conditioning true or did they ask false?
28:23Can I summarize if you allow me?
28:30Can I summarize if you allow me?
28:50>> Can I summarize all the seven questions
28:52which you have just told me
28:54after editing?
29:09So this is after editing wala PDF.
29:12Novel antidepressant
29:15vilazodone, first question.
29:19Clear, everyone?
29:21So this is our second question on
29:23nicotine replacement therapy.
29:37Answer should be
29:39not to take liquid one.
29:41Then pinpoint pupil respiratory
29:43depression
29:46naloxone.
29:48Rett syndrome, everybody marked correct.
29:50Rett syndrome, microcephaly, hand
29:52wringing movement. Korsakoff syndrome,
29:54again a PYQ. Anterograde amnesia.
29:58Then what's the point in living
29:59hospitalization? Classical conditioning
30:02based on the options
30:06we will come. So how many correct out of
30:08seven?
30:15How many out of these you could mark
30:17correct out of seven?
30:50>> This is the final PDF after editing.
30:576
30:597
31:016
31:027 4
31:05Was it doable?
31:09I think so apart from classical
31:11conditioning which was a conceptual
31:12question all of them were very simple.
31:15But classical conditioning was also
31:16doable question.
31:20I have to go through the options once
31:22again.
31:24Then only I can come to the final
31:25answer.
31:27So can we close up for psychiatry now?
31:32Okay.
31:34So that's all about psychiatry.
31:36Uh you will have the next subject now
31:38lined up.
31:43If any questions get back to me. Dravet
31:45syndrome was not a psychiatric question.
34:14>> Okay, welcome everyone. Welcome. Let's
34:17discuss the radiology related questions.
34:20>> [snorts]
34:23>> Let us discuss the radiology related
34:24questions. So, I hope you are able to
34:26see me and hear me. Give me a thumbs up.
34:28Give me a thumbs up if you are able to
34:30hear me and see me.
34:31So, I know some of the questions in this
34:35discussion that I will do will also be
34:37discussed by other subjects. So,
34:39radiology INI CET 2026,
34:42there was no isolated radiology
34:44question. Koi bhi akela radiology
34:46question nahi hai. They are all
34:48integrated with other subjects. And I
34:51would rate to rate them to be moderate
34:53to tough. Moderate to tough. Koi bhi
34:56akela radiology nahi hai. Jude hue
34:57question hai. So, let's see the first
34:59question.
35:00There was this question which we
35:01discussed in radiology classes, but is
35:03actually a neurology question, but we
35:04discussed similar to this. Ek bar dekhte
35:06hai.
35:07If you remember my aims predictor, I
35:09told you dystonia, PKAN are very
35:12important questions. So, what is what is
35:15this category? These are
35:16neurodegenerative conditions
35:21with brain iron accumulation.
35:26So, what will be the short form? We will
35:28call them as NBIA.
35:32What is common in NBIA is they all come
35:35to you with Parkinson's dystonia, basal
35:38ganglia involvement.
35:39So, out of the choices given,
35:42PKAN is a NBIA.
35:46PL2G6
35:48associated neurodegeneration is also a
35:50type of NBIA. Kufor-Rakeb syndrome is
35:54also a type of NBIA.
35:56But look at the choice number C, which
35:58is Wilson's.
35:59Now, the Wilson's would be copper
36:02accumulation and you might need a
36:03separate kind of a therapy. So, the
36:05question says, which of them distinctly
36:08different treatment? So, you might need
36:10a chelating agent. You read about all
36:11those in pharmacology. This is not
36:13exactly a radiology question, but I
36:15believe the best answer will be Wilson's
36:17disease. Because which of them requires
36:20a distinctly different treatment
36:22approach? So, three are of NBIA
36:25category. Wilson's is a different
36:27category.
36:28If we now look at the previous year
36:30questions, P K A N they have asked eye
36:33of the tiger sign on MRI.
36:35This is why we were discussing this.
36:37Wilson's they have asked face off
36:40giant panda on MRI.
36:44Although we are putting it in the
36:45radiology section, but it is like a mix.
36:48I told you this year INICT most of the
36:50radiology questions are actually
36:52integrated. They're not direct
36:53questions. So, how many of you got it
36:55right? Let me know in the comments.
36:58Now, the second question is again a
36:59indirect from your radiology class. If
37:01you remember in my radiology class in
37:02the dams back to basics, I told you
37:05histoplasmosis
37:08in endemic area
37:11mimics
37:13tuberculosis.
37:15Histoplasmosis in endemic areas mimics
37:18tuberculosis. This is my statement from
37:20my class lecture. I told you if a person
37:23is visiting places where you are exposed
37:25to caves or endemic area,
37:28it will look like TB. So, this is a
37:30woman from Assam, which is endemic for
37:33histoplasmosis. You have everything else
37:36pointing towards tuberculosis.
37:39Cavitatory lesion in the lung,
37:41granulomatous inflammation, Langhans
37:44giant cells, caseous necrosis.
37:47Everything in the question in including
37:49the lung biopsy, liver biopsy is
37:51pointing towards TB.
37:53But the good thing in the question is TB
37:54is not in the choice. So, if you
37:56remember from my classes, in endemic
37:59areas, histoplasmosis mimics
38:02tuberculosis. So, I am claiming this on
38:05my side. Indirectly I've told you, but
38:07again it is a indirect question. It is
38:09not just a radiology question. It needs
38:12your microbiology knowledge and you have
38:14to connect it also. Some also the
38:16patient were diabetic also. This is one
38:18of the histories people have mentioned.
38:20So,
38:21this took me look last 1 hour to recall,
38:23but I think this is the best recall of
38:25this question. Here onwards you will see
38:27everybody else using this recall. Okay,
38:29second question. Elderly patient
38:32female patient presents with acute left
38:35flank pain. Please confirm in the
38:37comments if this was the correct answer
38:39question.
38:41A female patient elderly age group has a
38:43left flank pain. So, we don't know what
38:45has happened. A left flank pain could be
38:48non-specific. It is they are not telling
38:49you is it a ureteric colic or is it
38:51diverticulitis? Is it a
38:55Is it a ovarian lesion or a tumor or a
38:57malignancy? They are not telling about
38:59it. You understand? So, was this the
39:02entire information given in the
39:03question? Yes. So, then the first step
39:06should always be an ultrasound abdomen
39:08and then confirmatory will be a CT scan.
39:11This is the most logical answer here
39:13that if you have a elderly patient, you
39:15would you know you end up flank pain. We
39:18do not know what is going on. You need
39:20to do a ultrasound followed by CT scan.
39:24Are you able to agree to this? Okay,
39:25people are saying she was not elderly.
39:27She was 40 year old. So, I will correct
39:30it. 40 years is young. Okay, mark my
39:33words. 40 years is young. Okay, so not
39:36elderly. It's okay. And again, if it was
39:38youngish youngest fish patient, I still
39:41would go with ultrasound because in a
39:42female patient, you don't want to
39:44directly give radiation and you will
39:46first do a ultrasound and they are
39:48saying no fever.
39:49Okay, beta. I agree to all of you. No
39:51fever, acute flank pain, 40 year old
39:54female, we'll go with ultrasound
39:56followed by CT scan.
39:59Everybody able to answer this?
40:01Okay.
40:02Okay.
40:03Now, let's see. Okay, some people are
40:05saying there was flank pain abdominal
40:06distension also. We will write it down.
40:08Do you agree there was abdominal
40:10distension?
40:15Even if there was, I would still go with
40:17ultrasound followed by CT to see what is
40:21going on on ultrasound and then go on
40:22with this.
40:24Okay. Now, next question direct
40:26predictor discussed in each of my class
40:28patient is HIV positive CD4 count is
40:31low. There are ring enhancing lesions in
40:33the basal ganglia. There were ring
40:35enhancing lesions in the basal ganglia.
40:38And if you attended DVT, I think this is
40:40my first slide only ring lesion. I told
40:42you in a patient with HIV always think
40:45of
40:46toxoplasmosis as the first answer.
40:49Toxoplasmosis is the most likely
40:51diagnosis in this image.
40:54Okay. Most likely diagnosis will be
40:56toxoplasmosis. If you got it right, give
40:58me a thumbs up. CNS lymphoma should be
41:02suspected in HIV patient if there is no
41:05response to antimicrobials.
41:10If there is no response to any
41:12antibiotics,
41:13TB is also a possible, but toxoplasmosis
41:17is the most likely cause of ring lesion.
41:19PML is caused by JC virus
41:24and it does not show any ring lesion.
41:28PML, if you remember from my classes and
41:31even the DVT session, I've marked it for
41:33you. PML will not show ring lesions. So,
41:37the best answer is CNS toxoplasmosis.
41:41The next question I what I could gather
41:44was this patient had history of
41:46tuberculosis treated in past.
41:49An MRI was shown. People said there were
41:51multiple axial and sagittal images
41:53showing
41:55vertebral lesions. So, I'm just putting
41:58a representative image. I don't know
42:00what the exact image was, but most
42:02students were saying there were three or
42:03four images showing sagittal images and
42:07transverse images of the lumbar spine.
42:09So, that is what most people said There
42:11was a spine problem on MRI and history
42:15of
42:16pulmonary TB treated in the past. What
42:20will be now the best investigation to be
42:22done? Are you able to understand this?
42:24What is the best investigation to be
42:26done now? Or what is the next step to be
42:28done?
42:29Now, serum electrophoresis will be done
42:31if you are strongly suspecting multiple
42:33myeloma.
42:35Here we are not thinking of multiple
42:37myeloma.
42:38A chest CT will show TB in the chest.
42:41But automatically it cannot prove
42:44automatically it cannot prove.
42:47Okay, automatically it cannot prove that
42:49there is spine TB.
42:51You understand? Not every patient with
42:53lung TB, any lesion in the spine is not
42:56necessarily spine TB. Mantoux will be
42:59non-specific
43:01if the MRI is non-conclusive of Pott's
43:03spine, I would go with a CT-guided
43:06biopsy. Uh probable choices that the
43:09people said was needle biopsy of the
43:11lesion. I would say CT-guided biopsy.
43:13And I'm adding here, people are saying
43:15the patient had low back ache.
43:18I'm adding it. And when I upload on the
43:20DAMS app, this will go like this.
43:23History of pulmonary TB 2 years back. I
43:25agree. History of pulmonary TB, okay.
43:292 years back. So, anybody with a
43:32pulmonary TB 2 years back, a spine
43:34lesion not automatically does not become
43:36Pott's spine.
43:38We need to do first MRI. But people were
43:40saying MRI was already given in the
43:42image. So, what will now be
43:43confirmatory?
43:45Uh electrophoresis cannot confirm TB. CT
43:47chest cannot tell you the TB is in
43:49spine. Mantoux is non-specific. Needle
43:51biopsy of the lesion would be the
43:53answer. And I would say it is a BYQ
43:55inspired question. There is a question
43:57in the past which has said,
43:59"Investigation of choice for Pott's
44:01spine is MRI."
44:03If in doubt, confirm with CT-guided
44:06biopsy. So, I believe this best answer
44:08should be a CT guided biopsy.
44:12Okay.
44:123 years history of ATT on four drugs.
44:16Okay.
44:17ATT on four drugs.
44:22Okay. So, I'm adding a low backache from
44:241 year.
44:26So, it would be parts, but you need to
44:28confirm it and these are the choices.
44:30And if the choices are these, this
44:32becomes the likely answer.
44:34If the MRI image was not given, then I
44:36would have said let's do a MRI first.
44:38If the MRI was not given, we would have
44:40done a MRI first. Okay. Now, let's see
44:43the next question. I believe it's again
44:44a pediatrics question.
44:46Falsely getting into radiology because
44:48of the CT and X-ray driven. So, the
44:50child has upper respiratory infection.
44:53Upper respiratory infection.
44:55What will be the most
44:57upper respiratory infection? Why would
44:59you do a HRCT? HRCT is done in
45:01interstitial lung diseases. Why would
45:04you do a CT of the chest in a pediatric
45:06patient with upper respiratory
45:08infection? So, probably the best answer
45:10would be no further investigation is
45:12required. And I think you would see this
45:15similar question being discussed in
45:17pediatrics. So, I'm not getting into the
45:19details. Some people are saying neck and
45:23chest CT. So, let us
45:27wait for this full question to be formed
45:29and MRI given in this. Okay. So,
45:33we will discuss this further in the
45:35pediatric session. Again, in the
45:36radiology some questions were not
45:38exactly fitting into radiology. So, I'm
45:40leaving it for pediatrics. If they
45:42change anything, you can, you know, go
45:44with them.
45:46A patient This is a difficult question.
45:48ACR category two gadolinium contrast
45:51agents.
45:52So, ACR category one
45:58agents are the older gadolinium agents
46:01which are linear
46:03in their architecture
46:05and more risk for nephrogenic systemic
46:08fibrosis.
46:10ACR category two are macrocyclic
46:14agents. So, they have that benzene ring
46:17and they are usually safe even if the
46:19patient has mild to moderate renal
46:22dysfunction.
46:24Even if the patient has These are the
46:26modern agents and even if this patient
46:29is having mild to moderate renal
46:30dysfunction, they are safe. They do not
46:32cause NSF.
46:35So, now see the question number one.
46:38A 30-year-old man has no available renal
46:41function test.
46:43But if you notice, there is no suspicion
46:45of a severe renal disease, it is safe.
46:47We can use it. A child with renal
46:50function
46:51A child with renal function which is
46:54normal, again, it is safe to use
46:56gadolinium.
46:5760-year-old diabetic man but normal
47:01renal history.
47:02Again, there is nothing to suggest renal
47:05dysfunction, only diabetic, we can still
47:07use it.
47:0830-year-old patient with estimated GFR
47:1150 ml. So, 30 ml is the cutoff after
47:13which we think of NSF. So, again
47:18looks like ABCD
47:21are correct. So, some people are saying
47:23normal renal function test, some people
47:25are saying without available renal
47:27function test. I believe both of them
47:29are correct.
47:30Both of them are correct and GFR is more
47:33than 50 ml again. So, I think we can
47:37give ACR category two MRI contrast
47:41agents in all the options given. There
47:43was no abnormal renal function mentioned
47:46anywhere. MRI contrast was mentioned, so
47:49even if they don't mention gadolinium,
47:50we will assume these are gadolinium
47:53contrast agents. So, gadolinium contrast
47:55agents earlier were linear agents. Now
47:58they are macrocyclic agents which are
48:00safe.
48:01So now if you notice patient with only a
48:04normal history but no renal function
48:06test again looks okay.
48:07More than 50 ml looks okay. Normal renal
48:10function test looks okay. 30-year-old
48:13patient with
48:14no available in looks okay. So all four
48:16are correct and I've seen this with
48:19it is like this question we would say
48:21this is like more tricky.
48:24And they have gone a level up. Remember
48:26in our classes we discussed when we give
48:28gadolinium in people with estimated GFR
48:30less than 30 ml there is a risk of NSF.
48:33That is the part we discussed in the
48:35class. Here they have gone a level up
48:37but if you notice this choice is not
48:39saying less than 30 more than 50. So it
48:43is like indirect not direct. So that is
48:46what I would say that all of them are
48:49correct.
48:50This question again is a orthopedics
48:52question but there's a MRI image like
48:54they do in the exam in INI paper they
48:56always create integrated questions. This
48:59patient had pain
49:01in the ankle after playing a sport.
49:04Can you tell me what is the MRI image
49:07showing? This is the Achilles tendon
49:10rupture.
49:13For those of you who are seeing it for
49:15the first time this is the calcaneum
49:19talus
49:20>> [snorts]
49:21>> tibia. So are you able to understand
49:23this? This is tibia talus calcaneum.
49:25This is the insertion of the Achilles
49:26tendon and the Achilles tendon is
49:29ruptured.
49:30Achilles tendon is ruptured. So if the
49:33tendo Achilles is ruptured steroid
49:36injection is actually contraindicated.
49:38You do not give steroid for tendon
49:40rupture.
49:42And history was not given. Some people
49:44are saying history was not given. Okay.
49:46Thompson sign is positive in Achilles
49:49tendon tear. That is correct. If you
49:51press the calf, you get the
49:53positive sign in this case.
49:56Injury is classified using Gotfried
49:58system is not correct. Gotfried system
50:00is used in rotator cuff tear. Rotator
50:02cuff tear.
50:03Okay. So, history was not given. Some
50:05people are saying the picture was not
50:07same. Okay. So, what was the image?
50:11And the weight bearing immediately is
50:12not recommended. If it was Achilles
50:15tendon tear, then Thompson sign is the
50:18answer. Gotfried classification is used
50:21for
50:22your
50:24rotator cuff tear to see the fatty
50:26accumulation in the muscle.
50:28So, most of the students that we
50:30discussed on the Telegram had an idea
50:32that
50:34Okay, let's see the choices. What were
50:35the choices? Steroid, most people were
50:38saying. Some in the plantar aspect also
50:41two enhancing cystic lesions were seen.
50:44There was one question which child with
50:47virus no, similar picture same location
50:50cast treatment. Some people are saying
50:52cast treatment will be the
50:54recommendation.
50:57So, again we will leave this question
50:58here for orthopedics discussion, but
51:00only thing I'm saying telling to you is
51:02this is a MRI image start MRI image.
51:05This is the discontinuity in the tendon
51:07with fluid around it. This is a
51:11patient with Achilles tendon tear.
51:14Again, the next question is also
51:16slightly integrated. I am keeping the
51:19question for surgery. And this patient I
51:22do not know what was the duration, but
51:24most of the students were saying the
51:26image in the right iliac fossa was
51:28showing us
51:30appendicitis.
51:32And most of the students said there was
51:34a ultrasound image, there was a Doppler
51:36image.
51:37So, please correct to me.
51:41Okay.
51:48Okay, so there is a
51:50appendicitis is seen and diagnosed on
51:52ultrasound within 48 hours. So, within
51:5648 hours
51:57then
51:59why would you further do a biopsy or a
52:01drainage or a CT scan if the ultrasound
52:03is confirmatory within 48 hours?
52:06Probably they will say surgical
52:08management, but I will leave it to the
52:11question and I will leave it to the
52:13exact duration. Some people were saying
52:15the time was not written. Some people
52:16were saying Doppler was okay. Doppler
52:19was not red, it is blue. Hardly matters.
52:21Hardly matters. Okay, hardly matters.
52:23Doppler is only showing vascularity
52:25here. So, ultrasound image, a Doppler
52:27image showing vascularity, age was 12
52:30year old. Okay.
52:34Okay, some people were saying after 48
52:37hours also how much? Okay, so we will
52:39still we will keep this question open.
52:42All I can tell you from radiology
52:43perspective, the ultrasound images if
52:46these were the images they are surely
52:47showing us appendicitis. And the
52:50management would depend on how the
52:52surgery people take the timing and the
52:54concept, but we are leaving it here for
52:57the surgery people. So, I am again
52:59telling you these two questions are not
53:02radiology questions. I am just showing
53:03you the images. There were radiological
53:05images in the question. So, let me
53:07revise for you
53:09so that we are on the same page of
53:11understanding.
53:12First question is a indirect question,
53:14not radiology question, but these are
53:16neurodegenerative disorders with brain
53:18iron accumulation. Today what I'll do is
53:21I will also put a image or a
53:24classification of NBIA on my Instagram
53:26handle so that you can also see any
53:28further disease they can use like
53:30Kufor-Rakeb syndrome is first time in
53:32the history of the planet they have
53:34asked such a question.
53:35Second is
53:36a Assam lady with granulomatous lesions.
53:39So, I feel probably it could be
53:41histoplasmosis because of the
53:43endemicity.
53:44Uh no fever, 40-year-old female with
53:48flank pain, you will first do ultrasound
53:50followed by CT.
53:52In HIV patient with ring lesions in
53:55basal ganglia, toxoplasmosis
53:58toxoplasmosis.
53:59Pott's spine on MRI suspicion old
54:02history of TB therapy, you will confirm
54:05with a CT-guided biopsy.
54:09And ACR group two MRI contrasts are
54:12generally safe even if there is mild to
54:14moderate renal function dysfunction,
54:17they are still safe. So, they don't
54:19usually cause NSF. So, I would say all
54:22the four choices are safe.
54:25Okay.
54:26And Achilles tendon tear Thompson sign
54:28is positive. Got clear sign is not is
54:31classification is not in the Achilles
54:32tendon tear. And steroid injection is
54:34not given for Achilles tendon.
54:37And appendicitis within 48 hours
54:40surgically if ultrasound is
54:41confirmatory, you should go for
54:43surgical. But depends on what the image
54:45was showing. Also depends on what the
54:48exactly the symptomatology was written.
54:51I 48 hours after onset would still like
54:56within the range of surgery, but I am
54:59you will soon have a surgical discussion
55:01after this. That should give us more
55:02insight. I wish you all the best and I
55:05would again say these questions are all
55:07integrated. There is not a single
55:10isolated question. They are all
55:11integrated with the other subjects. But
55:14if you have done radiology, it gives you
55:15the connect the dots. It helps you to
55:17connect the dots. It is no longer a
55:19paper where you can just simply ratify
55:20and go and give the paper. You have to
55:22apply your mind and the clinical
55:24thinking that we applied in the classes.
55:26I wish you all the best and I look
55:28forward to meeting you all on the other
55:30side. Let me know in the comments how
55:32many of So, whereas deformity question
55:35some of you are saying probably will be
55:36discussed in orthopedics.
55:39Okay, probably will will be discussed in
55:41the orthopedics.
56:10>> So, hi everyone. Very, very, very good
56:13afternoon to all the dear, dear
56:15students.
56:16Yes, so I'm here, obviously you know for
56:19what. It is going to be the obs and gyne
56:22recall now. And um
56:25yes, a little less questions in obs and
56:27gyne, but I think overall obs and obs
56:30and gyne was good. How was How was your
56:32feedback on OG in this paper in May
56:36INICET 2026. So, let me hear it out and
56:39then I will start. Yes, there are about
56:4111 or 12 questions. But yes, so let's
56:44see what we have to do. No, OBG is not
56:48correct. We had 11 questions. So, let's
56:50see what we have. So, let's look at the
56:53first question and I'm sure that this
56:55was an easy one. So, am I right if I say
56:59there was a question on shoulder
57:00dystocia?
57:01Yes, and we are talking about the turtle
57:05sign. Yes, a delay in the delivery of
57:08the shoulders and pulling back of the
57:11head. Yes, so now turtle sign, shoulder
57:14dystocia, and you were asked what is the
57:17next step. Am I right? So, what did you
57:19mark? Yes, right? So, what did you mark?
57:22So, the answer is going to be McRoberts
57:26maneuver. Yes, it is going to be the
57:28McRoberts maneuver. So, if you if you
57:30all have done it right, give me a
57:31thumbs-up. Yes, turtle sign is the
57:33diagnostic thing. Yes. I so wish they
57:37give more and more and more from obs and
57:38gyne because that is going to be scoring
57:40for you. So, let's look at the next
57:42question. This is directly from the OG
57:45classes as well as your handwritten
57:47notes and your workbook. Yes, so let's
57:49look at this. So, this was a question
57:52where the patient is 4 hours after
57:56you know, forceps delivery. Am I right?
57:59So, 4 hours after forceps delivery and
58:02then she had vaginal pain. Yes, and what
58:06else? Tell me. Tell me. Tell me. There
58:08was a bluish mass. Yes, there was a
58:11bluish mass. So, what is the diagnosis?
58:15Come on, tell me. So, this is going to
58:16be a vulval hematoma. Yes, so this is
58:20going to be a vulval hematoma. There is
58:22also a Yes. Even this is in your notes.
58:25Yes, so you have a image as well. I've
58:27already written there, you know, forceps
58:29delivery as well. So, have you done this
58:31one right as well? So, give me a
58:33thumbs-up if you have done even the
58:36second question right. Yes? Yes, it is a
58:39puerperal hematoma. Yes, no urine
58:42passed. Typical presentation. Pain.
58:44Okay, so these are all there exactly
58:46word by word in your handwritten notes,
58:49in your back to basic videos, and the
58:51workbooks that we teach. Okay? Going on
58:54to the next question. So, next question
58:57was an ultrasound image of lambda sign.
59:01Am I right? Yes. So, was it the lambda
59:04sign which is also called as the twin
59:07peak sign. And once you know that this
59:10is a lambda sign, we know this is a
59:13dichorionic and diamniotic type of twin
59:17pregnancy. And then the question asked,
59:20which complication will not be seen? Am
59:24I right? Was this the question? Yes. So,
59:26which complication will not be seen? Is
59:30the
59:31recall correct for everyone? Give me a
59:33thumbs up if the recall is correct. Yes?
59:35So, what is the answer? What answer did
59:37you mark? So, the answer is definitely
59:40going to be cord entanglement.
59:44Yes? Repeatedly I have revised with you,
59:47taught you that cord entanglement is a
59:50sign of or a complication of
59:52monoamniotic twins, not of diamniotic
59:56twins. Very good. Excellent. Happy for
59:58all of you. So, if you have done this
1:00:00one correct, again I want a thumbs up in
1:00:03the chat box, and then I will move on to
1:00:05the next question. So far, three out of
1:00:09three. Yes? Everyone three out of three?
1:00:11Very well. Okay, perfect. Now, let's
1:00:14talk about But if it is lambda sign,
1:00:17okay? Then it is DCDA. MC may you see a
1:00:21T sign, okay? So, T sign. Thank you so
1:00:24much. It means a lot when you all that
1:00:26at least some subject has made you
1:00:28happy. Yes? Hello. So, let's go on to
1:00:31the next question. So, the next question
1:00:33is a woman had history of preeclampsia
1:00:37in previous pregnancy. Currently, she is
1:00:4112 weeks pregnant. Okay, if they even if
1:00:44it was written MCDA, still but say if as
1:00:47long as it is DA, all right. Agreed. It
1:00:50was MCDA. They had not given the lambda
1:00:53sign, but still the answer remains the
1:00:55same. If it is a DA twin, then it cannot
1:00:59be Yes, cord entanglement. Okay. So, now
1:01:02she is 12 weeks pregnant, and what else?
1:01:05They have given you as of now her blood
1:01:08pressure is normal. And they had asked
1:01:11you what will you give for prevention.
1:01:14Is that right? Yes? So, is the recall
1:01:16right for everyone? Again, directly from
1:01:18your
1:01:20Uh, you know,
1:01:21notes. Even recent things that I have
1:01:23taught you, right? I've given you in the
1:01:25quizzes in the Telegram channel as well.
1:01:28Okay? So, then what are you going to do
1:01:30for prevention? Yes, it is going to be
1:01:33low-dose aspirin. Right? Please, I have
1:01:36specially made you write in your notes,
1:01:39there is no role of salt restriction.
1:01:42So, have you seen your workbooks or your
1:01:45notes or your B2B videos? You all know
1:01:48that I have specially given you what? I
1:01:50have given you that please do not do not
1:01:54do salt restriction. Okay? So, no role
1:01:57of salt restriction, definitely no role
1:02:00of calcium restriction, and no
1:02:02indication to give heparin. Okay? So,
1:02:05the answer is going to be aspirin alone.
1:02:08Is it clear to everyone? Yes? So, have
1:02:11you done it right? So, then give me a
1:02:13thumbs up.
1:02:14Okay? So, give me a thumbs up if it is
1:02:17right. So, no no role of giving low
1:02:19molecular weight heparin. Okay? So,
1:02:21aspirin starting at 12 weeks. So, four
1:02:24out of four. So, let me know. Let's go
1:02:27on to the next question. The next
1:02:29question was on probable signs of
1:02:32pregnancy. Yes? And it was a multiple
1:02:36completion type question. Right? So,
1:02:38when we say that, you all knew about
1:02:41Hegar's and you all knew about, I think,
1:02:45Goodell sign. That was also in the
1:02:47option. But, I have taught you in the
1:02:50class that even Braxton Hicks, they are
1:02:52again there in your class notes, in your
1:02:55workbooks, in B2B. What exact Do you
1:02:58remember? This is how I teach, that when
1:03:00you are doing B Palmer's sign, regular
1:03:03rhythmic uterine contractions. Yes?
1:03:06Those are actually the Braxton Hicks
1:03:08contractions that you are feeling. So,
1:03:10yes, even Braxton Hicks contractions are
1:03:13going to be included in the answer. So,
1:03:16these all three will be included in the
1:03:19probable signs of pregnancy.
1:03:23The fourth one was an option called as
1:03:26Seharat or something like that. That is
1:03:28not a part. I you know, the correct
1:03:30language is not there. But yes, these
1:03:32three will be included. Okay? It will be
1:03:35included in the probable signs of
1:03:38pregnancy. Okay? So, have you done this
1:03:40one correct? Yes? So, then we move on to
1:03:44the next question. Are you ready for the
1:03:47next question? Yes. Okay. So, the next
1:03:50question was match the following. Again,
1:03:53I have repeatedly told you that this is
1:03:55how they give in INI CET exams. Yes? On
1:03:59one side, they will give you the
1:04:01syndromes. And on the other side, they
1:04:04will give you the hormones. And you have
1:04:06to match the hormones. Yes? So, now
1:04:10let's quickly do this. These were the
1:04:12four options. Yes? So, please remember.
1:04:15The options as as far as PCOS is
1:04:18concerned, we all know LH is high. FSH
1:04:22is normal, maybe slightly low. Estradiol
1:04:25levels are normal. Yes? What about
1:04:28Asherman? All hormones are normal. Yes?
1:04:33All hormones are normal. What about
1:04:35Sheehan's? In Sheehan's, all hormones
1:04:38are low. Okay? All hormones are low. LH,
1:04:42FSH, and estradiol.
1:04:45Yes? What about primary ovarian
1:04:47insufficiency? This means ovarian
1:04:50failure, which is similar to what?
1:04:52Menopause. So, what did we know? LH and
1:04:56FSH both are going to be high. And
1:04:59estradiol levels are going to be low.
1:05:02Right? So, those are the correct
1:05:04hormonal profiles of these patients.
1:05:07Right? I'm happy that the marathon was
1:05:09useful for all of you. So, now we have
1:05:12discussed six questions, and please tell
1:05:15me have you done this all right? So, six
1:05:17out of six for everyone. Let me know.
1:05:19Let me know your score out of six so
1:05:22far.
1:05:23The next question was again about what?
1:05:26The next question was about HPV vaccine,
1:05:30and I definitely said even before the
1:05:32exam that this is going to come in the
1:05:35exams, right? And this was based on the
1:05:38WHO guidelines for the HPV vaccination.
1:05:41It was again a multiple completion type
1:05:44question. Yes? So, what were the or true
1:05:48and false statements? Yes? So, what what
1:05:51is going to be the answer? So, please
1:05:53remember option number one, the primary
1:05:56focus is girls between 9 to 14 years.
1:05:59That's right. Yes, this is the target
1:06:02age group. This is how we have exactly
1:06:05written in the workbook as well, right?
1:06:08So, this is a target age group. So, this
1:06:11is a correct statement. Yes? What about
1:06:13the second one? The second one said that
1:06:16single dose can be used as an
1:06:19alternative to two doses. Is that true?
1:06:22Yes. So,
1:06:25So, alternative to two doses, that is
1:06:27also correct. I have taught you these
1:06:29age guidelines.
1:06:31And as per the guidelines, we can give
1:06:34one or two doses, right? So, that is
1:06:37also a correct statement, okay? So, it
1:06:40can be definitely used as an
1:06:41alternative. What was the third
1:06:43statement? We want 90% coverage for the
1:06:47vaccine. Yes, that is also right, right?
1:06:50So, when you are targeting the
1:06:52population, you want a 90% coverage,
1:06:56okay? So, please remember this. Now,
1:06:58what about no need for screening, okay?
1:07:03No need for screening. This is a
1:07:06incorrect statement. We have to do the
1:07:09screening, okay? So, you have to do the
1:07:11screening even after the vaccine. Yes,
1:07:15so now you have to tell me, are the
1:07:17options correct or there were some other
1:07:19option because it was a multiple
1:07:20completion question and therefore you
1:07:23have to let us know. Yes, so what about
1:07:27Okay, even the Indian HPV vaccine in as
1:07:30per the Indian HPV vaccine that was the
1:07:33campaign, okay? So, the campaign was
1:07:3614-year-old girls, but overall yes, the
1:07:39target age group is 9 to 14 years,
1:07:42right? So, as per the campaign, it was
1:07:45given to currently 14-year-old girls,
1:07:47but it was primarily about screening.
1:07:50Yes, so no need for screening after the
1:07:52vaccine is wrong, okay? That is
1:07:55incorrect, yes? So, that comes to the
1:07:58seven questions, okay? Yes, WHO
1:08:01definitely says one dose or two doses,
1:08:04those are the same as guidelines and
1:08:05they're directly there in your workbook,
1:08:09okay? Beta, as far as the
1:08:12current vaccine campaign was done, in
1:08:15that campaign they were giving the
1:08:16injections only to 14-year-olds. But
1:08:19yes, when we talk about target age group
1:08:22for the HPV vaccination, it is usually
1:08:24girls between 9 to 14 years, okay?
1:08:28Okay, somebody is saying one option had
1:08:32Yes, yes, it is a mix and match of WHO
1:08:35guidelines and Indian guidelines because
1:08:37we follow WHO guidelines, okay? So,
1:08:40please remember this. So, screening has
1:08:42to be done. Had 100%
1:08:45Yes, prevention, no need for screening,
1:08:47that is wrong. Nothing can give 100%
1:08:51prevention, okay? So, please understand,
1:08:53screening has to continue, okay?
1:08:56So, that is a wrong statement. Chalo,
1:08:59then let's move on to the It cannot
1:09:01prevent all cancers. Okay, nothing can
1:09:04prevent all cancers. It is only
1:09:06preventing from four strains. Is that
1:09:09understandable? Okay? So, please
1:09:11remember this.
1:09:13Beta, what campaign was the campaign Kia
1:09:17was made we were giving it to
1:09:1914-year-old girls. But when you are
1:09:21saying the primary target for the
1:09:23vaccine, it is ranging from 9 to 14
1:09:26years. In the current campaign that was
1:09:28done, they haven't asked you about the
1:09:30campaign. Yes? So, in the current
1:09:33campaign which was launched worldwide,
1:09:36in that they were giving it to
1:09:3714-year-old girls. Okay? But here the
1:09:39question is asking the primary target
1:09:42for the vaccination. Okay?
1:09:45Let's look at the next question. Let's
1:09:47wait for more correct recall in the
1:09:49options and then maybe we'll see the
1:09:51wordings and see what is required.
1:09:53Right? This is the current recall I have
1:09:55got. Okay? One option was prevent all
1:09:59cervical cancers. No, it cannot prevent
1:10:01all cancers. That is why you have to do
1:10:04a screening. Okay? So, let us have a
1:10:06correct recall because people are giving
1:10:08more options. So, then we will see what
1:10:11is required. Okay? The rectocele
1:10:13question is a surgery question but you
1:10:15defecography is what the surgeons do.
1:10:17Yes? Coming to the other questions, hold
1:10:19on. So, then there was a question on
1:10:21primary amenorrhea and they said uterus
1:10:25is absent, the breast tissue is present.
1:10:29Yes? They said LH FSH is normal and
1:10:32testosterone was high. Yes? And they
1:10:36also mentioned sparse pubic and axillary
1:10:40hair. Yes?
1:10:43So, what is the answer? Yes, the answer
1:10:45is androgen insensitivity syndrome.
1:10:49Okay? So, it is AIH. No, it is not MRKH.
1:10:53Beta, MRKH may testosterone levels will
1:10:56not be high. Yes, and that was very
1:10:59clearly mentioned and this is exactly
1:11:01how we have done it even in the class.
1:11:04Yes, so please remember I've already
1:11:06said usually it is absent hair and they
1:11:09can sometimes write sparse pubic and
1:11:12axillary hair. So if you go and see your
1:11:14notes you will see it as it is. So
1:11:17testosterone levels are absolutely
1:11:19normal in MRKH. Coming to the
1:11:22respiratory question also. So eight
1:11:24done. So what is your score out of eight
1:11:26so far? Coming coming. So let's move on
1:11:29to the next question. The next question
1:11:32is your 16-year-old girl. She has a
1:11:3516-weeks pregnancy. Yes, and there was
1:11:40sexual assault by a 22-year-old
1:11:44man. Is that right? Yes, sexual assault
1:11:47by a 22-year-old man and you had to say
1:11:52what is not correct medico-legally.
1:11:57Is this right? Was this the question?
1:12:00So it was a single best answer. So we
1:12:02were asking you, please remember, okay?
1:12:05It was asking you not correct
1:12:08medico-legally.
1:12:10Okay? So please remember when we say not
1:12:12correct medico-legally, the first option
1:12:14was inform police for this. Yes? So is
1:12:19that right? Yes, this is a correct
1:12:21statement. We have to inform the police.
1:12:23The second statement was one doctor's
1:12:27opinion are needed for MTP. This is also
1:12:31correct. The third option said
1:12:34uh you know, get consent
1:12:38from parents for examination.
1:12:41Yes? Is it right? Is was this the
1:12:43option? Yes? Get consent from parents
1:12:46for examination. Yes, and the fourth was
1:12:50preserve fetal tissue for DNA. Yes,
1:12:54preserve fetal tissue for DNA. So, this
1:12:57is actually a forensic question. What is
1:13:00the answer? The answer will be get
1:13:03consent. Okay, why? Because when you
1:13:06talk about the legal age of consent,
1:13:08that is why repeatedly in my Telegram
1:13:10channel I was asking was it about
1:13:12consent for examination or consent for
1:13:15MTP? Right? Here the question said
1:13:19consent for examination.
1:13:22And the consent for examination, what is
1:13:25the age? This is a forensic MCQ. The age
1:13:29for consent for examination is not 16
1:13:32years. It is 12 years. Right? So, beyond
1:13:3512 years, the girl can give the consent
1:13:38for examination. Okay?
1:13:41Because yes, up to 20 weeks, we need one
1:13:44doctor's opinion for MTP. Yes, but when
1:13:47we talk about consent for examination,
1:13:50okay? No, consent for MTP was a separate
1:13:54option where it was one doctor is needed
1:13:58for MTP. That was a separate option. One
1:14:01doctor needed for MTP. That was a
1:14:04separate option. And the next option was
1:14:08get consent from parents for
1:14:10medico-legal examination. Yes, I've
1:14:13confirmed it. So, if this is the correct
1:14:16recall, then yes, for medico-legal
1:14:18examination,
1:14:20the consent age is 12 years. Okay? For
1:14:24MTP, it is a different
1:14:27uh cutoff. Okay? So, that is consent for
1:14:30MTP. Okay?
1:14:32Not consent for examination. MTP was a
1:14:36Okay, you're all fighting with each
1:14:37other. It is okay. Right? As I said,
1:14:41there was an option on MTP, but that was
1:14:44one doctor needed for MTP. Okay? So,
1:14:47please remember. Yes, I think you should
1:14:50go and see the forensic notes or ask the
1:14:52forensic faculty. Yes. So, the Supreme
1:14:55Court or the medico-legal aspects, they
1:14:58say that it is always recommended to
1:15:01preserve tissue for DNA analysis. Okay?
1:15:05So,
1:15:06all right. So, we will see to get
1:15:09consent it was mentioned only get
1:15:11consent from parents. But, the question
1:15:13was about medico-legal
1:15:16Okay? So, I have asked a lot of
1:15:18students. They are saying that it was
1:15:22consent for examination. No, beta. Two
1:15:25doctors are not needed for MTP. Up to 20
1:15:28weeks, it is one doctor. 20 to 24 weeks,
1:15:31it is two doctors. Okay?
1:15:34Let's I have confirmed this with the FMT
1:15:37faculty as well. Okay? So, even the FMT
1:15:41faculty is saying the answer if this is
1:15:44the correct record, the answer will be
1:15:46consent for examination because the age
1:15:49for that is 12 years. Okay? Is that
1:15:52okay? Let's move to the next question.
1:15:55So, this was nine. Let's move on to the
1:15:5810th question. The next question says
1:16:01cause of mild physiological
1:16:05dyspnea. And if you have attended my
1:16:08classes, I teach physiological changes
1:16:11going back to actually physiology. Okay?
1:16:13So, please remember this. I have always
1:16:17taught that when you don't know
1:16:18anything, go with what? Progesterone.
1:16:20Okay? So, please remember this. The
1:16:23first option was progesterone-induced
1:16:26respiratory drive. Yes?
1:16:30So, progesterone-induced
1:16:33drive. B. Low tidal volume. Please
1:16:37remember this is wrong. I have taught
1:16:40you. You can go and check your notes.
1:16:41Tidal volume increases, minute
1:16:44ventilation increases.
1:16:47Okay? So, option C was high PCO2. No,
1:16:51PCO2 actually decreases. All right? And
1:16:56PO2 increases. Right? So, PCO2 decrease
1:17:00PO2 increase
1:17:02so the answer is progesterone induced
1:17:04respiratory drive. Right? So, now
1:17:07anybody can recall the fourth option for
1:17:09this? Anyone? So, you know, if you have
1:17:11attended my class, I know how to help
1:17:14you when you don't get confused. Right?
1:17:16So, I said, "When you don't know
1:17:18anything, go with progesterone." Yes,
1:17:20that's the answer. Progesterone induced
1:17:23respiratory
1:17:25drive. Okay? No, but in the previous
1:17:27question, the pregnancy was not beyond
1:17:2920 weeks. Pregnancy was 16 weeks. The
1:17:33man's age was 22 weeks. The man who did
1:17:36the sexual assault. Okay?
1:17:39High oxygen consumption. Okay, somebody
1:17:42has written high oxygen consumption as
1:17:45the fourth option. Okay?
1:17:48So, the precise low oxygen. Okay,
1:17:51somebody is saying low oxygen
1:17:53consumption. So, low oxygen consumption
1:17:55makes more sense and that is wrong. I
1:17:57have taught you even in the class that
1:17:59oxygen consumption actually increases by
1:18:0120%. But, the main answer will remain as
1:18:06progesterone induced respiratory drive.
1:18:10Okay? So, let's go on to the next
1:18:12question. There was Was there another
1:18:14question?
1:18:16Question number 11, which was on frothy
1:18:19green discharge? Yes?
1:18:22Yes?
1:18:23Was there a question on a frothy green
1:18:26discharge?
1:18:28Yes? So, frothy green discharge and I
1:18:31think they said negative Amsel or I
1:18:34think they said a negative whiff test.
1:18:37What did they say?
1:18:38>> [snorts]
1:18:38>> So, negative amsel criteria or they said
1:18:42negative whiff test.
1:18:44And I think that was easy. But what did
1:18:47the question ask? Did the question ask
1:18:48you the diagnosis? Yes. So, this is
1:18:52trichomonas. And if it is trichomonas,
1:18:55we have taught you what? That you will
1:18:57see a motile flagellate organism on
1:19:02saline microscopy.
1:19:04Yes? So, I have taught you even in DVT.
1:19:07If you remember, I've taught you frothy
1:19:08is a keyword for trichomonas, right?
1:19:11Green discharge is characteristic. So,
1:19:14yes, it is trichomonas. And you will see
1:19:17motile flagellate organisms in the
1:19:21saline microscopy. Yes. Okay? So, very
1:19:24good. Now, can you give me Yes, can you
1:19:26tell me what exactly were the other
1:19:28options if somebody can recall? And
1:19:31these are the 11 questions that I have
1:19:33so far. If you have any other recalls,
1:19:36please tell me. Uh okay. Okay, so motile
1:19:40organism was given to you?
1:19:42Yes. So, what? Pruritus is present in
1:19:45trichomonas. Okay? So, please remember
1:19:48this. All right?
1:19:54Yes. So, pruritus can be present in
1:19:56trichomonas. But the moment you read the
1:19:58word frothy, you know it is trichomonas.
1:20:02So, All right. So, one option said clue
1:20:05cells, one said pseudo hyphae. Okay,
1:20:08what else?
1:20:09Any other question? Uh what was the
1:20:11other option?
1:20:13Yes. So, rectocele is a surgery
1:20:16question, beta. Woh gyne ka question
1:20:18nahi hai. Gyne wale defecography nahi
1:20:20karte hai. So, it is a surgery question.
1:20:22I think the question was about
1:20:25um
1:20:26rectocele size on defecography. Yes? So,
1:20:30please remember this. I think Dr. Gaurav
1:20:33will discuss this with you. I do not
1:20:35have the question on Pearl Index. Maybe
1:20:37you have given it to the PSM faculty. So
1:20:39let me get in touch and if you remember
1:20:43then please please let me know
1:20:46what was the exact question. Okay. All
1:20:49right. Somebody said the last option was
1:20:51gram-negative diplococcus. So no. Right?
1:20:54So those are the 11 questions that I
1:20:56have. Right?
1:20:59Green discharge again is characteristic
1:21:02to Trichomonas beta G. Also you said
1:21:05that there is inflamed cervix or
1:21:07something like that you said. Yes?
1:21:10Testosterone question. What was the
1:21:12testosterone question? I think there was
1:21:14the that was the same question on
1:21:16androgen insensitivity syndrome. Yes?
1:21:19Androgen insensitivity may be a time
1:21:21that testosterone levels are high. Are
1:21:24you talking about the same question or
1:21:25some other question?
1:21:28Yes. Okay. So I know so we have
1:21:31motile flagellate organism. Yes. Okay,
1:21:34that's great. Yes, DVT covers everything
1:21:37and please this is a reminder for all of
1:21:40you.
1:21:41DVT is going to have an excellent
1:21:44excellent hit rate in your NEET PG. All
1:21:47right. So please use DVT for your
1:21:49revisions. We promise it will have an
1:21:51excellent hit rate. Right? So that is
1:21:54what you need to know. All right?
1:21:59All right. Let's see if we have any
1:22:00other recalls.
1:22:02Uh
1:22:03there was a separate question on
1:22:05exogenous test on testosterone therapy.
1:22:08Okay. So let me know by what was the
1:22:10question on exogenous testosterone.
1:22:15All right.
1:22:17Let's see. Let's see. I I do not know
1:22:20that question. So if you have a recall
1:22:24All right. A man was taking testosterone
1:22:26and I think FSH LH was asked.
1:22:31So please remember if you are taking
1:22:32exogenous hormones, they are going to do
1:22:35a feedback suppression. Yes? So they
1:22:38will do a feedback suppression when you
1:22:41give exogenous hormones. That is what
1:22:43even OCPs do. Yes? So when you give
1:22:45exogenous hormones, there is going to be
1:22:48feedback suppression. So all three will
1:22:51be suppressed. GnRH So typically
1:22:54testosterone has a more stronger
1:22:56feedback on LH, but it will also have a
1:22:59feedback on GnRH. So let me see what are
1:23:01the recalls. Pearl index again a typical
1:23:04PSM question and they will take. Okay?
1:23:0817-hydroxylase.
1:23:09I think it was pediatrics question here.
1:23:11So sir is collecting the recall and they
1:23:13will come here for you.
1:23:15Should we go on to the next subject?
1:23:20Okay.
1:23:23Right. For your testosterone question,
1:23:25exogenous, please send me the you know,
1:23:29recall options in my telegram group as
1:23:32well. Okay?
1:23:36Yes, but I think 17-hydroxylase was like
1:23:38pediatric question here.
1:23:41There was no arrow on
1:23:43Okay, no arrow on J. So let's see what
1:23:45are the correct options and then we will
1:23:47be able to give you a better answer.
1:23:49What is the best possible answer among
1:23:51that?
1:23:52Okay. Hello. Let's have the next
1:23:55subject and meanwhile if you have more
1:23:57recalls, do send us to in the telegram
1:24:00channel. Okay?
1:24:02All the best. Please don't worry. You've
1:24:05done your part. Okay? You've done your
1:24:07part and whatever the paper was, I
1:24:09understand some of the subjects were
1:24:11very tough. Right? So if it is tough, it
1:24:15is tough for everyone. Right? So please
1:24:18just relax. Whatever you have done,
1:24:21you've done your best. Now what you have
1:24:23to do is you have to prepare for the
1:24:25next exam. Every exam is a new
1:24:27opportunity. How one exam goes, it does
1:24:30not mean it is going to affect the other
1:24:32exam as well. Right? So, take it as a
1:24:35new opportunity, revise important
1:24:38things.
1:24:39Please ensure that you focus on
1:24:42important things. There is no point
1:24:43doing unnecessary
1:24:46unusual things. Focus. Know your
1:24:49concepts well and try and apply the
1:24:51concepts. Because if you see, I was
1:24:53seeing Dr. Sumaya's recall as well,
1:24:55there were a lot of integrated
1:24:57questions. Yes? So, for that you need
1:25:00concepts, but you so that you are able
1:25:01to apply those concepts. Perfect. Please
1:25:04do send me the
1:25:06recall options and then we will see what
1:25:08is the best possible answer among the
1:25:11combinations. Just let me know was it a
1:25:13multiple completion type question, the
1:25:15testosterone one, or a single best
1:25:18answer type of question?
1:25:20The exogenous. Yes, I know. I know a lot
1:25:24of colon in the paper and I think a lot
1:25:26of biochem in the paper as well. So, it
1:25:28is tough for everyone, no matter what
1:25:30you say.
1:25:33Great. All the best. We'll see you on
1:25:35the other side and we are there for you.
1:25:37We are going to push you, back you up
1:25:38for your NEET PG exam and that is a much
1:25:41bigger opportunity coming your way. Take
1:25:43care. Relax
1:25:45and don't worry. Let's see what we can
1:25:47learn and move and improve. Okay?
1:25:51Fine. Single best. Okay, I will work up
1:25:53on the recall and we'll get back to you
1:25:55on that one as well. Okay?
1:25:57I know there should have been more
1:25:59questions. Yes?
1:26:01Shallow.
1:26:30>> [snorts]
1:26:32>> Okay, so welcome all of you. I hope I'm
1:26:35audible and visible.
1:26:37Can I get a quick thumbs up from
1:26:38everyone?
1:26:39Uh I hope my audio and video all going
1:26:42smooth.
1:26:43Yes. So
1:26:45good afternoon everyone. So how was your
1:26:48dermatology? I think I would say that in
1:26:51dermatology the questions are more from
1:26:53the expected topic only.
1:26:55Um whatever recalls I've got till now,
1:26:58they are mainly from the infectious
1:26:59disorder. Like there was one question
1:27:01from herpes. Uh there was one question
1:27:03from scabies. And
1:27:06I think there was another question from
1:27:08cutaneous uh
1:27:10malignancy. There was one from
1:27:11psoriasis.
1:27:13Uh there was one from fungal infection
1:27:14also. So let's see what we have got uh
1:27:19Yes.
1:27:20Nikolsky sign was something which is
1:27:21yes, which I felt for you. It was little
1:27:24difficult because they have asked the
1:27:25match the following type of questions.
1:27:27But chalo, let us start with the
1:27:28questions. See but you they are all
1:27:30recall questions. So you may not find
1:27:32the images which I have put
1:27:34to be the exact image what you got in
1:27:36the exam. So I've just attached a image
1:27:39according to the description given to me
1:27:41by the students. So this was the first
1:27:43question. I would like you to tell me if
1:27:46there is any more corrections or any
1:27:47more information given in the question.
1:27:50So this was the first question which was
1:27:51there. And this was an infant with itchy
1:27:54lesion on hand, feet, and periumbilical
1:27:57area.
1:27:58Uh you can see some vesicles. That's
1:28:01what student told me. It was looking
1:28:03more eczematous. There was scaling which
1:28:06is visible. And they have classically
1:28:08mentioned that they were itchy. Now
1:28:10please remember, itching in an infant,
1:28:13which is extensive, specifically
1:28:15including palm and sole, but you
1:28:17remember, this is scabies. Scabies in an
1:28:21adult usually spare head and neck and
1:28:24palm and sole because the adult work, so
1:28:28because of friction the palm sole gets
1:28:30spared, and because of sebum the head
1:28:32and neck get spared. But please remember
1:28:34for the infants, the palm soles are
1:28:37considered to be one of the common site,
1:28:39and the lesions which they get is the
1:28:41vesicular lesions. They are more
1:28:43eczematized, so you see features like
1:28:46scaling, you see redness, you see
1:28:48extreme amount of itching. Now, the
1:28:50sites which they have given is very
1:28:51classical, the peri-umbilical areas, the
1:28:53hands and feet. And yes, if they have
1:28:56given crust, that also goes in favor of
1:28:59scabies, but you because see, in scabies
1:29:01in infant, you see eczema or
1:29:04dermatitis-like feature along with the
1:29:06classical feature of scabies. So, this
1:29:08is a question from infantile scabies,
1:29:11and obviously
1:29:13eczema was not the option. Bleeding was
1:29:15there.
1:29:16If the child scratches a lot, it can
1:29:19bleed. So, I don't know whether they
1:29:21have shown a image with bleeding on
1:29:22that. Um yellowish crust, it could be
1:29:26yellowish crust in scabies, but bleeding
1:29:29until unless the patient scratches too
1:29:30much, bleeding do not occur. Only when
1:29:33the children the infants they scratch,
1:29:35the bleeding can be one of the feature.
1:29:37Okay? Erosion ho sakta hai papule
1:29:40Atopic dermatitis now, some students are
1:29:42saying why not atopic dermatitis? But
1:29:45you for atopic dermatitis in an infant,
1:29:48face and the extensors are the common
1:29:50site. Just on palm and sole, it should
1:29:53not be atopic dermatitis. And for atopic
1:29:56dermatitis, there should be some history
1:29:57of chronicity, family history of
1:30:00allergy, which should be given. But
1:30:01nothing like that is given in this
1:30:03question. The case is it clear? So, if
1:30:05it is palm sole specifically with
1:30:07vesicular lesion, that should be
1:30:09scabies.
1:30:12Now, coming to the next, yes, vesicles
1:30:14are more in favor of scabies, but you if
1:30:16they have mentioned vesicles with
1:30:18crusting, itching, palm sole, I would
1:30:21prefer scabies over atopic dermatitis.
1:30:24But if they have given involvement of
1:30:25the face, extensors,
1:30:28more of eczematous lesion, then it could
1:30:30be atopic dermatitis also. But atopic
1:30:32dermatitis, as I told you, there should
1:30:34be some history of atopy. Either a
1:30:36family history of asthma or in a child
1:30:39the history since birth, something like
1:30:40that should be given, okay?
1:30:46Okay, coming to the next question,
1:30:48multiple painful vesicles on the penile
1:30:51shaft, what can be the diagnosis? Now,
1:30:53I'm not sure whether a image was
1:30:55attached with this question or not, but
1:30:58because they have mentioned that there
1:31:00are vesicles and which are painful, I
1:31:03will go with herpes genitalis as one of
1:31:06the answer. But you in chancroid, you
1:31:08get painful ulcers.
1:31:11There is no vesicle, there is painful
1:31:13ulcer, and we call it chancroid. In
1:31:16vesicles, the ulcers are hard, painless.
1:31:19Hard, painless ulcers, but they have
1:31:22specifically mentioned
1:31:25the
1:31:26painful condition. Painless is not
1:31:28given. Streptococcus, it can cause
1:31:31folliculitis like feature, but on the
1:31:33penile shaft, there is no hair,
1:31:35especially on the tip, and that is why
1:31:37it cannot be streptococcus infection.
1:31:39Multiple painful grouped vesicle is a
1:31:42feature of herpes. So, this question
1:31:44should be option number one, herpes.
1:31:47Now, there was a match the following
1:31:48question. I could just get three
1:31:50options, but you so you have to tell me
1:31:52the other options if there were any more
1:31:54options. So, on the first, there was
1:31:57pseudo-Nikolsky, then there was false
1:31:59Nikolsky, and there was Nikolsky sign.
1:32:02But you I think this is very easy that
1:32:05Nikolsky is seen in pemphigus vulgaris
1:32:08and if you remember when we give a
1:32:10tangential force on the skin surrounding
1:32:13the bulla that is known as Nikolsky
1:32:16sign. The skin peels on giving a
1:32:18tangential force. This is known as
1:32:20Nikolsky sign. Now but you Nikolsky sign
1:32:23if you remember I told you it is seen
1:32:26only in intraepidermal split. You cannot
1:32:30do Nikolsky sign in a subepidermal
1:32:32split. But sometimes what happen but you
1:32:35we take the skin and we peel it off in
1:32:38the bullous disorder when you
1:32:40intentionally peel the bullas the there
1:32:44is already a bulla you have taken one
1:32:46margin and you are putting or giving a
1:32:48lateral force that causes peeling off
1:32:50the skin. This type of Nikolsky is known
1:32:52as false Nikolsky which is a feature of
1:32:55bullous pemphigoid or subepidermal
1:32:58split. You have you are actually pulling
1:33:02the skin of that lesion. The bulla the
1:33:04margin you are pulling intentionally or
1:33:06you're giving a lateral force on the
1:33:08margin and that is extending that bulla
1:33:11that is your false Nikolsky. And what is
1:33:14pseudo Nikolsky but you in pseudo
1:33:16Nikolsky because of epidermal damage
1:33:19necrosis of the epidermis there is
1:33:21peeling of the skin on giving a slight
1:33:24pressure. This is a feature seen in drug
1:33:26reactions like SJS. So these were the
1:33:29three options which I could see here but
1:33:30you.
1:33:32Okay there is one more option which is
1:33:34cerebiform tongue and pemphigus vegetans
1:33:37which was given but you. So that will be
1:33:39directly connected in pemphigus vegetans
1:33:42you see thick lesions you see
1:33:44more of
1:33:46I would say cauliflower like or more
1:33:48like a vegetative growth. Wherever it
1:33:50happens you get a vegetative growth. So
1:33:52that should be one of the option there.
1:33:55Okay. So these were the three options
1:33:56from Nikolsky.
1:33:58Next is a black color lesion. I'm not
1:34:01sure whether the exact image was given
1:34:03or not, but can you see a blackish
1:34:05lesion on the sole? And the student told
1:34:08me the image looks like a melanoma. If
1:34:11it is looking like a melanoma, it should
1:34:14be skin biopsy, which is the next thing
1:34:17you will do in this patient. So, if you
1:34:19see a lesion on the acral part, which
1:34:22looks like a acral melanoma, then you
1:34:24have to do a skin biopsy. Now, but you
1:34:27please remember there is another
1:34:29condition known as tinea which is
1:34:32very classically occur on the palm skin.
1:34:35Now, I'm not sure whether they have
1:34:37given you the image of palm or they have
1:34:39given you the image of the the sole. If
1:34:42the image was almost a similar image, so
1:34:45what students are saying that when the
1:34:46image was similar image, then it should
1:34:48be the melanoma and you have to do a
1:34:51skin biopsy to confirm the atypical
1:34:55melanocytes, which are proliferating
1:34:57inside this particular area. Okay? So,
1:35:00image if it is same, then it should be
1:35:02very classical of malignant melanoma and
1:35:05the skin biopsy is obviously the next
1:35:07thing for any cutaneous lesion,
1:35:09cutaneous malignancy. Usually, we do
1:35:10excisional biopsy, but you we are not
1:35:13doing just a punch biopsy to confirm the
1:35:15diagnosis. We are treating the lesion
1:35:16all together and we are confirming that
1:35:18it is malignant melanoma. So, this is a
1:35:20similar image. If this was the exact
1:35:22image given, then but you malignant
1:35:24melanoma and followed by that skin
1:35:27biopsy should be the answer.
1:35:29Now, another question again, it was a
1:35:31image-based question. Now, in this
1:35:33question, but you you have to help me
1:35:35because I haven't got much of the
1:35:37information. Now, some of the students
1:35:39says that the scales, which are present,
1:35:41they were yellowish scale, which was
1:35:43shown. And the question was patchy hair
1:35:45loss with itching. If they write it is a
1:35:49patchy hair loss with itching and
1:35:51something like this, then it could be
1:35:53tinea capitis and then the answer
1:35:56becomes topical anti-fungal. But but you
1:36:00if the image has a different scale like
1:36:02a more thicker white silvery scales
1:36:06without itching then it can be scalp
1:36:08psoriasis also. So you have to help me
1:36:10what else was given?
1:36:13Another another option was oral steroid.
1:36:16What else was given but you oral steroid
1:36:19is some of the students saying was
1:36:20option number three. Do you remember
1:36:23option number four? Oral anti-fungal was
1:36:26given.
1:36:27Was it oral anti-fungal or topical
1:36:29anti-fungal? Both are given?
1:36:33See if they are saying that itching is
1:36:35not given if they are saying itching is
1:36:37not given what what about the image but
1:36:40you was it more like this which is shown
1:36:44here? Do you see? Please remember hair
1:36:47loss is not a feature of
1:36:50not a feature of psoriasis. You will not
1:36:53see hair loss in psoriasis not a feature
1:36:56of psoriasis. So if they are writing
1:36:59that there was a patchy hair loss with
1:37:01scales I would say that anti-fungals
1:37:04will be the option. Okay, they are
1:37:06saying that there was oral anti-fungal
1:37:08there was no topical anti-fungal but you
1:37:10then the oral anti-fungal becomes the
1:37:12answer keeping in consideration the
1:37:14tinea capitis. Okay.
1:37:17One of the option was oral antibiotics
1:37:20oral antibiotics if these are the option
1:37:23and if they have given that there is
1:37:25hair fall also I would mark the option
1:37:28as option number four which is
1:37:30anti-fungal because hair loss is not a
1:37:32feature of psoriasis hair loss is a
1:37:35feature of fungal infection. It should
1:37:37be tinea capitis. Okay, it should be
1:37:40tinea it should be fungal infection what
1:37:43you can see. Okay but you I hope this is
1:37:45clear.
1:37:47Topical later. Okay, so fungal
1:37:49antifungals were given orally and the
1:37:52steroid were given topical. That's what
1:37:54students are telling me that topical
1:37:57steroid was given and the antibiotic
1:38:00were oral and methotrexate was oral.
1:38:02Okay.
1:38:03If they are writing that there was hair
1:38:05loss, it is very unlikely to be
1:38:08psoriasis but you but again the image
1:38:10becomes important here. Sometimes in a
1:38:13very long-standing psoriasis where you
1:38:15have thick scale, you can get hair loss
1:38:18also. But if this is this sort of a
1:38:21image was given, I will go with
1:38:23antifungals more. Okay. Topical steroid
1:38:26is not given for any of them but you I
1:38:28would not ask you to give topical
1:38:30steroids even for psoriasis for scalp
1:38:33because the skin is very thick and just
1:38:35using topical steroids won't help. Okay.
1:38:39If there is no hair loss, then the
1:38:41question changes completely.
1:38:44Okay.
1:38:46So, here I think we need a proper image
1:38:48and I think that will solve the
1:38:49question.
1:38:52Coming to the next question, I think
1:38:54this question was done by
1:38:57Deepti ma'am also that
1:39:00silvery was mentioned in the question.
1:39:01Okay, Ash is saying that in the previous
1:39:03question silvery scale is mentioned. If
1:39:06they write silvery scale, but you the
1:39:08things changes here. If they write
1:39:10silvery scale, some students are saying
1:39:12silvery scales were not given.
1:39:14Scarring was mentioned.
1:39:21Because scarring or silvery, you have to
1:39:23be sure
1:39:25because
1:39:26even a single word will make a lot of
1:39:28difference. Scarring goes in favor of
1:39:30fungal infection more and silvery goes
1:39:33in favor of psoriasis more.
1:39:41Okay, students are saying there was no
1:39:43silvery given. So I think see
1:39:45there is different recalls which we are
1:39:46getting much of. Whatever exact recall
1:39:48if you get you can just post it here so
1:39:50that I can come up with a better
1:39:51question tomorrow when I'll be doing
1:39:53again the session. Coming to the next
1:39:56one, a female presented with greenish
1:39:58frothy discharge. Whiff test was
1:40:00negative. Now some students say that
1:40:02whiff test was given. Some students are
1:40:04saying that Amsel's criteria was given.
1:40:06But whatever it is, if it is negative it
1:40:08rules out bacterial vaginosis. And what
1:40:11microscopy you see if you have greenish
1:40:13frothy discharge which is a feature of
1:40:14trichomoniasis much of. In
1:40:17trichomoniasis
1:40:19sorry, in trichomoniasis you get motile
1:40:22flagellates which is the trichomonas
1:40:25which you see or which you can
1:40:27demonstrate on a simple saline mount or
1:40:30in a KOH mount. Pseudohyphae is a
1:40:32feature of Candida. In Candida you get
1:40:36greenish sorry, in Candida you get
1:40:38whitish discharge which is very very
1:40:40itchy. Clue cells is a feature of
1:40:42bacterial vaginosis but the question
1:40:43rule out the Amsel's criteria and the
1:40:45whiff criteria. So option number three
1:40:47becomes the correct answer for this much
1:40:49of.
1:40:50Can you tell me what was option number
1:40:51four given because I'm not sure what was
1:40:53the next option given in this question.
1:40:58>> [clears throat]
1:40:59>> Okay, so you have to tell me what was
1:41:01the next option if you know anyone if
1:41:03you can
1:41:04remember option number four.
1:41:06Coming to the next again I'm not very
1:41:08much sure that what was the exact
1:41:09question but students were saying that
1:41:11they have asked that at what level we
1:41:14inject or we insert the dye in a tattoo.
1:41:17So in a tattoo the dye was given at the
1:41:20level of dermis. So you put the dye at a
1:41:23dermal level. Now I want to ask much of
1:41:26that what else was given
1:41:29in the question. I said in the previous
1:41:31question gram negative diplococci was
1:41:33given. Okay, so I'll just add it here
1:41:36gram negative diplococci.
1:41:40Coming to this one, you have to tell me
1:41:42what was the question? Achha, there was
1:41:45an image here. The image of tattoo was
1:41:48given. And what what was the question?
1:41:52That what is the level of putting the
1:41:54dye in a tattoo, right?
1:41:58Achha, only the image was given. Only
1:42:00image of a tattoo was given. And they
1:42:03have asked
1:42:07There was another option as muscle.
1:42:10Muscle and vasculature was option number
1:42:13four. Muscle and vasculature
1:42:16was option number four.
1:42:19Done. Done. Muscle and vascular
1:42:22level was another.
1:42:24Chalo, where does the ink lie? That was
1:42:27the question. Where does the ink lie?
1:42:30Good.
1:42:31So, I think this was the easy one. Ink
1:42:33lies in a dermal compartment.
1:42:35Next.
1:42:38Now, I have no idea what was this
1:42:40question, but somebody told me that
1:42:42something related to Ruffini's and
1:42:44Pacinian. Did they ask you the question
1:42:46on the location? Did they ask you
1:42:49question on
1:42:51uh I don't know what was the question,
1:42:52but just I have put this image. So, you
1:42:54have to tell me what was the question
1:42:56given.
1:43:00Okay, so now they're saying but you can
1:43:02tattoo me they're asking you where you
1:43:04will not put the dye. So, if they're
1:43:06saying that where do you will not put
1:43:08the dye, obviously you will never put
1:43:10the dye in the muscle and the blood
1:43:11vessel.
1:43:12The exact site where we prefer to put is
1:43:16dermis.
1:43:17Because if you put it in epidermis, the
1:43:19dye get you know, like it is very
1:43:21superficial and there's a good chance
1:43:23that the ink fades away. Putting lower
1:43:25down also has a greater chance. Like if
1:43:28you put it in subcutaneous tissue, the
1:43:30chances of dye moving out is also high.
1:43:33So, if they are asking you where you can
1:43:35never put a ink in a tattoo or a dye in
1:43:38a tattoo, then obviously muscle and
1:43:40vasculature becomes the option. But, if
1:43:43the question is pick one site, then I
1:43:45would ask you to pick dermis as the best
1:43:48option. Okay.
1:43:51Okay, they have asked the histopath
1:43:53question. So, I think histopath will
1:43:55they this will be then become a patho
1:43:58question or a physiology question
1:44:00because histopath they will be teaching
1:44:01you more. I thought they have asked you
1:44:03about the location of function, which is
1:44:05something to do with dermatology. Okay,
1:44:08G. Hello. So,
1:44:10these were some of the question, but you
1:44:12anything which we have missed here, you
1:44:14can just write it down so that I can add
1:44:17when I will be taking a
1:44:19option tomorrow. Anything else?
1:44:22A Nikolsky sign we have already
1:44:24discussed Dharmesh Nikolsky,
1:44:26pseudo-Nikolsky, and I think false
1:44:28Nikolsky I've already discussed.
1:44:30Anything other than these we had
1:44:35Okay, so that physiology that Pacinian
1:44:37corpuscle will be discussed in
1:44:38physiology. Don't worry, physio and
1:44:39patho.
1:44:43Anything else?
1:44:48Okay. So, I think these were the only
1:44:51questions we had around the
1:44:55We have around eight questions in
1:44:57dermatology, seven to eight questions in
1:44:59dermatology which I got. So, if you have
1:45:01any more questions, just post it here.
1:45:03And I think there are other teachers who
1:45:05are waiting for the next session. So,
1:45:07please do keep posting. You can also
1:45:09post it on my or on the DAMS Telegram
1:45:12channel so that I can just take it and I
1:45:13can make a better session tomorrow.
1:45:15Okay?
1:45:51>> You got one second, doctor.
1:46:09Okay.
1:46:11We start, doctor? We start?
1:46:14Okay to start.
1:46:17I think all the questions were easy
1:46:19questions straight from the
1:46:22notes.
1:46:24You just want to see it.
1:46:48Just one second, doctor.
1:46:53Yes.
1:47:01Uh what is the answer for the question,
1:47:03doctor? You what?
1:47:04>> I want to see straight back. Where to
1:47:06see?
1:47:26>> Yes.
1:47:27Yeah.
1:47:28What are the answers you marked for this
1:47:30question?
1:47:32Yeah, from notes. Very good. Thank you.
1:47:33Thank you. Most of the question
1:47:38All from notes. Yeah, very good. So,
1:47:40look here. Lamotrigine a drug useful for
1:47:45Just one second.
1:47:51Lamotrigine useful for
1:47:55Also, first-line drug of choice.
1:47:57First-line drug of choice. Okay, make a
1:47:59question. So, first-line
1:48:02drug of choice for Okay. Actually
1:48:10Yeah.
1:48:11Actually, for absence seizure, drug of
1:48:14choice is ethosuximide.
1:48:16Ethosuximide. Okay. And for myoclonic
1:48:19seizure, we can go for valproates.
1:48:22Atonic, valproates. And among the
1:48:25option, best answer go for tonic-clonic
1:48:28seizure, we can go for valproates. I
1:48:30mean, lamotrigine can be useful for
1:48:33tonic-clonic seizure. Okay.
1:48:35Myoclonic seizure, best answer go for
1:48:37valproate. You can go for tonic-clonic
1:48:40seizure. Right? Next.
1:48:43All are ligand-gated receptor, except
1:48:47What is the answer?
1:48:48All are ligand-gated except
1:48:51Everything we discussed. Just once
1:48:53again, I'll show.
1:48:55Just once again, I'll show. Actually
1:49:01Look at this.
1:49:04In our regular class, we discussed all
1:49:07our class notes.
1:49:08Look here. Ligand the ligand-gated
1:49:11receptors. We discussed, no? Are the
1:49:14nicotinic receptor, GABA-A receptor,
1:49:16NMDA receptor. Things three, all are
1:49:19ligand-gated except the histamine.
1:49:21Histamine. So, so histamine is the
1:49:24cyclic AMP receptor. So, answer for this
1:49:27question, you can go for option number
1:49:30A,
1:49:30H2 receptor. Yeah.
1:49:37Right? So, here the same question,
1:49:39ligand-gated. The same thing we
1:49:41discussed for
1:49:44this one. See picture.
1:49:50Same image. This is our class notes,
1:49:52general pharmacology class notes. Look
1:49:55at this. These are the ligand-gated
1:49:58receptor. So, answer should be H2.
1:50:01That's all. Okay? Coming to next
1:50:04question. Look at it.
1:50:07I think there's one question.
1:50:10Uh flupentixol.
1:50:13This question came or not, doctor? What
1:50:15is the real question? Flupentixol, any
1:50:18idea?
1:50:21Uh flupentixol.
1:50:23This question came or not?
1:50:25I think somebody told you something.
1:50:27Flupentixol regarding adverse reactions,
1:50:30something they told. Any idea?
1:50:37This question I have to check, doctor.
1:50:39Flupentixol question I have to check.
1:50:42What is the real question? I have to
1:50:43check. Okay?
1:50:46Do you have any idea? Flupentixol, no
1:50:48idea? Okay. Now,
1:50:50uh this question, LD50 ED50 question. I
1:50:53think straight question, very simple
1:50:55question. What answer?
1:50:57They given LD50 value, ED50 value. So,
1:51:01answer?
1:51:04Flupen- fenfluramine. Okay,
1:51:07fenfluramine.
1:51:09Fenfluramine causing cardiac valve
1:51:12fibrosis, so needs regular cardiac
1:51:15checkup. So, fenfluramine appetite
1:51:18suppressant causes cardiotoxicity like
1:51:21valve fibrosis. So, fenfluramine is
1:51:24okay. So, answer four. So, it's the same
1:51:26thing. See what we discussed. Actually,
1:51:28all are very easy question from our
1:51:30class notes. For example, look at this.
1:51:33The same image we discussed.
1:51:37Right.
1:51:42Yeah.
1:51:43See.
1:51:54See, these are all the important images
1:51:57I taken.
1:52:00It is the one picture, second picture
1:52:03from class notes LD50, ED50.
1:52:06And there's one more question,
1:52:08belozodan, a antidepressant from our
1:52:11regular class notes. And look at this.
1:52:14And then where the board
1:52:17ticagrelor from our class notes.
1:52:21And
1:52:22cilnidipine, a CCB having anti-calcium
1:52:27channel blocking property, was our class
1:52:29notes.
1:52:31And then look at this.
1:52:33The organophosphate compound poisoning,
1:52:35oxime [clears throat] binding with the
1:52:37anionic site. Same image, that is
1:52:40negatively charged area, anionic site.
1:52:43Oxime goes and binds here. The same
1:52:45image.
1:52:47And then varenicline.
1:52:53Uh varenicline, a nico- partial
1:52:56nicotegnist, a very good drug having
1:52:59black box warning for cardiotoxicity.
1:53:02This is the image. And then we discussed
1:53:04about resmetirom, a very important
1:53:08thyroid hormone receptor beta agonist
1:53:11useful for mash. This a straight
1:53:14question.
1:53:17And then
1:53:18uh
1:53:19aminoglycoside concentration dependent
1:53:22killing pattern.
1:53:23This straight away from straight notes.
1:53:26And then antimicrobial and the uses. For
1:53:29example, doxycycline wonderful choice
1:53:32for skin infection.
1:53:35And then clarithro, very good drug for
1:53:38so-called
1:53:39uh H. pylori infection in
1:53:42gastritis.
1:53:43And then bremelanotide mechanism of
1:53:45action. I have collected almost 18
1:53:48question in that eight question. 12
1:53:50questions straight away from the notes.
1:53:53The against six question uh combine all
1:53:55the chapter notes. Okay. Now, look at
1:53:57this. We done LD50 ED50. The answer is
1:54:02you know.
1:54:03And normal agent
1:54:06uh normal agent for depression.
1:54:09Anti-depressant a latest drug. Here
1:54:12among the option, vilazodone. Can you
1:54:15please answer? What else they give an
1:54:17option?
1:54:18They ask about
1:54:21Yeah.
1:54:23Fenfluramine main
1:54:26appetite suppression centrally acting
1:54:28drug causing cardiotoxicity
1:54:31needs cardiac checkup. Okay.
1:54:35Second option is sibutramine. Okay.
1:54:37Fenfluramine, I'll make it.
1:54:38Fenfluramine, I'll make it. I'll come
1:54:41I'll come.
1:54:42Can you
1:54:43look at this question?
1:54:45Uh
1:54:46what is the any
1:54:51No, normal agent useful for depression.
1:54:54Apart from this, any other options are
1:54:56given, sir? Can I please answer?
1:54:58Trazodone, etizolam, vilazodone.
1:55:02Vilazodone is sparine serotonergic
1:55:05partial agonist and reuptake inhibitor.
1:55:08Any Can you please answer what is the
1:55:10fourth option? Any idea?
1:55:12Fourth option any idea mean?
1:55:17Novel mean What is the novelty? What is
1:55:20the latest? The latest because latest
1:55:22also called novelty. That is compared
1:55:24into existing drug, old drug. What is
1:55:26the novelty? Novelty is the partial
1:55:29agonist and reuptake blocker is called
1:55:31novelty.
1:55:33Okay.
1:55:35Balmoral side. Okay, Balmoral Balmoral
1:55:39Balmoral side.
1:55:43Balmoral
1:55:44side. Okay, Balmoral side. So, answer
1:55:47for question option C.
1:55:49Now, take a regular correct statement.
1:55:52Take a regular correct statement.
1:55:55Ticagrelor antiplatelet units of P2Y12
1:56:05pro-drug it is
1:56:06and metabolism and excretion through
1:56:09air. Undergo metabolism by liver,
1:56:12undergo excretion by bile. This is also
1:56:14What is the one more statement? Any
1:56:15idea?
1:56:17Ticagrelor antiplatelet a P2Y12
1:56:21inhibitor
1:56:24and it is undergo metabolism in liver,
1:56:27undergo excretion through bile. Any idea
1:56:29what is the one more? They asked
1:56:31incorrect They asked incorrect, huh?
1:56:33Okay.
1:56:35They asked for incorrect.
1:56:39One uptake not One option was this needs
1:56:43ah One option needs activation. One
1:56:45option needs activation. No, no, no. It
1:56:47It is no need for activation.
1:56:50Okay.
1:56:56It's a reversible.
1:56:59Only ticlopidine, clopidogrel, prasugrel
1:57:03are irreversible. It is reversible.
1:57:06Ticagrelor, cangrelor are reversible.
1:57:09Reversible.
1:57:11P2Y12 blocker. It's a reversible.
1:57:14Clop- ticlopidine,
1:57:16clopidogrel, prasugrel are irreversible.
1:57:20Whereas, it is reversible, right answer.
1:57:23It's causing more bleeding than
1:57:26ticlopidine.
1:57:28And undergo metabolism in liver, okay.
1:57:30Needs activation, no, wrong answer. That
1:57:33means, which is incorrect, which is
1:57:35incorrect.
1:57:36Incorrect is no need. Only ticlopidine,
1:57:39clopidogrel, prasugrel are
1:57:42prodrug, okay.
1:57:44So,
1:57:49yes.
1:57:55Next one.
1:57:58Uh okay. So, reversible, needs
1:58:01activation. Okay, right. Okay. Thank
1:58:04you, thank you. I'll make it.
1:58:06Now, just to go through this, I will
1:58:07make a refined video for you, okay. Now,
1:58:10look.
1:58:12Cilnidipine
1:58:13not cross reflex tachycardia due to its
1:58:16action. See, most oral dihydropyridines
1:58:19are L-type of CCB. Cilnidipine has L
1:58:23plus N-type of blocking property. So,
1:58:26answer due to N-type, okay. So, here, L,
1:58:31N, T are not. Only CCB mean only three
1:58:34things. Either L-type, N-type, T-type.
1:58:37It's L plus N. The N-type blocking
1:58:40responsible for no risk of reflex
1:58:43tachycardia or
1:58:45this answer. Okay.
1:58:49Can you please look at this?
1:58:51Catalase positive
1:58:54gram positive
1:58:57Why not?
1:58:59L L All the L type of channel like
1:59:02amlodipine, nifedipine all are L type. L
1:59:05type causing reflex tachycardia
1:59:07tachycardia. This drug has no severe
1:59:11tachycardia because it has N type. The
1:59:13question was cilnidipine not causing
1:59:16reflex tachycardia due to what? Due to N
1:59:18type. If this is blocking L plus N but L
1:59:22type main causing reflex tachycardia
1:59:24because of blocking N only no reflex
1:59:27tachycardia. So speak answer go for N.
1:59:30Go for N.
1:59:32Okay. Next.
1:59:44Catalase positive
1:59:49gram positive cluster sensitive to
1:59:52cefoxitin and oxacillin. What is the
1:59:55drug of choice?
1:59:56Anybody? This needs microbiology
1:59:59knowledge then only you can answer for
2:00:01the question. Come on.
2:00:06Yeah, I'll make it one of the option.
2:00:08Take out the reverse I'll make it I'll
2:00:09make it. Okay, good. Now look here.
2:00:12Catalase positive gram positive clusters
2:00:18Vancomycin also there in option.
2:00:20Oh, vancomycin also there in option.
2:00:22Okay, okay.
2:00:25Actually, catalase positive gram
2:00:28positive mean we're talking about
2:00:30staphylococcal
2:00:32and sensitive to cefoxitin oxacillin
2:00:34mostly it's case of MRSA. Mostly it's
2:00:37case MRSA. For MRSA the drug of choice
2:00:41always go for vancomycin.
2:00:44If vancomycin is there mean answer
2:00:46vancomycin. If not there we go for clock
2:00:48sign. If vancomycin is there answer
2:00:51should be vancomycin. For MRSA drug of
2:00:53choice vancomycin. Good. So answer
2:00:55vancomycin. Very good.
2:00:58No.
2:00:59Choose correctly matched pairs. Okay?
2:01:03This is from small molecule. This was
2:01:06discussed in DVD. Okay? Now look here.
2:01:09I think they mentioned about sunitinib
2:01:13and targets.
2:01:18Sunitinib and target. Trastuzumab
2:01:21target. Gefitinib target.
2:01:23They're asking right which is right.
2:01:25Look here. Sunitinib has multiple
2:01:30receptor blocking property especially
2:01:32blocking VEGFR and PDGFR.
2:01:36So it is wrong match.
2:01:39Trastuzumab HER2 right match.
2:01:43Gefitinib again EGFR1. Yes, right. HER1
2:01:47also called EGFR. EGFR also called HER1.
2:01:50So right statement. So I need one more
2:01:53answer. Anybody? What is one more answer
2:01:55letter? One option?
2:01:57Here this B and C are right. I need what
2:02:01the one more option. Any idea?
2:02:03Nilotinib. Yeah. Nilotinib was given.
2:02:07What is the target? Nilotinib. Yeah.
2:02:11Tyrosine kinase enzyme blocker. Useful
2:02:15as a drug of choice for AML.
2:02:17Okay? Useful for treatment of CML. We
2:02:20having
2:02:22uh imatinib, dasatinib, nilotinib all
2:02:26are very good drug for CML.
2:02:28Imatinib first generation. It is second
2:02:30generation. Tyrosine kinase. That mean
2:02:33it is also it's a it's two. B, C, D are
2:02:37true statement. Okay?
2:02:40B said yes. BCR ABL oncogene. BCR ABL
2:02:44oncogene useful as a drug for CML. Yes,
2:02:48good answer, good. So, answer B C D.
2:02:52Okay, good.
2:02:54Next.
2:02:55Uh this question. Bradycardia,
2:02:58hypotension,
2:03:00also associated with the sweating and
2:03:02pinpoint pupil. Which of the following
2:03:04drug acting by binding to
2:03:07cholinesterase? And the action which
2:03:09binding site? Actually, they given Look
2:03:11at this.
2:03:12Patient having bradycardia,
2:03:16hypotension,
2:03:17with sweating and pinpoint pupil.
2:03:21Diagnosis of organophosphorus
2:03:24compound poisoning.
2:03:26And pupil also pinpoint pupil. Which of
2:03:28the following drug acting by binding
2:03:30with the cholinesterase?
2:03:32And by by the what site? What site? The
2:03:36bind So, the choice will be atropine.
2:03:39First choice. But asking, which is going
2:03:41to reactivate cholinesterase
2:03:44by binding with the what site? Actually,
2:03:47oxime. Oxime are the one going to
2:03:51the
2:03:52organophosphorus
2:03:54compound binding with the
2:03:57esteratic site.
2:03:59Esteratic site. Okay? Whereas, oxime
2:04:02binding with the anionic site.
2:04:05I don't know what the right option. Can
2:04:07you please tell me what are the option
2:04:09they given after?
2:04:10Oxime mean they binding with the anionic
2:04:14site and causes enzyme reactivation. So,
2:04:18if they given pralidoxime, pralidoxime
2:04:21they reactivate they reactivate
2:04:24cholinesterase. Actually, in our in our
2:04:27regular class, you can see the image.
2:04:29Just look at the image. I given
2:04:31beautiful image for you. Look at this.
2:04:37Look at this image. Look at this.
2:04:39See.
2:04:41Organophosphorus compound binding with
2:04:44the esteratic site. Oxime bind with the
2:04:46anionic site. It is the right answer.
2:04:49Okay? So, pralidoxime binding with the
2:04:53anionic site of the cholinesterase and
2:04:56causes enzyme reactivation. The same
2:04:59thing we discussed in the class notes.
2:05:00Okay?
2:05:07So, answer pralidoxime binding with the
2:05:11anionic site of the cholinesterase. Yes,
2:05:14good answer. Good. Fantastic.
2:05:21Next one.
2:05:22Uh this question little bit tricky.
2:05:25Okay, look here.
2:05:33Swetha, that's another question option
2:05:36anionic site.
2:05:38Esteratic site.
2:05:40Actually, oh
2:05:42This another question.
2:05:43Somebody posted
2:05:45I thought same question.
2:05:47See.
2:05:49In general, in organophosphorus compound
2:05:52poisoning, OPC binding with the
2:05:56esteratic site.
2:05:58Whereas oxime binding with the anionic
2:06:01site and causes enzyme reactivation.
2:06:05Image was Okay, okay. I'll I'll try to
2:06:08collect the image. If you have the
2:06:09image, kindly post me. I will make it
2:06:12correct. But the concept is in general,
2:06:15oxime binding with the anionic site of
2:06:18the enzyme. Okay?
2:06:20I don't know what the exact image given.
2:06:22If you have the image, kindly post me. I
2:06:24will modify the question with the
2:06:26option. Okay?
2:06:28Yeah. Look at this.
2:06:30Uh this is very tough question, I think.
2:06:33Anti-aging drugs mechanism
2:06:37and matching question. That is
2:06:39autophagy. That is still repairing.
2:06:45Auxin action doesn't depend on OPC.
2:06:49One option. Okay, I'll go through it
2:06:51quickly.
2:06:54Other questions are atropine was
2:06:56answered. Okay, that means there's a two
2:06:58question on OPC.
2:07:00Can you please answer whether there's a
2:07:02two questions on OPC compounds?
2:07:06Atropine, a direct muscarinic
2:07:08antagonist, useful as a first-line
2:07:10therapy to control the muscarinic
2:07:12symptom. But a definite treatment,
2:07:15reactivation of cholinesterase, that is
2:07:17by using oximes.
2:07:20Okay, I will check it. I will check it.
2:07:23Another Another question. I'll check it.
2:07:26Now, look at yeah, anti-aging drug.
2:07:29Here, you know
2:07:41Okay, auxin question. If you have a
2:07:44right question, can you please post me
2:07:46what is the exact question?
2:07:49I have the two questions on OPC. Okay,
2:07:51ma. Okay. I have only one question. That
2:07:54is
2:07:56paraoxon binding with which site of the
2:07:59enzyme? Answer, anionic. What about next
2:08:02question? I don't have the question. If
2:08:04you have the question, I'll modify the
2:08:05question. Okay. There are two questions.
2:08:07I got only one question from the student
2:08:09side. So, I will make I will ask the
2:08:12students to give me another question
2:08:14also. I'll make it. Okay.
2:08:16Now,
2:08:17uh, anti-aging. Here,
2:08:20look at. You know metformin, your target
2:08:24is AMPK.
2:08:26You know rapamycin target is mTOR. Only
2:08:30two more thing you should know,
2:08:32spermidine, yeah, histone
2:08:35acetyltransferase
2:08:38targets inducing anti-aging.
2:08:41Then res- resveratrol,
2:08:44it is going to be targeting against
2:08:47targeting via SIRT1 AMPK pathway. Now,
2:08:51this question was there, sir.
2:09:00Whether this question is there or not?
2:09:03One question is there, I think.
2:09:06It is matching question or straight
2:09:08question or
2:09:09multi-response question, okay.
2:09:14Both questions were there.
2:09:17Okay. There are two question came. Yeah,
2:09:20yeah, yeah. Yeah, this question there,
2:09:21no? So, here, target metformin targeting
2:09:25against AMPK.
2:09:28So, AMPK activator, same question. Yeah.
2:09:35Yeah. And spermidine
2:09:38Suppose single response question mean, I
2:09:42go for this. Multiple mean, all are
2:09:45right answer. What the answer given?
2:09:47What the option you asking? Anti-aging
2:09:49mechanism, all are right match, right
2:09:52mechanism. Single answer mean, best is
2:09:55go for spermidine.
2:09:58Others also trying for anti-aging, but
2:10:01it's already proven to have anti-aging
2:10:03property. So, single response answer
2:10:06mean, I go for option A.
2:10:08But, multiple response mean, all are
2:10:10under trial for anti-aging.
2:10:13Matching question. Matching question,
2:10:14that mean, they ask about what is the
2:10:16target. Spermidine target, and metformin
2:10:20target, like the matching question.
2:10:21Yeah, I will make it matching.
2:10:23Matching question.
2:10:25Yes, okay.
2:10:29Next
2:10:31nicotine deep breath therapy. Ready?
2:10:33Nicotine this therapy we very well
2:10:35discuss in class one. We put good
2:10:38animation for smoking and all this we
2:10:40discuss, no? Now question was look at.
2:10:45Now look at.
2:10:46One scenario on child with
2:10:50ex- exposed to insect
2:10:52pesticide. Okay, okay. This is one more
2:10:54question and okay, you see a child
2:10:57exposed to pesticide. Okay, okay, okay.
2:11:01Right.
2:11:02Okay, I do understand. Now can you
2:11:04answer for the question? Nicotine deep
2:11:07breath therapy. Nicotine gum better than
2:11:10lozenge, no?
2:11:12Caffeine avoided 15 minutes before
2:11:15nicotine, yes. For nicotine absorption
2:11:18we need
2:11:20acidity. It's going to make alkalination
2:11:24that make poor absorption. So, it should
2:11:26be avoided 15 minutes before taking
2:11:29nicotine gum. This is the right answer,
2:11:31two statement.
2:11:33Varenicline
2:11:34has black box warning for CVS. Yes, it
2:11:38is actually it is black box warning
2:11:41mainly for psychiatry, neuro-psychiatry
2:11:44problem. It causes suicidal depression.
2:11:48Not cardiac, it may cause some cardiac
2:11:50problem but not black box warning. Wrong
2:11:52statement. So, for this question right
2:11:55answer among the option I go for B. What
2:11:57is the one more option? Anybody want to
2:11:59answer?
2:12:00What is the one more option given after?
2:12:02Nicotine deep breath therapy.
2:12:05So,
2:12:06better answer among the option go for
2:12:09option B. What is the one more option
2:12:11anybody?
2:12:13Any idea?
2:12:22>> I need one more option. If we have that
2:12:24option, please post to me. I'll make it
2:12:26right.
2:12:30Gas tool.
2:12:34Gas tool. Okay, okay. Gas tool intestine
2:12:38dude. Okay, okay, okay.
2:12:40You know it has nicotine. We have
2:12:43inhaler, patch, lozenge, and chewing
2:12:45gum. There's no tablet. So, wrong
2:12:48answer. The same thing the same thing we
2:12:51are discussing in our regular class.
2:12:53Just watch. Look at this.
2:12:55Actually,
2:12:57you look at these images. Look at this.
2:13:12Look at this. Just one second.
2:13:15Nicotine uh
2:13:16we have nicotine slide.
2:13:28Yeah, see. Nicotine mean only patch
2:13:32form, inhaler, lozenge, and chewing gum.
2:13:35There's no tablet form. Okay? And
2:13:38remember
2:13:39varenicline enhance suicidal thoughts.
2:13:42That's why blood was only not for
2:13:44cardiology, only PO. Okay? Yeah.
2:13:50Now, look at this.
2:13:52See, actually for and for appearing in N
2:13:56S C T, they don't want a straight
2:13:58question. They need
2:14:00whether you are able to understand the
2:14:02concept or not. That's all. So, in one
2:14:05question they want to test four chapter
2:14:07knowledge.
2:14:08So, if you understand all the chapter
2:14:11very well, mean you can you can have a
2:14:13good correlation. They need your
2:14:17correlating capacity, cognitive thinking
2:14:20capacity, not the memory power. So, I
2:14:23need to study. All faculty will give
2:14:25super super notes for you. But, you
2:14:27don't correlate everything after. Then
2:14:30only you can get a very good rank. Okay?
2:14:32So, most of the question out of 18
2:14:34question,
2:14:3512 question straight notes. Remaining
2:14:37five to six question, if you read every
2:14:39chapter, you can think and can rule out
2:14:41other options also. Easy only. Okay?
2:14:44Now, straight away PYQ, straight away
2:14:47DVD, straight away on less same line may
2:14:50not be expected for your INICET. You
2:14:52need con- cons-
2:14:54thinking capacity. Right. Now, look at
2:14:56this.
2:15:02Yeah. This question, I think straight
2:15:05away from notes, I think. Come on,
2:15:07answer.
2:15:16Resmed drug mechanism action. What
2:15:18answer?
2:15:19It's a very latest drug
2:15:22useful for NASH.
2:15:25One graph they're asking. Oh, order of
2:15:27kinetic. First order is saying okay okay
2:15:29okay. Nobody given this question after
2:15:32kinetic graph question. Okay.
2:15:35Regarding order of kinetic. Okay, I'll
2:15:36go with it. And resmed drug
2:15:39thyroid hormone receptor agonist useful
2:15:41for metabolic dysfunction associated
2:15:46state of hepatitis.
2:15:50Okay.
2:15:52Yeah, good good. This I think everybody
2:15:54will answer. Good.
2:15:56Now, there's one more question matching
2:15:58type of question regarding antibiotic
2:16:00and the uses. Look here.
2:16:03Clarithromycin useful for H. pylori.
2:16:06Among
2:16:07and streptomycin
2:16:09second line drug, not a first line drug
2:16:11for TB. And doxycycline wonderful drug
2:16:14for TB infection. Of course,
2:16:16azithromycin also wonderful drug for
2:16:18clarithromycin TB infection. So, I think
2:16:21this was matching question, easy
2:16:23question only.
2:16:25Amoxicillin useful for sensitive
2:16:27gonococci. Normally, gonococci today
2:16:29drug of choice will be ceftriaxone. For
2:16:31sensitive organism, we can try
2:16:33amoxicillin. Okay, this question is
2:16:35there or not, doctor?
2:16:37This question is came or not?
2:16:40Okay. A curve on first order kinetics
2:16:44versus zero order.
2:16:45This question I have not received,
2:16:46doctor. Frankly speaking, if I receive
2:16:49the question, I will make I will Again,
2:16:51I refine all the question with the
2:16:53proper answer. I will make complete
2:16:55video, okay? As soon as possible, I will
2:16:57complete video. And for this question
2:16:59came or not, doctor? Can you please
2:17:01answer? Clarithromycin.
2:17:03Yeah, macrolide useful for H. pylori,
2:17:06triple drug therapy. Amoxicillin, yes.
2:17:09So,
2:17:10everything I matched perfectly. Right,
2:17:13matching question. Yeah.
2:17:15Uh mechanism of action of bedaquiline.
2:17:18Can anybody What are the options they
2:17:19asked, doctor?
2:17:21This was a question regarding mechanism
2:17:23of action of bedaquiline. What are the
2:17:24options they asked for? Any idea?
2:17:27This one is discussed The delamanid,
2:17:29bedaquiline, all are discussed in
2:17:32regular class notes only. Just look at
2:17:34this. Look here.
2:17:42Look here. Bedaquiline, delamanid newer
2:17:45drug for MDR-TB. While bedaquiline
2:17:48inhibits the mycolic acid as well as
2:17:50protein synthesis. Yeah, it's great.
2:17:53It's over there. So, I need what are the
2:17:56other options given for this question?
2:17:58Any idea?
2:18:00Can anybody detect? What are the other
2:18:02option? One is inhibiting ATP synthesis.
2:18:05Next option, inhibiting mycolic acid.
2:18:09Any other option you came to know,
2:18:12doctor?
2:18:14Or yeah, RNA
2:18:17polymerase
2:18:18inhibition. Okay, okay. One more option.
2:18:23Inhibiting Oh, inhibiting
2:18:25arabinogalactan.
2:18:26Arabinogalactan.
2:18:28Yeah, very simple only.
2:18:32RNA polymerase is rifampicin.
2:18:34Arabinogalactan is your ethambutol. And
2:18:37synthetic blocker is your bedaquiline.
2:18:40So, answer should be option number B.
2:18:42Straight question. Okay.
2:18:45Next.
2:18:52Which antibiotic Ah, this is a very,
2:18:54very straight question. Which antibiotic
2:18:57is concentration-dependent
2:18:59killing pattern?
2:19:01This question came or not? Can you
2:19:02please answer?
2:19:04This question came or not?
2:19:07Which antibiotic is
2:19:09concentration-dependent
2:19:11killing?
2:19:14The right answer go for aminoglycoside.
2:19:18Beta-lactam antibiotic is only follows
2:19:20time-dependent killing. Anybody what the
2:19:23one more option given, doctor? Can you
2:19:25able to read this?
2:19:27Ethambutol. What is the one more option
2:19:28can you able to read this? Yeah,
2:19:30ethambutol. So, answer option A is
2:19:32straight question. Okay.
2:19:35Then.
2:19:37Swetha.
2:19:41Anybody? Swetha, what is the one more
2:19:42option?
2:19:44Those who have studied first time feel
2:19:46moderate tough. Those who have studied
2:19:48two times are telling easy to moderate
2:19:50paper. Okay. Right.
2:19:53Anybody?
2:19:55What is the one more option, here?
2:19:56Answer me like I said. One more option?
2:19:59Okay, I'll get it.
2:20:06Vanco medicine. Yeah, one more option
2:20:07vanco medicine. Yeah, good.
2:20:10Vanco medicine follows time to kill.
2:20:13Okay, good. Thank you.
2:20:15Now, this was fenfluramine.
2:20:18Yeah, appetite suppressant, suppressing
2:20:21appetite. It causes cardio toxicity, so
2:20:26need cardiac checkup. This, I think, one
2:20:29option I given hepatotoxicity also. What
2:20:32is the one more option? I have to check
2:20:34until Okay, fenfluramine is centrally
2:20:38acting sympathetic agent, appetite
2:20:40suppressant,
2:20:42causes cardio toxicity. What is the one
2:20:44more option I want?
2:20:49Okay.
2:20:50So,
2:20:52I have to have one question. The order
2:20:55of kinetic, order of kinetic, first
2:20:58order versus zero order kinetic. That
2:21:00question I had received.
2:21:02Okay, that question I had received. I
2:21:05think remaining question I had
2:21:06collected, so we'll hear.
2:21:09Most of the question, now tell me, I
2:21:11showed evidence from our class notes
2:21:13including my face itself. So, what is
2:21:16the meaning mean?
2:21:18Out of 18 question what we discussed
2:21:20here, 12 question from our notes only.
2:21:23See, beta blocker notes, vanco medicine,
2:21:27and on doxycycline, mesh, remdesivir,
2:21:31and then look at this.
2:21:33Uh varenicline, nicotine, and look at
2:21:36this. Anionic site binding with OPC
2:21:38compounds, and look at this.
2:21:41Cilnidipine, L plus N among this dipping
2:21:44only one drug blocking L plus N,
2:21:46cilnidipine, and look at this. And
2:21:49your figure lock, irreversible blocker,
2:21:53and more bleeding than clopidogrel.
2:21:57And then,
2:21:58vilazodone, a latest antidepressant
2:22:01called sparine.
2:22:04And then, look at this, LD50
2:22:07called therapeutic index.
2:22:09And ligand-gated receptors all exert
2:22:11like this. So,
2:22:13everything from the
2:22:16notes only. But, extra four to five
2:22:19question, if you understand whole
2:22:21pharmacology, easily can make out. Okay?
2:22:24And may God bless you, doctor. Those who
2:22:27are worked strongly, heavily,
2:22:30consistently, definitely going to get a
2:22:32very good rank. God is waiting to give a
2:22:34very good opportunity. So, may God bless
2:22:37you. In meanwhile, if you have extra
2:22:40question, kindly post to me.
2:22:43I have received first-order, zero-order
2:22:46kinetic-based question I received. If
2:22:48you have any other question, please post
2:22:50me, doctor. Okay? Plasma concentration
2:22:53versus graph, sigmoid. Oh, log
2:22:56dose-response curve also there.
2:22:58Plasma concentration versus graph,
2:23:01semi-log. Okay, the two graph
2:23:04question I have received. Kindly post
2:23:07me, doctor. Kindly post me.
2:23:08And if you want, I just show my
2:23:11number. Please take it.
2:23:18Kindly post your queries, post your
2:23:21extra question to my WhatsApp number. I
2:23:24will make full refined question with
2:23:27explanation and post you as soon as
2:23:31possible. Okay?
2:23:35So, thank you very much. All the very
2:23:38best. Okay? All very best. Thank you.
2:23:40Thank you.
2:23:50>> Uh one question.
2:23:51Mecamylamine
2:23:53when combined the three pen tall
2:23:57Okay.
2:23:58I
2:24:00street pen tall street pen tall a GABA
2:24:02useful for epileptic disorder. What is
2:24:05the question after?
2:24:07What so one question I am discussing
2:24:10kinetic excretion. One more question
2:24:12what about street pen tall? A GABA
2:24:15agonist useful for ball sensation
2:24:18regarding that. Okay.
2:24:21And
2:24:22one more thing semi log plasma
2:24:24concentration and semi log based
2:24:26question. So three more question I
2:24:28received almost 22 question we received
2:24:33still more question to be received. So
2:24:35pharmacology that much important
2:24:37important topic. Anyway, God bless you
2:24:40all the very best. Thank you for the
2:24:42great opportunity. Thank you.
2:25:05One option agranulocytosis.
2:25:09therapeutic
2:25:14drug correlation based equation.
2:25:23LFT
2:25:25Okay.
2:25:26Street pen tall pen for a minute LFT
2:25:28Okay. Thank you. Thank you.
2:25:31Pen for a minute and [clears throat]
2:25:32street pen tall will come in LFT like
2:25:34the question. Okay. Okay. I will get the
2:25:36full question. Okay then. Thank you.
2:25:38Thank you.
2:25:57>> the exact details.
2:26:07Am I audible?
2:26:23Great.
2:26:26So,
2:26:27neonatal meningitis caused by Here also
2:26:30I get two versions.
2:26:32Some people said neonatal meningitis not
2:26:34caused by
2:26:37Okay? If If you say neonatal meningitis
2:26:40caused by if that is the question,
2:26:43answer will be Listeria monocytogenes.
2:26:49If it is not caused by
2:26:53Staphylococcus aureus, if they mention
2:26:55not caused by
2:26:59then we can think of staff aureus,
2:27:01Streptococcus pneumoniae,
2:27:04Haemophilus influenzae. This usually
2:27:06they won't cause neonatal meningitis.
2:27:08Neonatal meningitis caused by what is
2:27:09the mnemonic? BELK.
2:27:13Group B Streptococcus, E. coli,
2:27:16Listeria.
2:27:20It's a multiple type, very good. But
2:27:22what My question is, sorry.
2:27:31Just a minute.
2:27:36It is multiple type. And
2:27:39and it may it may be neonatal meningitis
2:27:41not caused by neonatal meningitis
2:27:43usually not caused by staff or your
2:27:45streptococcus others
2:27:48others.
2:27:51Asking ideological agent means we can go
2:27:53for Listeria monocytogenes first major
2:27:56choice. Second I don't know Hemophilus
2:27:58influenza present or not or anything in
2:28:00in this list is present GBS
2:28:04E. coli
2:28:07Listeria
2:28:10Klebsiella pneumoniae
2:28:156 week infant very good. I want a full
2:28:17question my dears.
2:28:19I'll give my mobile number if possible
2:28:22please type the full question.
2:28:24Okay or I'll say
2:28:25after finishing this sit and think I'll
2:28:27give as much as information then only we
2:28:30can analyze exactly what they are
2:28:32asking.
2:28:34Ask about to caused by
2:28:38Okay, step 10 Listeria step means
2:28:40streptococcus pneumonia or streptococcus
2:28:42agalactiae.
2:28:45That is important.
2:28:47Not streptococcus pneumonia if
2:28:48agalactiae is there that may be the
2:28:50correct answer.
2:28:54Okay,
2:28:55please here anything is there in this
2:28:57list
2:28:58anyone recollect GBS E. coli Listeria
2:29:02Klebsiella pneumoniae you note it or
2:29:04I'll say you think you please send it to
2:29:06me it will be really helpful to you.
2:29:08Otherwise I can go only for Listeria
2:29:10monocytogenes.
2:29:12Because the question is it is caused by
2:29:14everybody says very good. It is caused
2:29:16by at present as per your choice a 6
2:29:19weeks old very good very good very good.
2:29:22Right.
2:29:24Next is most meningitis 6 weeks
2:29:28meningitis bacterial ideological agent
2:29:30very
2:29:36I'll collect it.
2:29:37I will write it as a homework. After
2:29:40that, I collect multiple sources,
2:29:41multiple information, then we'll assume
2:29:44and assemble a good version. I'll come
2:29:46back you with another version. This
2:29:48version one, I'll come back you with
2:29:50version 2.0, okay?
2:29:55Next is women using vaginal tampon
2:29:57admitted with shock syndrome mechanism
2:29:59of action of toxin. Always I used to say
2:30:02we have a question on mechanism of
2:30:04action of toxins.
2:30:07We have a question on eggs morphology.
2:30:11Okay?
2:30:12Egg morphology, exotoxins, and vectors.
2:30:16These three I used to tell always. Any
2:30:18question about vectors, can you think?
2:30:21Women using vaginal tampon admitted with
2:30:23shock syndrome. What is the mechanism of
2:30:25Basically, it's a super antigen.
2:30:31Super antigen.
2:30:37It is attached with a variable beta side
2:30:40chain of the T-cell receptor. Variable
2:30:43beta.
2:30:50Super antigen. We discussed in our what
2:30:52is called
2:30:54uh
2:30:55DVT.
2:30:56I gave big examples of all super
2:30:59antigens. And in my notes also,
2:31:01it attached to the variable beta side
2:31:03chain of the T-cell receptor, then only
2:31:05we call it a super antigen.
2:31:07It caused cytokine storm.
2:31:09It caused a cytokine storm. Variable
2:31:11beta side chain. Very good, very good,
2:31:13very good. Option was A B C D C B C D A
2:31:16B C multiple type. Okay.
2:31:18And usually it attached with, please
2:31:21remember, MHC2
2:31:24MHC2 and variable beta side chain of the
2:31:26T-cell receptor.
2:31:29It attached with MHC-II outside. MHC-II
2:31:32and variable side chain of the beta
2:31:34variable beta side chain of the T-cell
2:31:37receptor. Both are correct options. Very
2:31:38good. Very good.
2:31:40Yes.
2:31:41Then the option is
2:31:42these two are the correct option.
2:31:46I don't know what order they gave. I
2:31:47can't do AB AC and all, but these two
2:31:50are the correct answers, my dears.
2:31:53Can you think any question?
2:32:00Not B cell, not MHC-I.
2:32:03Not MHC-I.
2:32:06Child with cranial nerve palsy,
2:32:08hydrocephalus, low CSF glucose and high
2:32:11protein, lymphocytes.
2:32:14Lymphocytes predominant. Child, cranial
2:32:17nerve palsy, hydrocephalus,
2:32:19low glucose and high protein,
2:32:21lymphocytes predominant. I got one
2:32:23option, tuberculous meningitis. That is
2:32:25the correct option. I don't know about
2:32:27others. If anything on fungus, that may
2:32:29be a close thing, but we can go for
2:32:31tuberculous meningitis.
2:32:35You just think about the question and
2:32:37get the other choices also.
2:32:42TB meningitis. Very good. Very good.
2:32:44Single. TB meningitis. Very good.
2:32:48Okay, TB meningitis.
2:32:50Next is
2:32:52stool microscopy. I always I used to say
2:32:54egg morphology one picture will come.
2:32:57Egg morph without egg morphology there
2:32:58is no question.
2:33:01Stool microscopy.
2:33:03Parasite egg shown here. What is it? I
2:33:06got the message from you people. I don't
2:33:09know the egg is correct or not. You
2:33:10people tell the same egg you have seen.
2:33:13Clear shell.
2:33:19With the blastomeres.
2:33:24Hookworm egg.
2:33:26It is hookworm egg.
2:33:29Okay, viral, fungal, pyogenic. I'll
2:33:31write it previous question.
2:33:36I'll write it pyogenic.
2:33:42Viral, fungal.
2:33:46It is mostly suits for
2:33:50It's mostly suits for tuberculous
2:33:51meningitis. Good.
2:33:59What is the mode of entry means?
2:34:06Enterobius was an option here. Ascaris,
2:34:09Ancylostoma,
2:34:10Enterobius.
2:34:13Ascaris serrated edges, easily you can
2:34:16rule out.
2:34:17Enterobius kidney or plano-convex
2:34:19plano-convex. It is kidney or
2:34:21plano-convex.
2:34:26Kidney or plano-convex.
2:34:29Mode of entry. Okay, okay, not identify
2:34:32mode of entry. Very good.
2:34:34This only expected from you.
2:34:37Is skin penetration
2:34:38by filariform larva.
2:34:41Mode of entry, then it totally wrong.
2:34:43Mode of entry, skin penetration.
2:34:51Because I got the message. My kids after
2:34:53the urge after came out of the exam,
2:34:55"Sir, one question came from uh
2:34:57hookworm, sir, this is the image." But
2:34:58they didn't mention what they exactly
2:35:00asked. Now you people are telling how it
2:35:02enter. By a food water.
2:35:10Skin penetration by a filariform larva.
2:35:19Skin penetration filariform larva.
2:35:21Ancylostoma was not given as a direct
2:35:23option. Very good. That is INECT. They
2:35:26will not ask mostly not direct.
2:35:28First you need to identify the egg. I
2:35:30told Jill Jang Chuck.
2:35:32First you need to identify clear shell.
2:35:34Jill Jang it is Ancylostoma egg. Next is
2:35:38something related to Ancylostoma they
2:35:40will ask. What are the mode of
2:35:41transmission? What are the infective
2:35:43stage? Something they will ask.
2:35:46Okay? Soil, yes.
2:35:49Skin penetration from soil. Source is
2:35:51from soil. It is soil nematode. Very
2:35:53good. Food, water, soil. Very good.
2:35:57History of dyspnea and respiratory
2:35:59problem.
2:36:07So I'm collecting all the information
2:36:08from multiple sources. We'll get a
2:36:10beautiful version, complete version
2:36:12soon.
2:36:15One option is ingestion. Very good.
2:36:17Food, water, soil, ingestion.
2:36:25I'll remove all those things.
2:36:28Okay?
2:36:30Food, water, soil, ingestion. Very good.
2:36:32Very good. Very good.
2:36:36Next is diphtheria toxin. I got one.
2:36:41Only one answer. Sir, AB subunit.
2:36:43Diphtheria toxin has AB subunit. A for
2:36:46action, B for binding.
2:36:48A for action.
2:36:51B for binding. I don't know what exactly
2:36:52question.
2:36:55Because I got only one clue like
2:36:56telegraphic word. Sir, diphtheria toxin
2:36:59they asked. I told no, exotoxin they
2:37:01will ask.
2:37:03Egg morphology they will ask.
2:37:05Okay?
2:37:06Fatigue, shortness of breath. Where?
2:37:09Here.
2:37:18>> Right. EF2 was an option. Very good. It
2:37:21acts on elongation factor two to inhibit
2:37:24protein synthesis.
2:37:31Elongation factor two. ADP ribosylation.
2:37:34Very good.
2:37:35ADP ribosylation.
2:37:40It is ADP ribosylation mechanism of
2:37:42action. Elongation factor two inhibits
2:37:44protein synthesis.
2:37:47Toxin mainly affects myocardium and
2:37:49nerves. That one is correct actually.
2:37:51Multiple choices. Very good. Second, it
2:37:54affects man. Remember my mnemonic, man.
2:37:56Myocardium.
2:38:00Nerves, adrenal.
2:38:06So, question is about diphtheria toxin.
2:38:09Okay?
2:38:11Basically, it's exotoxin.
2:38:14Maximum action uh that option I
2:38:16mentioned actually. Neuropathy and
2:38:18myocardium. Very good.
2:38:20Anything anything?
2:38:22Anything apart from other choice?
2:38:24Elongation factor two is okay. ADP
2:38:27ribosylation. AB subunit. All three are
2:38:30correct.
2:38:31I don't know the fourth option. Will
2:38:32just please send the fourth option.
2:38:34We'll find.
2:38:37And one question they asked, what the my
2:38:40kid just sent. I just copy pasted.
2:38:42Typical history of myco- mycosis. I
2:38:44don't know what typical history they
2:38:45give, but I I got the message. Sir,
2:38:48typical history of mucormycosis, uh but
2:38:50the option had Rhizopus.
2:38:53They don't know the other option. So,
2:38:56that is the good thing. People remember
2:38:57only the answer. Mucormycosis history,
2:39:00it is mucormycosis Rhizopus. I would
2:39:02They don't know about the other option.
2:39:03What about the other option?
2:39:05It is not plasmid-mediated.
2:39:10That is wrong option because it is what
2:39:12mediated? Phage-mediated.
2:39:16So, if if AB subunit ADP ribosylation of
2:39:20elongation factor two now means ABC is
2:39:22the answer.
2:39:25D is not the correct answer because it
2:39:27is not plasmid-mediated. It is not
2:39:29plasmid-mediated. Diabetic and steroid,
2:39:32that is the typical.
2:39:37Diabetic with the steroid.
2:39:41It is
2:39:42diabetic with steroid is the predominant
2:39:45what is called predisposing factor for
2:39:47mucormycosis.
2:39:49Nose had black head sharp, very good.
2:39:57The nose [snorts] had black head sharp.
2:39:59Option is aspergillus.
2:40:02Aspergillus fumigatus.
2:40:05Rhizopus, candida, cryptococcus.
2:40:12Aspergillus, candida
2:40:16cryptococcus.
2:40:23Good.
2:40:26Corticosteroid black head sharp. Superb.
2:40:28Superb. That is sufficient.
2:40:30Face and black structure.
2:40:32Histoplasmosis is there. I don't know.
2:40:35Okay, difficult vision.
2:40:43Somebody says histoplasma. I will write
2:40:45that also.
2:40:47And
2:40:49after confirming with other sources,
2:40:51I'll get back you.
2:40:53Candida tropicalis.
2:40:57Aspergillus fumigatus.
2:41:01Good. Good. Good.
2:41:04Good. good.
2:41:06Good.
2:41:07Next vesicular lesion on penis two to
2:41:10three day history.
2:41:12This they give the choices.
2:41:14Okay, wherever painful herpes and
2:41:17hemophilus, remove this.
2:41:19Usually it won't cause genital infection
2:41:22and syphilis is painless.
2:41:25And vesicular lesion, we can go for
2:41:27herpes.
2:41:28Vesicular lesion I can go for herpes.
2:41:31There is no doubt on it.
2:41:34Here no histoplasmosis. I will remove.
2:41:36Thank you, my dear. Thank you.
2:41:39Thank you. There is no histoplasm.
2:41:43The photo was there.
2:41:46Kindly send the photos search in Google.
2:41:49Herpes, if you find the photo, please
2:41:51send the photo we can add.
2:41:53Okay, yes. Some questions are
2:41:55overlapping. It may be dermit question
2:41:57and it may be micro question, don't
2:41:59worry.
2:42:02Some question may be pharmacology
2:42:03microbiology. Microbiology can easily
2:42:06integrate with all other subjects.
2:42:10Unstained halo, that one word in CSF.
2:42:13Cryptococcus, I got the key point in the
2:42:16question. Key answer, that's all. I
2:42:19don't know exactly what it is any case
2:42:21of meningitis HIV
2:42:23HIV meningitis India ink unstained halo
2:42:28CSF any points are there low CD4 count.
2:42:38Yes, within one or two questions only,
2:42:39don't worry.
2:42:42Please send the I will give my number.
2:42:44You WhatsApp me, mention your name. I
2:42:46will tag you in the question. I will
2:42:48acknowledge you because it's given by
2:42:50you.
2:42:51Nothing wrong in it.
2:42:53HIV history was there, very good.
2:42:56HIV
2:42:57meningitis
2:43:02Or they may give altered sensorium, some
2:43:04other story.
2:43:06HIV history CD4 is 40, very good. This
2:43:09That's a good actually. CD4 count is low
2:43:11CD4 count.
2:43:14Cavitation in lung.
2:43:24Cavitation in lung cavity, very good.
2:43:29Then un-stained halo, cryptococcus. I
2:43:32want other choices also. Please give the
2:43:33other choices.
2:43:37Hyphe formation means it is not
2:43:39cryptococcus.
2:43:41Hyphe formation may be there,
2:43:43aspergillus. They produce some hyphe
2:43:44pseudo hyphe maybe what is called
2:43:48candida will be there. I want the exact
2:43:49question, please. Usually halo
2:43:52un-stained halo in CSF go for
2:43:54cryptococcus, no doubt on it.
2:43:57Next is splenectomy organism. I don't
2:43:59know that exactly. Okay, which organism
2:44:02I don't know. It is previous question
2:44:04choices. Splenectomy means capsulated
2:44:06pathogen.
2:44:08Maybe NHS organism.
2:44:11Neisseria meningitidis
2:44:17Haemophilus influenzae
2:44:21Streptococcus pneumoniae
2:44:31Toxoplasmosis, okay.
2:44:34Splenectomy organism anything is there?
2:44:37Like that question.
2:44:41E. coli pneumococcus was given, very
2:44:42good. Then streptococcus pneumoniae is
2:44:44the answer, E. coli.
2:44:47Pneumococcus is these two are there?
2:44:50Strep pneumoniae, yes. Options were
2:44:52strep pneumoniae is the option. That is
2:44:54the correct answer. If step pneumoniae
2:44:56is that is the correct answer, what
2:44:57about the other two choices?
2:45:00Just you can think and give.
2:45:03Patient needs antibiotic. He was
2:45:05splenectomized before. What organism
2:45:07will you add?
2:45:09Always give cover for
2:45:12Bacillus anthracis box two plasmid. Yes.
2:45:16Bacillus is very high molecular. Little
2:45:18tough question.
2:45:20Box two
2:45:21gene for glutamate capsule.
2:45:26Polypeptide capsule.
2:45:35Polypeptide capsule.
2:45:41Only step pneumoniae, sir. Then step
2:45:42pneumoniae is the correct answer.
2:45:44Clostridium difficile
2:45:47Which cover to be added equally?
2:45:50Streptococcus pneumoniae difficile. I
2:45:52didn't get the exact question. Candida
2:45:54also there. Okay, lot of organisms are
2:45:56coming there.
2:45:58Yes.
2:45:59These are all the first stand
2:46:00information you think after analyzing
2:46:04any question from immunology.
2:46:09Any question from immunology? Because
2:46:11past many years we are getting only one
2:46:14or two questions from immunology. Here
2:46:16we are not getting any direct question
2:46:17from immunology.
2:46:19And any question from culture medium?
2:46:26Diphtheria toxin was not asked. No, no,
2:46:28somebody already mentioned. Clostridium
2:46:30difficile asked. Clostridium difficile
2:46:32AB toxin. A enterotoxin, B cytotoxin.
2:46:39Three year history after splenectomy.
2:46:44This is my number, my dears. Feel free
2:46:47not today, even tomorrow also.
2:46:51You can please
2:46:55This is my number.
2:46:58I can write it here.
2:47:02Many of you already have my number.
2:47:04Doesn't matter. Just mention your name,
2:47:07write the question.
2:47:08Whatever we can recollect, you please
2:47:10write the question. We'll make it.
2:47:12Question on autoclave, nobody told. Just
2:47:15I have pepsin and pepsin or division of
2:47:18cleavage of
2:47:20immunoglobulin.
2:47:23Bacteria with
2:47:28I I want to CJ day pro I mean I made a
2:47:31question CJD uh
2:47:34prion based disease, how to sterilize
2:47:36sodium hydroxide and autoclave.
2:47:38Before that, you soak into sodium
2:47:40hydroxide, you autoclave. That option is
2:47:42there or not? You make it.
2:47:51Okay. So, you please make the question.
2:47:54Think aram se. Make the question
2:47:56perfectly. Send it to me. We'll make
2:47:58another I because I have only 10
2:48:00questions with me now.
2:48:02But usually microbiology is 17 to 18
2:48:04question. Something overlapping with
2:48:06other subject also, doesn't matter. I
2:48:08will make it at least 17 questions. You
2:48:10please sit and think and send it to me.
2:48:14Okay?
2:48:18One big machine picture temperature for
2:48:20prion was given not 121.
2:48:23Prion temperature is high.
2:48:25134
2:48:27like that. You need to soak into sodium
2:48:29hydroxide. That is important.
2:48:31Soak into sodium hydroxide. Yes, 134.
2:48:33Yes, you're right.
2:48:37Okay? Hey, don't be panic. Don't worry.
2:48:39You already done.
2:48:41Okay? Now you can see you just analyze
2:48:43how what is the paper how they ask this
2:48:45time.
2:48:46Okay, any city INICT means definitely it
2:48:49should be a little bit tough paper not
2:48:50routine. More applied oriented. You need
2:48:52to apply many things. Integrate many
2:48:54things you need to apply.
2:48:56Got it? Autoclave wrong option
2:48:59Geobacillus stearothermophilus that is a
2:49:01quality control agent. I don't know what
2:49:03question they exactly asked in
2:49:05autoclave. Did they ask quality control
2:49:07agent? Did they ask about temperature
2:49:09for this thing? Prions? Exactly frame
2:49:12the question and please send it to me.
2:49:14Okay?
2:49:16Any of which is very good. Already
2:49:18mentioned Dr. Siddharth
2:49:20Rohit.
2:49:22Good. So, don't worry. This is my
2:49:25number. You just mention your name and
2:49:28WhatsApp me personally.
2:49:31I will correct it if I get two to three
2:49:33version of the questions. I will discuss
2:49:35with you people. We will make a perfect
2:49:37question paper.
2:49:39Okay, I'll meet you with a perfect
2:49:40question. Sure. Thank you.
2:51:04>> Yeah.
2:51:05Hi everyone. Hello. Good evening. Good
2:51:07evening.
2:51:08So,
2:51:09I hope you're feeling
2:51:12okay now.
2:51:13From the initial reaction, it appears
2:51:15that it was a typical INICET paper,
2:51:18which was a typical paper.
2:51:20Uh I got three questions.
2:51:23Uh two of which were very easy and very
2:51:25doable and something that we discuss in
2:51:26every class. But one question actually,
2:51:29I need your help. Uh very vague recall.
2:51:32Three options, everybody could recall
2:51:34fourth option, nobody could recall, and
2:51:36everybody said it was a multiple correct
2:51:38type of question. So, I need you to
2:51:41think of what were the options, whether
2:51:43A A B C and whatever.
2:51:45So, the question was some people
2:51:47recalled halothane lowers blood
2:51:48pressure. Some people said halothane's
2:51:50effect on cardiac output and blood
2:51:52pressure. The three options which I got
2:51:54100% One was low BP stimulates
2:51:58baroreceptor or baroreceptor cause
2:52:00increase in BP. Second option, sorry,
2:52:03this got here. Uh second option from
2:52:05here. 20 to 30 mm fall is expected. Some
2:52:09people said 10 to 20 mm fall is
2:52:11expected. Third was cardiac output
2:52:13lowering with deepening plane of
2:52:15anesthesia. Okay?
2:52:17Yes, everybody is recalling.
2:52:2020 to 30 mm, okay, this is perfect. Then
2:52:23BP reduces parallel to anesthesia depth,
2:52:25this is perfect. Very good. And low BP
2:52:28stimulates baroreceptor or baroreceptor
2:52:32cause increase in BP.
2:52:34Now, what about these two?
2:52:36BP reduces the
2:52:39cardiac output. The BP reduces as the
2:52:42Yeah, that is okay. BP aligns, that is
2:52:45okay. 20 to 30, okay. BP starts to
2:52:47decrease early, very good, okay.
2:52:50I know that you guys are repeating these
2:52:53two things perfectly. 20 to 30 mm fall
2:52:56and cardiac output lowers with deepening
2:52:58plane of anesthesia. Question was
2:53:00starting as halothane causes fall in
2:53:02blood pressure. Choose the correct
2:53:03option and it was multiple correct, very
2:53:05good. So, cardiac output halothane
2:53:07causes lowering of BP. So, this is good,
2:53:10perfect.
2:53:15Anybody can recall the fourth option?
2:53:18We are over and over these three
2:53:19options.
2:53:23Anybody can recall the fourth option?
2:53:25Baroreceptor is stimulated.
2:53:28Okay, low BP stimulates baroreceptor.
2:53:30This is correct, okay.
2:53:32Okay, so we have got the third option
2:53:34also correct one. Baroreceptor causes
2:53:36increase in BP is not the option.
2:53:39Low BP causes baroreceptor stimulation.
2:53:41Okay, very good. Low BP stimulates
2:53:44baroreceptor.
2:53:45Okay, perfect.
2:53:47Fourth option, anybody? We are going to
2:53:50spend a lot of time on only this because
2:53:52this is where I am also getting
2:53:53confused. Also,
2:53:56also can you recall what was the option
2:53:58A B A B C? I mean, what what was it?
2:54:04Fourth option.
2:54:07Both were different. One option was
2:54:09parallel. One other option was related
2:54:11to cardiac output.
2:54:13Can you recall the exact
2:54:15When BP lowers, baroreceptor gets
2:54:17activated.
2:54:18Okay, when BP decreases, it stimulates
2:54:21baroreceptor. Halothane causes decrease
2:54:23cardiac output. Was it?
2:54:26Halo decreases cardiac output. Was this
2:54:30the fourth option?
2:54:32One is parallel effect BP decreases with
2:54:34depth.
2:54:35And cardiac output was one depth of
2:54:37anesthesia was one option 20 to 23 true
2:54:40false or cardiac output decreases. Okay,
2:54:43halothane decreases cardiac output.
2:54:45BP decreases with depth of anesthesia.
2:54:47Okay, so I think I'm getting the four
2:54:49options.
2:54:50So I will discuss this question and I
2:54:53must tell you that I'm pretty
2:54:54disappointed with
2:54:56people at INICT. You know, most of the
2:54:58modern textbooks of anesthesia which we
2:55:00read the 10th edition, ninth edition of
2:55:02Miller don't even mention halothane.
2:55:05Because it is an obsolete agent.
2:55:09Halothane directly reduces cardiac
2:55:11output. Okay.
2:55:14Okay, halothane directly reduces cardiac
2:55:18output.
2:55:30Okay.
2:55:32I don't know what to do when exact
2:55:34number is asked because frankly
2:55:36after I got this question and I got this
2:55:39option of 20 to 30 mm fall is expected.
2:55:41I searched the entire text related to
2:55:44anesthesia including online and nowhere
2:55:48it is mentioned. So I am presuming that
2:55:50this is the wrong option. Okay.
2:55:52Now let me tell you what the text says.
2:55:55Every inhaled anesthetic agent we have
2:55:58read about this decreases cardiac
2:56:01output. So all decrease cardiac output.
2:56:04But the predominant mechanism of
2:56:06decreasing cardiac output by all other
2:56:09anesthetic agents is by peripheral
2:56:11vasoconstriction
2:56:13except halothane which causes minimum
2:56:16decrease in SVR and we have written this
2:56:19in our notes.
2:56:20Minimum peripheral vasodilatation and
2:56:23maximum decrease in cardiac output. So,
2:56:26it does directly decrease the cardiac
2:56:28output. But, this effect is directly
2:56:32related to the depth of anesthesia. So,
2:56:34decrease in cardiac output is directly
2:56:37proportional to depth of anesthesia. So,
2:56:41more [snorts] is the depth of
2:56:42anesthesia, more is the decrease in
2:56:45cardiac output. But, low BP doesn't
2:56:49stimulate the baroreceptors. And that is
2:56:51why halothane causes decrease in cardiac
2:56:54output, decrease in blood pressure, but
2:56:57also decreases heart rate. And this is
2:56:59something that we have written as an
2:57:01exception. Only inhaled anesthetic agent
2:57:05to cause decrease in heart rate.
2:57:09Why? Because it
2:57:12doesn't affect the baroreceptor. It
2:57:15doesn't activate because with fall in
2:57:16blood pressure, increase in heart rate
2:57:19is a baroreceptor reflex. And both
2:57:22propofol as well as halothane doesn't
2:57:24stimulate the baroreceptor. That is why
2:57:27these are the only two agents which
2:57:29decrease the blood pressure, but also
2:57:31cause bradycardia. So, according to me,
2:57:33right now I will consider option number
2:57:36B as false.
2:57:39Option number A as false.
2:57:43But, both option number C and D are
2:57:46true.
2:57:47Cardiac output lowering with deepening
2:57:50plane of anesthesia and directly reduces
2:57:53cardiac output.
2:57:56Okay.
2:57:57Yeah, this is ridiculously difficult
2:57:59question. I must tell you most of the
2:58:01postgraduates in anesthesia won't be
2:58:02knowing these specifics of one drug that
2:58:05we use in anesthesia. So, don't don't
2:58:09beat yourself down. I'm telling you from
2:58:11last 15-20 minutes I have been searching
2:58:13this 20 to 30 mm Hg because even I don't
2:58:15know from where this figure came. and
2:58:17then I have to presume that this is the
2:58:19false option, right? So, two options
2:58:21that were correct is cardiac output
2:58:23lowering effect is proportional to the
2:58:25depth of anesthesia. And yes, halothane
2:58:27does directly decrease
2:58:29cardiac output by affecting the
2:58:31myocardial contractility, but no, low BP
2:58:34doesn't stimulate baroreceptor and that
2:58:36is why you don't get tachycardia. And 20
2:58:39to 30 mm fall is expected is something I
2:58:41could not find, so I'm presuming it to
2:58:42be false, right? Rest two questions were
2:58:45very easy. What are the order of
2:58:46structures pierced during lumbar
2:58:48puncture? And they write wrote the
2:58:50order, so we know
2:58:52that
2:58:53uh
2:58:54the first thing
2:58:56is skin followed by subcutaneous
2:58:59tissue
2:59:01followed by supraspinous
2:59:04ligament
2:59:06followed by interspinous
2:59:09ligament followed by ligamentum flavum
2:59:13then dura
2:59:14then subdura
2:59:17then
2:59:19arachnoid
2:59:20and then you reach the
2:59:24subarachnoid space.
2:59:27Subarachnoid space.
2:59:29Okay?
2:59:31So, skin may be always susceptible to
2:59:34supraspinous ligament then interspinous
2:59:37ligament then ligamentum flavum then
2:59:40dura then
2:59:42subdural and then arachnoid. I really
2:59:44don't know what options
2:59:46Yeah, subdural epidural but the way you
2:59:49subdural epidural if it is epidural it
2:59:52will come above okay subdural epidural
2:59:55okay so epidural will then come before
2:59:57the dura. So, A B C D would be epidural
3:00:01E would be dural and F would be
3:00:03arachnoid, okay?
3:00:06This question was very easy. Anesthesia
3:00:07supposed to give you easy questions.
3:00:09This question was very easy, okay?
3:00:12Both were there. Okay.
3:00:19and epidural We will have a proper
3:00:22recall session where I will compile all
3:00:24these things.
3:00:30Okay.
3:00:31Perfect.
3:00:32Then a standard question we discuss it
3:00:35every single time. We discussed it in
3:00:37INICET predictor. We discussed it in
3:00:39marathon. We discussed it all the time.
3:00:41Intraoperatively sudden and abrupt rise
3:00:44of ETCO2. Your diagnosis was made here
3:00:46MH.
3:00:48But yet they gave a 104° F temperature
3:00:51increase in heart rate to 150 and raised
3:00:53blood pressure.
3:00:56So, no no problems here. Do you remember
3:00:59the options here?
3:01:01Do you remember the options here?
3:01:04Can you recall me the options here?
3:01:09I'm so happy to hear only anesthesia was
3:01:11good out of three. You should you
3:01:12managed to do two. I know.
3:01:15Yeah, MH was there. Other options do you
3:01:17remember?
3:01:18Heatstroke, very good.
3:01:20What else?
3:01:23MH, what else?
3:01:27Just give me the options. For tomorrow
3:01:28it would become easy.
3:01:31Heat, other was heat syncope. Okay.
3:01:35And heat exhaustion.
3:01:37Oh, so
3:01:39even if you don't know MH, you will know
3:01:41that intraoperatively you would not have
3:01:44all these things.
3:01:46All right. So, heat syncope, heat
3:01:48exhaustion
3:01:51Okay. Perfect. Right? So, three
3:01:54questions. Any other questions that
3:01:57you recall?
3:01:58Any other Any other questions in
3:02:00anesthesia after thoroughly asking you
3:02:03and one of my known persons who gave the
3:02:05exam, they told me three. But is there
3:02:07anything else that we are missing?
3:02:10Even I love anesthesia, so we are common
3:02:12in that.
3:02:17Anything else?
3:02:2310 minutes after going into surgery
3:02:25where I got 10 minutes
3:02:28during the surgery.
3:02:34Take care.
3:02:35Perfect.
3:02:38All these things I will put in
3:02:44in the proper recall, you know.
3:02:47So, surgery is waiting for you. So, I
3:02:51hope this was good. I will recall it.
3:02:53There will be a proper
3:02:57proper recall session. If at all you
3:02:59feel that there is anything that you
3:03:01want to tell me, just put it up on the
3:03:03Telegram group. And I will know. You can
3:03:05tag me. Anshul Diwakar is my name. Or,
3:03:07you can send me the questions on
3:03:09Telegram at Anesthesia Shots Anshul.
3:03:11Okay?
3:03:12Ciao. Bye.
3:03:51>> [sighs]
3:03:52>> Hi. Good evening.
3:03:56How was the paper? I know that this time
3:03:59INI CET, especially the surgery part,
3:04:02was not as easy as it was in the
3:04:05previous few INICET exam. I guess the
3:04:08whole paper was moderate to tough.
3:04:11So, uh
3:04:13you know, let's discuss some of the
3:04:14questions which I have got based on the
3:04:16recall. Although it is a very early
3:04:18recall.
3:04:19So, we'll get more questions and the
3:04:21more options. Uh
3:04:23As uh let's see uh
3:04:25tomorrow, day after.
3:04:28Now, yes, there are lots of new topics.
3:04:30Uh but uh
3:04:32Okay, let's see uh
3:04:33some of the questions which I have got.
3:04:36According to ATLS, correct sequence of
3:04:38management. See, now the ATLS guidelines
3:04:40uh in the in the uh
3:04:42DVT sessions also, these revision
3:04:44sessions also, we had discussed that now
3:04:46the ATLS says C
3:04:50A B C D E.
3:04:52So, catastrophic bleeding is the first
3:04:55one. This is the second one.
3:04:57This is the third, and this is the
3:05:00fourth. So, that should be the correct
3:05:01sequence.
3:05:04That should be the correct sequence. So,
3:05:06I hope uh these were the options. If you
3:05:09feel any of the things are different,
3:05:11please let me know.
3:05:13Next question, I guess uh this was easy.
3:05:15So, I will say that was a easy question.
3:05:18Patient of trauma comes with eye opening
3:05:19to pain,
3:05:21localizes pain, and incomprehensible
3:05:22sound. They asked for the GCS. So, this
3:05:24is
3:05:27E2
3:05:30M5
3:05:32V2. So, GCS should be
3:05:35nine, if that was in the option, GCS
3:05:38nine.
3:05:42Yes, see uh the questions I'll discuss,
3:05:44and then let's 2 minutes after the
3:05:46discussion. Uh
3:05:47Whatever you feel that I had not
3:05:49discussed, and it was there in the
3:05:50surgery, so please you can uh you know,
3:05:53give your suggestion or your comments.
3:05:56In a patient of primary blast injury,
3:05:58the burn comes under this also multiple
3:06:00times we had discussed. So, burn comes
3:06:02under quaternary blast injury. This one
3:06:06is blunt.
3:06:08This one is penetrating.
3:06:11And this is because of the pressure.
3:06:15Okay, so this also I'll put in the easy
3:06:17question.
3:06:20A patient of colon injury with more than
3:06:2150% circumference laceration. Now, this
3:06:23is something new. Generally, the AAST
3:06:25grading, the important ones are the
3:06:27spleen, liver, kidney, but this time
3:06:29they had asked See, AAST had given
3:06:31grading for everything for duodenum, for
3:06:33bowel, for, you know, everything they
3:06:36had given pancreas and all, but
3:06:37generally the important ones are spleen
3:06:40and liver and kidney. This time they had
3:06:42asked about bowel.
3:06:45Okay, so
3:06:47more than 50% circumference, it is grade
3:06:50three.
3:06:51Grade three. Grade one is just hematoma
3:06:54or
3:06:55you know, only hematoma,
3:06:58contusion.
3:07:01This one is less than 50% circumference.
3:07:03This is more than 50%.
3:07:06Grade four is complete transaction.
3:07:12And grade five is massive injury. Grade
3:07:14five is massive injury.
3:07:16A face and chest, whatever was given in
3:07:18the blast injury, even if the face,
3:07:20chest, or whatever part, if the burn is
3:07:23They had asked about the burn, it should
3:07:24be It should be quaternary. And then no
3:07:27matter wherever burn occurs, face,
3:07:29abdomen, lower limb, wherever it occurs,
3:07:31burn comes under that.
3:07:35Which of these is not included in the
3:07:37lethal triad of trauma? See, in the
3:07:39lethal triad, hypothermia, coagulopathy,
3:07:41and acidosis are there. Now, I don't
3:07:43know whether hyperkalemia or something
3:07:45else was there, but whatever apart from
3:07:47these three is the answer.
3:07:50Hypothermia, acidosis, and coagulopathy,
3:07:52that comes under trauma triad.
3:07:56And a burn was not mentioned, but if
3:07:58they have shown that area was burned,
3:08:00that is uh equally good. So, by the way,
3:08:02whether they mention or they don't
3:08:04mention, if the burn image was shown or
3:08:06the mention was there, then
3:08:08hyperkalemia is not a part of
3:08:11deadly triad or the lethal triad.
3:08:14Now, this was a question, uh 26-year-old
3:08:16female after fall from the bike bike or
3:08:18active or scooty, whatever they had
3:08:19written. Comes with pain in the pain and
3:08:21swelling in the left leg, feeble pulse,
3:08:23swelling. And also they had mentioned
3:08:25that even after giving analgesic, the
3:08:27pain is persistent. And now the pulse is
3:08:30not palpable. Next step should be
3:08:32fasciotomy. Okay, so that was a very
3:08:34classical
3:08:35mention of
3:08:38compartment syndrome and fasciotomy
3:08:41should be done.
3:08:43Fasciotomy.
3:08:49Okay, see, when when they talk about the
3:08:51trauma triad,
3:08:53it should be like triad means there
3:08:54should be three things. So, that lethal
3:08:56triad is hypothermia, acidosis, and
3:08:59coagulopathy.
3:09:01And a coagulopathy, compartment syndrome
3:09:03mentioned, okay, it was if it is
3:09:05mentioned, then it should be fasciotomy.
3:09:10Now comes the question in the
3:09:10laparoscopic hernia repair while
3:09:12dissecting the myopectineal orifice, how
3:09:14much medial you go to the pubic pubic
3:09:16tubercle so that it can cover the whole
3:09:18myopectineal orifice? In when we do a
3:09:20laparoscopic hernia surgery, we need to
3:09:22cover the whole myopectineal orifice so
3:09:24that the direct, indirect, as well as
3:09:26the femoral hernia gets covered, and in
3:09:28future also that does not get,
3:09:30you know, uh
3:09:32hampered.
3:09:34So, medially you should go minimum 2 cm.
3:09:38See, they say 2 cm medial to the pubic
3:09:41tubercle, 4 cm superior to the
3:09:44inguinal liga I mean inguinal canal, and
3:09:466 cm lateral to the deep inguinal ring.
3:09:49That should be the coverage when you put
3:09:51a mesh there.
3:09:52Compartment pressure is more than 30 mm.
3:09:55Okay, if they had given 90 or whatever,
3:09:57compartment syndrome is in the pressure
3:09:59is more than 30. To be more specific,
3:10:01more than 32. That is the arterial end
3:10:03of the
3:10:04capillary. 30 or 32.
3:10:08Okay, so
3:10:102 cm.
3:10:142 cm.
3:10:15Okay, okay, so you're saying four to the
3:10:174 cm. Answer should be 2 cm.
3:10:24Distance between Cooper's ligament pubic
3:10:26tubercle is not a question. I mean, uh
3:10:28that is that cannot be a question. What
3:10:30is the distance between Cooper's
3:10:32ligament and pubic tubercle. Cooper's
3:10:33ligament ultimately comes to the pubic
3:10:36tubercle only. So, that I don't think
3:10:38that is a question. So, you must be
3:10:39getting confused. That cannot be a
3:10:41question. What is the distance between
3:10:42Cooper's ligament and pubic tubercle?
3:10:45And what is the minimum that should be
3:10:46checked? So, that minimum
3:10:492 cm medial to the pubic tubercle.
3:10:55There was a image-based question. I
3:10:57don't know in anatomy also they might
3:10:58discuss. There was a muscle given. So, I
3:11:01don't know whether they asked muscle in
3:11:03the conjoint tendon or they asked muscle
3:11:05in the inguinal ligament. Because the
3:11:07part of the muscle which forms the
3:11:09conjoint tendon is
3:11:11internal oblique and transversus
3:11:14abdominis.
3:11:15And inguinal ligament is formed by the
3:11:18external oblique aponeurosis. So, what
3:11:20was the exact question that you need to
3:11:23be
3:11:24Okay, external oblique, internal
3:11:25oblique, transversus abdominis.
3:11:28Okay, so
3:11:32whether pubic tubercle was there in the
3:11:33hernia question or not. Forget about
3:11:35Cooper's ligament. Pubic tubercle was
3:11:38there or not.
3:11:41Okay, external oblique was given in the
3:11:43image.
3:11:44Okay, you are saying linea alba was also
3:11:48in one of the question.
3:11:52Okay, muscle was attached to muscle was
3:11:54downward below. Okay, so external
3:11:56oblique goes like when you put your
3:11:58hand in the pocket, so that is the
3:12:00direction of external oblique.
3:12:04Okay, so you are saying it was a image
3:12:06based and it was external oblique as the
3:12:09answer.
3:12:11The pubic tubercle was there, then
3:12:13no doubt.
3:12:15This is a new question.
3:12:17In defecography, rectocele is diagnosed
3:12:19when the bulge in vaginal wall is more
3:12:21than
3:12:23So, that is 2 cm. 2 cm. Then the Mostly
3:12:27it is seen in the patients of chronic
3:12:29constipation or sometimes when there is
3:12:31a weak pelvic floor. So, at the time of
3:12:33defecation, a part of the rectum goes
3:12:36into the vagina. So, that is by because
3:12:39there is weak pelvic floor. So, when it
3:12:41is more than 2 cm, that is
3:12:44you say then it is rectocele. And
3:12:47defecography is you put a like a kind of
3:12:49a semi-solid contrast material in the
3:12:51rectum, ask the patient to defecate, and
3:12:53when the patient is defecating, at that
3:12:55time you take the image and you will
3:12:56know how much of that is protruding into
3:12:59into the
3:13:00you know, the vaginal wall. So, 2 cm.
3:13:05This question Sumesar also discussed.
3:13:07Patient comes with pain in the right
3:13:08iliac fossa for 48 hours. Ultrasound
3:13:10image of acute appendicitis was given. I
3:13:12guess there was Doppler also was
3:13:13included in that.
3:13:15What is the management? So, acute
3:13:17appendicitis patient, whether patient is
3:13:19coming in less than 48 hours, more than
3:13:2148 hours, if it is acute appendicitis,
3:13:24we go for surgery.
3:13:28The only area where we don't prefer
3:13:30surgery is when there is appendicular
3:13:32mass or when there is appendicular lump.
3:13:34So, in that case we follow the
3:13:36Ochsner-Sherren regime, otherwise,
3:13:38patient comes less than 48 hours, more
3:13:40than 48 hours, if there is no lump, you
3:13:42go ahead and do surgery. CT is not
3:13:44required because the ultrasound was very
3:13:46much suggestive of acute appendicitis.
3:13:48Ultrasound image was suggestive of acute
3:13:51appendicitis. If the ultrasound is kind
3:13:53of equivocal, when they say that they
3:13:55cannot comment whether it is normal or
3:13:57not normal, then in those cases, you go
3:13:59for CT. Straightaway CT is not required.
3:14:02It is done only if the ultrasound is not
3:14:04very conclusive.
3:14:07Okay, so this question was there, and
3:14:09surgery should be the answer.
3:14:13Which of the following feature best
3:14:14distinguishes small bowel obstruction
3:14:16from paralytic ileus?
3:14:18See, small bowel obstruction
3:14:21when there is some mechanical
3:14:23obstruction. Now, mechanical obstruction
3:14:25could be
3:14:27extramural, intramural, or intraluminal.
3:14:31In all these cases, what happens, the
3:14:33bowel initially tries to overcome the
3:14:35obstruction, and there is contractions
3:14:38or peristalsis, and because of that
3:14:40contraction or peristalsis, pain occurs.
3:14:42In paralytic ileus, there is loss of
3:14:45peristalsis.
3:14:47Loss of peristalsis, there are a number
3:14:50of reasons, increased sympathetic
3:14:52activity, there are certain electrolyte
3:14:54disorders like hypokalemia, certain
3:14:55drugs can also cause. So, in this case,
3:14:58the pain will not be there because the
3:14:59bowel is not contracting.
3:15:01Okay, so it should be
3:15:03colicky abdominal pain.
3:15:06It will be seen in small bowel
3:15:09obstruction, it will not be seen in
3:15:12paralytic ileus.
3:15:15Okay, yes.
3:15:17Match the clinical condition with the
3:15:18most appropriate investigation.
3:15:21Pancreatic pseudocyst,
3:15:23CT scan.
3:15:24Thyroid nodule,
3:15:26FNAC.
3:15:31Just let me know if because all these
3:15:33based on the memory. So if you think
3:15:34that uh it was not there or it was
3:15:37something different, just let me know.
3:15:39Prostate cancer, PSMA PET, obstructive
3:15:41jaundice, multiple time discuss this is
3:15:45MRCP. So I guess uh this is also a easy
3:15:48question.
3:15:50PSMA PET, yes, okay. PET PSMA. PSMA I I
3:15:54mean if they give PSMA, if you know the
3:15:56full form of PSMA, then it is
3:15:58prostate-specific membrane antigen. It
3:15:59is much easier.
3:16:01Okay, PSMA is nothing but PET PSMA or
3:16:04PET is the same thing. Yes, good good
3:16:07good.
3:16:08So see, not that difficult till now.
3:16:12I mean, it is difficult, but not out of
3:16:14the world kind of things.
3:16:17Principle of TME in the management of
3:16:18rectal cancer. TME is total mesorectal
3:16:21excision.
3:16:24So total mesorectal excision is a
3:16:26principle which is followed in the
3:16:29middle and lower 1/3 of the rectal
3:16:31cancer.
3:16:33Middle 1/3 or the lower 1/3. So whether
3:16:36we are doing LAR or whether we are doing
3:16:38APR,
3:16:41both in both surgeries this principle is
3:16:43followed.
3:16:45See, because the lymphatic drainage and
3:16:47blood supply comes to the rectum via
3:16:49mesorectum. So you have to remove the
3:16:52whole mesorectum in order to get a you
3:16:54know, negative margin and in the to
3:16:56prevent the future risk of recurrence.
3:16:59So in that case,
3:17:01the whole mesorectum should be removed
3:17:03and mostly people they do sharp
3:17:05dissection. Although it is a mostly
3:17:07sharp, somewhere blunt, but majority of
3:17:09the people they go for sharp dissection.
3:17:11You have to go into that holy plane and
3:17:14you need to remove the whole mesorectum.
3:17:16Blunt dissection is not recommended.
3:17:19Only affected part removed. So if you're
3:17:21leaving the mesorectum behind, okay, one
3:17:23of the option was ligation of internal
3:17:25iliac. It is not required.
3:17:27So, this was not there. Ligation of
3:17:30you're saying
3:17:32internal iliac artery. No, the blood
3:17:35vessel which is which needs to be taken
3:17:37care of blood vessel.
3:17:40We ligate
3:17:44inferior mesenteric artery. Inferior
3:17:46mesenteric artery is artery which is
3:17:48supplying to that part, not the internal
3:17:49iliac.
3:17:51Okay, B was complete blunt dissection.
3:17:53Okay, so that is thing the complete
3:17:57blunt dissection. Okay, that is again
3:17:59going in the favor that I said that
3:18:01majority of the dissection should be
3:18:02done sharp.
3:18:04Okay, so yes, in toto is means you're
3:18:06removing the same thing. So, that is
3:18:08clear cut. A very nice I can see I have
3:18:10taken so many recalls. So, this time the
3:18:13I mean, you're helping me a lot by
3:18:15telling me the options. This is I really
3:18:17appreciate. Um I know the day when you
3:18:20give exam, you are exhausted, but all of
3:18:22you are sitting here discussing this
3:18:23thing. I really appreciate and I thank
3:18:26all of you
3:18:27to be part of this,
3:18:29you know, discussion.
3:18:31A patient of obstructive jaundice comes
3:18:32with palpable gallbladder which is
3:18:34non-tender weight loss. This is very
3:18:36classical
3:18:38Courvoisier's law or the rule and it is
3:18:42periampullary cancer or carcinoma
3:18:45head of pancreas. Whatever is there was
3:18:48in the option.
3:18:50Okay, what was I mean, carcinoma head of
3:18:52pancreas or periampullary? Anything uh
3:18:54So, I guess this was in the option. I
3:18:56don't know what was the fourth option.
3:18:57If it is HCC, it is
3:18:59Okay, you're saying 60-year male
3:19:02patient.
3:19:03Okay, now you remember the age and sex
3:19:06of the patient also in the question.
3:19:08Really appreciate the memory, the recall
3:19:10memory. Choledocholithiasis. Okay, thank
3:19:13you very much. CBD stone
3:19:16was the fourth option. So, very
3:19:18classical Courvoisier's law.
3:19:22Which of the following is a risk factor
3:19:23for cecal volvulus? See, cecal volvulus
3:19:26occurs on the right side and specially
3:19:28see cecum, ascending colon, and
3:19:29transverse colon are usually fixed to
3:19:31the lateral abdominal wall via the
3:19:33peritoneal folds. So, in the surgery,
3:19:35when we do the surgery of that area and
3:19:37when we mobilize that right sided colon,
3:19:40then there are chances of cecal volvulus
3:19:42in which the cecum, ascending colon,
3:19:44transverse colon, and the terminal
3:19:45ileum, everything gets rolled up. So, it
3:19:48should be previous abdominal surgery.
3:19:50Previous abdominal surgery.
3:19:53Previous abdominal surgery for the cecal
3:19:56volvulus. For the sigmoid, you can say
3:19:58that you know, long mesentery, narrow
3:20:01base, uh
3:20:03constipation as well as you know,
3:20:05laxative abuse, all those things,
3:20:06elderly age, that is for the sigmoid.
3:20:08But, if they have specifically said
3:20:11cecal, okay, you're saying female gender
3:20:13one option.
3:20:16Female gender, doesn't matter. It should
3:20:19be previous abdominal surgery.
3:20:22Okay.
3:20:23Lactose, lactulose, and laxative abuse,
3:20:26lactulose abuse is the same thing.
3:20:30In prostate cancer, Gleason grade score
3:20:324 + 4 8, 4 + See, there are
3:20:36traditional scoring system,
3:20:38traditional,
3:20:40and there is a new grading system.
3:20:43Okay, in our back to basic urology part,
3:20:45I had discussed this thing.
3:20:47Traditional like
3:20:493 + 3 score is 6.
3:20:52Then there is one 3 + 4
3:20:557 or 4 + 3
3:20:577, then there is 4 + 4 8, and there
3:21:01there is 9 or 10.
3:21:04So, as per the new grading system, this
3:21:06is one, this is two, this is three, this
3:21:09is four, and this one is five.
3:21:12So, this should be grade five. I guess
3:21:13pathology people will also discuss that
3:21:15is depending on what they see because
3:21:17the customer prostate is kind of
3:21:19heterogeneity. So they do they see two
3:21:22areas and in each areas they will see
3:21:24how many cells they resemble like the
3:21:26normal cells which are the cells which
3:21:28are not resembling cribriform cells and
3:21:31poorly differentiated. So based on that
3:21:33this is given.
3:21:35So uh
3:21:364 + 4 8 should go to Oh, sorry. 4 + 4 8
3:21:39should go to grade
3:21:414. See, grade 4. Grade 4. Sorry, grade
3:21:434.
3:21:45Okay, grade 4.
3:21:47Okay, this is this.
3:21:51Grade 4.
3:21:53Yes, yes, 4. Sorry.
3:21:56Patient comes So, this is a new question
3:21:58uh kind of pathology surgery mixed uh
3:22:00but yes while looking at these things it
3:22:02is mainly the surgeon the urologist and
3:22:03they will see this.
3:22:06Okay, grade 4. Yes, uh
3:22:08Patient comes with left flank pain. What
3:22:10investigation done? This was discussed
3:22:12by sir also so me sir. So, it should be
3:22:14like left flank pain. The first thing
3:22:15that should come to your mind is
3:22:17probably it is a
3:22:19renal stone. So, initial investigation
3:22:21is CT followed by I mean ultrasound
3:22:24followed by CT.
3:22:26Ultrasound followed by CT.
3:22:30In a young patient, so
3:22:33giving young patient goes again in the
3:22:36I mean favor of the stone because
3:22:37elderly people you can think about the
3:22:39malignancy and all but young patient is
3:22:40going again in followed by
3:22:43option NCCT followed by CCT. CCT
3:22:45followed by MRI. Okay, so he's saying
3:22:47CCT followed by MRI.
3:22:50NCCT followed by CT.
3:22:55So, answer should be USG followed by
3:22:57NCCT if they had specified NCCT and not.
3:23:03Acute left pain, no abdominal fullness.
3:23:05Yes.
3:23:07Which is a predominant or characteristic
3:23:09electrolyte abnormality in the refeeding
3:23:11syndrome? So, refeeding syndrome we know
3:23:13that characteristic feature is
3:23:15hypophosphatemia.
3:23:17Although you will see hypokalemia, also
3:23:20hypomagnesemia, also hypocalcemia, also,
3:23:23but this is the
3:23:25characteristic feature. I'll put that in
3:23:27an easy question.
3:23:31Okay, easy question.
3:23:36Now, this was a question on shock
3:23:38assertion and reason type of question.
3:23:40In shock, early blood transfusion is
3:23:42beneficial, and reason says blood
3:23:44transfusion increases oxygen delivery.
3:23:46Both are the true statement, and yes,
3:23:48reason explains assertion.
3:23:52So, option number A is correct.
3:23:54See, shock I mean, blood transfusion is
3:23:56mainly useful in the hemorrhagic shock,
3:23:58and hemorrhagic shock is much more
3:24:00common than the septic and other thing.
3:24:02So, I would say that uh option number A,
3:24:04assertion and reason both are true, and
3:24:07the reason is the correct explanation
3:24:08for the assertion.
3:24:11Okay, uh the characteristic electrolyte
3:24:13abnormality or driver metabolic
3:24:16abnormality or whatever the
3:24:18pathognomonic or the
3:24:20you know, telltale electrolyte
3:24:22abnormality.
3:24:23This question was also easy. Solitary
3:24:25thyroid nodule FNA C shows follicular
3:24:27neoplasm. What is the next step? We know
3:24:28that FNA C cannot differentiate between
3:24:30adenoma and carcinoma, so you should go
3:24:32for a hemithyroidectomy. I don't know
3:24:34what was the option number D.
3:24:36But, uh
3:24:38Okay, early blood transfusion is
3:24:40recommended in trauma resuscitation.
3:24:41Thank you very much.
3:24:44In trauma resuscitation.
3:24:47Okay, now it becomes more specific,
3:24:49because not in all type of shocks we
3:24:51give blood transfusion. So, you are
3:24:53saying trauma resuscitation makes it
3:24:55very clear-cut uh
3:24:57answer.
3:25:00Hemithyroidectomy. Okay, yes.
3:25:06Now, I don't know that there was an
3:25:08image of acral lentiginous type of
3:25:10melanoma and what is the investigation
3:25:12they had asked. So, just tell me a skin
3:25:15biopsy should be done the
3:25:17biopsy of that area should be done. I
3:25:19guess there were options like zank smear
3:25:21or some KOH or
3:25:24these were the options. So,
3:25:26zank, KOH.
3:25:29Skin biopsy should be the answer if it
3:25:31was a uh
3:25:34Early blood transfusion is recent to
3:25:35prevent dilutional coagulopathy. No, no,
3:25:37no. Early blood transfusion is not to
3:25:38prevent dilutional coagulopathy. It is
3:25:41uh you say that uh
3:25:42the
3:25:43over judicious uh you know, use of
3:25:45crystalloid should be avoided and as
3:25:48early as possible blood transfusion
3:25:50should be started. So, that is not the
3:25:52main reason that you want to prevent the
3:25:54dilutional coagulopathy.
3:25:57Skin biopsy, KOH, zank smear. Okay, so
3:26:00that is uh
3:26:02Biopsy is not given, then I don't think
3:26:05uh the question will be valid uh or it
3:26:07will not be a melanoma then. Melanoma on
3:26:09heel black color, yes.
3:26:12Acral lentiginous heel black, so biopsy
3:26:16should be the answer. Without biopsy
3:26:19though, I don't think that uh
3:26:21you know, question is valid.
3:26:26Okay, fourth option you are saying radio
3:26:28Okay, in that radioiodine. Okay, thank
3:26:30you very much. Radio-
3:26:32iodine.
3:26:36Now, there was an image based question
3:26:38on the cleft disorder and I guess there
3:26:40were questions like cleft lip I mean
3:26:42images of cleft palate, bilateral cleft
3:26:44lip, and the oblique facial cleft.
3:26:46Oblique facial cleft when it goes from
3:26:48uh you know, from the lip it is going up
3:26:50to the
3:26:50eye.
3:26:52So, tell me uh
3:26:55uh what uh
3:26:57what was there I mean if anybody
3:26:58remembers uh what were the images? Cleft
3:27:01lip was there, cleft palate was there,
3:27:03and bilateral cleft lip, and oblique
3:27:06facial cleft. Well, these were the four
3:27:07uh
3:27:08images there.
3:27:10Cleft palate, cleft image given, and uh
3:27:12match the following. Yes, it was a match
3:27:14the following question.
3:27:17Match the following type of question.
3:27:25Okay, so these were the questions. Now,
3:27:27there are something organism causing
3:27:29obsie. I was discussing uh Surya sir's
3:27:32uh you know, this recall also. I guess
3:27:34Streptococcus pneumoniae was there in
3:27:36the
3:27:37option.
3:27:40Streptococcus pneumoniae.
3:27:45Acute history of 2 days. It cannot be, I
3:27:48mean, apart from trauma, it cannot be
3:27:51anything else. 2 days may black color
3:27:53will be who's pain, non-painful. Uh I
3:27:55don't think uh 2 days may anybody can
3:27:58develop melanoma, and anybody can have
3:28:01anything non-painful in 2 days. I mean,
3:28:03that is just maybe that patient has step
3:28:05on a black paint. So, in 2 days, so that
3:28:08much black lesion uh is some paint or
3:28:11some, you know, other things, some
3:28:13color. So,
3:28:16melanoma may acute history, I mean,
3:28:19depending on acute history is not seen
3:28:21in melanoma. I don't think acute history
3:28:23is correlating with that. Encapsulated
3:28:25single organism. Yes, Streptococcus
3:28:27pneumoniae. That is the
3:28:30encapsulated
3:28:31organism.
3:28:37Okay, colon cancer staging. Just tell me
3:28:39whether any question was there on the
3:28:40colon cancer staging or any other
3:28:43staging.
3:28:442 days is see, acute history Sometimes
3:28:47there are the melanomas which are
3:28:48aggressive, they can spread or they can
3:28:50grow at a rapid rate. But, like 2 days
3:28:52back, the patient was absolutely fine,
3:28:54and in 2 days he is getting a lesion on
3:28:56the heel that is big enough that is uh
3:28:59not correlating so
3:29:01some some people are saying key acute
3:29:03history was not given so it is not going
3:29:05in favor.
3:29:07Okay, there was a purulent discharge
3:29:09fist line anal. Okay, so there was a
3:29:11question of
3:29:13fistula in anal
3:29:15and I guess they asked
3:29:18what was the uh
3:29:20Okay, midline cleft was also there. So
3:29:22let's see I need to see midline cleft
3:29:26lip you are saying.
3:29:29Fist line anal so what was the
3:29:32sphincter
3:29:35preserving surgery.
3:29:38See fistulotomy fistulectomy
3:29:41fistulotomy
3:29:44fistulectomy
3:29:49sphincter injury
3:29:51can happen. It can happen. Now you tell
3:29:54me what was the option?
3:29:56Lift procedure
3:29:59video assisted anal fistula treatment
3:30:01usually these are
3:30:04sphincter
3:30:06preserving. Now tell me whether these
3:30:08four were the options or there was
3:30:10something else.
3:30:12Ligation of intersphincteric fistula
3:30:13tract waft
3:30:15Okay, so waft was there so it is very
3:30:17much clear cut this is the answer.
3:30:20Lift is a surgery in which you go
3:30:22between the intersphincteric plane and
3:30:24you find the fistula and ligate it. So
3:30:26among waft and lift lift may still there
3:30:29is some chance of sphincter injury if
3:30:31you don't enter into the
3:30:33plane. Okay, so although lift is
3:30:34considered to be sphincter preserving
3:30:36provided you enter in the correct plane.
3:30:38But suppose you go here and there in the
3:30:40plane it can cause injury to the
3:30:41sphincter. So if waft was there in the
3:30:44option that is clear cut because you are
3:30:45not cutting anything you are just going
3:30:47in the fistula tract you are just
3:30:48curetting and you know it will heal on
3:30:50its own.
3:30:51So which is Okay, you are saying which
3:30:54was not sphincter preserving.
3:30:56Okay, so then this is sphincter
3:30:57preserving, this is sphincter
3:30:59preserving. Now,
3:31:01out of fistulotomy fistulectomy, this is
3:31:04having
3:31:05maximum risk of
3:31:09sphincter injury if these were the
3:31:12options.
3:31:14Okay, so sphincter preserving was
3:31:16whether they had asked yes or no, that
3:31:18we need to confirm. Not preserving, most
3:31:21of the people say which
3:31:23one causes. So, if fistulectomy was
3:31:26there in the option, this is the one
3:31:28which causes maximum chances of
3:31:31sphincter injury.
3:31:35Okay, file act file act is also
3:31:38sphincter preserving.
3:31:42So, fistulectomy fistulotomy, whatever
3:31:44was there, that should be the answer.
3:31:49Okay, fistulotomy was not there. Okay,
3:31:52now you made my life easy, fistulectomy
3:31:54should be the answer.
3:31:56Now, you tell me about from this 25 we
3:31:57have no no question on colon cancer
3:31:59staging, so let me strike this out if it
3:32:02is not there.
3:32:04Now, you tell me anything else. 25
3:32:07approximately 25 questions we had
3:32:09discussed.
3:32:12One question, pre-sacral mass
3:32:14congenital.
3:32:16Okay, congenital.
3:32:21Pre-sacral
3:32:22mass.
3:32:24What were the options?
3:32:27Remnant
3:32:28anal forming tube.
3:32:32Dermoid cyst.
3:32:34A question regarding rectal carcinoma
3:32:35was TME, I guess we had discussed.
3:32:38Hodgkin's lymphoma staging actually does
3:32:40not come under surgery because Hodgkin's
3:32:42lymphoma people they don't do surgery.
3:32:44It is maybe pathology people and all
3:32:47they will discuss. Hodgkin's lymphoma,
3:32:49non-Hodgkin's lymphoma per se are not
3:32:51surgical disorders.
3:32:54Okay, swelling in testis drains into
3:32:57superficial Okay.
3:33:00Lymph node
3:33:03drainage of testis you are saying.
3:33:08Yes, I guess there was a question lymph
3:33:09node drainage, so
3:33:13uh
3:33:14it is
3:33:16pre
3:33:18para-aortic
3:33:20or inter-aortocaval
3:33:24or paracaval lymph nodes.
3:33:28So, these are the lymph nodes which
3:33:30drains the testis.
3:33:36Okay, so
3:33:37yes, I need to know what was the image
3:33:40of this pre-sacral mass and what were
3:33:41the options? Options you are saying some
3:33:44uh
3:33:45dermoid cyst uh
3:33:48and epidermoid cyst you are saying.
3:33:52Dermoid, epidermoid.
3:33:55Although congenital pre-sacral mass
3:33:57mostly it goes in the favor of
3:33:59sacrococcygeal teratoma, but uh yes, we
3:34:02need to know more. A meningocele could
3:34:04also be seen in that area, but we need
3:34:06to know what was the question.
3:34:09We check superficial inguinal lymph
3:34:11nodes in the scrotal swelling. No, okay.
3:34:13So, you are saying it was a assertion
3:34:14and reason question. Assertion was
3:34:17testicular cancer. Assertion was
3:34:20testicular cancer superficial inguinal
3:34:24lymph node
3:34:26examination done.
3:34:29What was the reason? Testis drain.
3:34:33Reason?
3:34:35Testis
3:34:36drain into
3:34:39superficial inguinal lymph
3:34:44Okay, so this you're saying
3:34:46the scrotal swelling
3:34:49testis drain See, this statement is
3:34:51absolutely wrong.
3:34:53In testicular cancer, superficial
3:34:55inguinal lymph node examination done
3:34:58if
3:34:59testicular cancer involves
3:35:03scrotum.
3:35:04Then this is done.
3:35:07Okay, although testis is not the primary
3:35:10uh I mean inguinal lymph nodes are the
3:35:12not the primary draining area, but if
3:35:14you ask me in testicular cancer,
3:35:16superficial inguinal lymph node
3:35:18examination is done, I would say that is
3:35:21a true statement.
3:35:23And this is not. So, you can say
3:35:25assertion is true
3:35:27and the reason is false.
3:35:30Examination is done.
3:35:33Tailgut cyst, dermoid, chordoma. Okay,
3:35:35you're saying some
3:35:38tailgut cyst.
3:35:42Chordoma.
3:35:47Scrotal swelling involves examination.
3:35:49Okay, so it was not testicular cancer.
3:35:51You're saying scrotal swelling involves
3:35:53examination. So, if that is the option,
3:35:55then it is very much A is a correct
3:35:56statement.
3:35:58Scrotal
3:36:00swelling
3:36:02involves
3:36:04examination of
3:36:06superficial inguinal lymph node. That is
3:36:08true statement. That is true. Scrotal
3:36:10swelling, absolutely true statement.
3:36:13Testis drains into superficial inguinal
3:36:15lymph node. That is wrong. That is
3:36:16wrong.
3:36:18Okay, anything else? Anything else which
3:36:20you remember?
3:36:23So, now you can say that I would still
3:36:25put the exam into a difficult category
3:36:27because INI CET we expect the subject
3:36:29questions to be easy, but this time it
3:36:31was not as it easy as it was before. But
3:36:35after looking at the questions and
3:36:36discussing with you people, I will say
3:36:38that it was a doable paper. It is not
3:36:40something out of the blue except one or
3:36:42two question. It was a very much uh
3:36:45from the syllabus. And I mean the
3:36:47syllabus is nothing like syllabus, but
3:36:49uh
3:36:49most of the things you must have done.
3:36:51And thank you very much. And it is was a
3:36:53lovely discussion. And I could gain so
3:36:56many uh you know, the proper questions
3:36:59and the options and uh
3:37:01Okay, in the triad question, acidosis
3:37:02was not there. So, let me check uh that
3:37:04what was there. Acidosis, if you are
3:37:07saying it was not there in the triad.
3:37:09We need to see what was there.
3:37:14Okay, thank you very much. And uh
3:37:16I wish you all the very best for the
3:37:18result. And also
3:37:20I wish you
3:37:22the very best for the upcoming NEET exam
3:37:24also. Okay, so you have done the
3:37:25question, done the paper, relax today.
3:37:28And you know, from tomorrow you start
3:37:30preparing for NEET. Thank you very much.
3:37:32And uh you know, best wishes. Good
3:37:34night.
3:37:50>> Ready.
3:38:00Uh
3:38:08Hello everyone.
3:38:10Yes.
3:38:12So, how was the paper?
3:38:16Yes.
3:38:19Yeah, good evening. So, how was the
3:38:21paper?
3:38:27So, two three questions directly came
3:38:29from uh B2B, beyond the workbook, right?
3:38:32And uh the other one from the workbook.
3:38:35So I hope you did well.
3:38:39Today as we are doing a generalized
3:38:41recall which will help you to ascertain
3:38:43how many you got correct and then maybe
3:38:45tomorrow or day after we'll be doing a
3:38:46proper recall right. So help me out with
3:38:48the choices.
3:38:50I have been able to zero in many of the
3:38:53choices so let's start with the first
3:38:55question right.
3:38:58This in this question there is a little
3:39:00bit of confusion. So please write down
3:39:03in the chat box
3:39:04what you can tell me about this. So here
3:39:07the
3:39:10Yeah, so the here the options were so
3:39:12some of you are saying that they were
3:39:15asking
3:39:16the about the intercalated disc right.
3:39:19So remember intercalated disc in the
3:39:22first page of the workbook two lines are
3:39:25written the question is exactly from
3:39:26there. Intercalated disc is nothing but
3:39:29increases the cell to cell union right
3:39:31formed by the desmosomes and inside the
3:39:33intercalated disc we have the yes they
3:39:36are present at the Z lines where we have
3:39:38the gap junctions. So had they given you
3:39:41option of
3:39:42both
3:39:44gap junctions and the desmosomes
3:39:48and if desmosomes was
3:39:50not given then they must have given you
3:39:52hemi desmosomes as some students have
3:39:54messaged me right. So please try to
3:39:57recap.
3:40:11Tight junctions option was also there
3:40:13okay. Okay tight junctions are given as
3:40:15on occludens they cover your deco up.
3:40:17Zone occludens they cover it please see
3:40:19zone occludens I have written for you.
3:40:20Okay okay thank you Muralidharan thank
3:40:22you so much. But if you see Muralidharan
3:40:24I have written zone occludens other if
3:40:26tight junctions was given Muralidharan I
3:40:28will change it to tight junctions. Okay,
3:40:29thank you for pointing out. It's an open
3:40:31discussion. Wherever you feel that I
3:40:33need to change the choices, please help
3:40:34me, right? D was surface adherence.
3:40:37Okay.
3:40:38So, I will change it to surface
3:40:40adherence. A tight junction is same as
3:40:43zona occludens. So, with this we can
3:40:44take as the combined one, right? And
3:40:47maybe I will write surface adherence
3:40:48also. So, was the
3:40:51answer uh
3:40:53more than one correct?
3:40:56Achha, okay. Thank you, Devnar.
3:40:57Intercalated disc make on such a
3:40:59junction hota hai ye pucha tha. So,
3:41:01uh Devnar 48 JD is asking me uh rather
3:41:04telling me that intercalated disc make
3:41:06exactly junction. Dekhiye, intercalated
3:41:07disc make junction was asked. I think
3:41:09everyone should have got it correct.
3:41:11Answer is nothing but gap junction. But
3:41:13then
3:41:14Chetna is telling one more person in the
3:41:16chart. I can read up the charts of all
3:41:17of you. More than one correct type.
3:41:19Dekhiye, more than one correct type make
3:41:21the better answer is gap junctions plus
3:41:23desmosome or gap junction and desmosome,
3:41:25right?
3:41:27So, moving on to question number two. GS
3:41:29receptor is present in
3:41:31Remember, this was also done in the uh
3:41:34INICT recall as well. So, where we
3:41:36discussed the which ones are having beta
3:41:39one, beta two, right? So, beta
3:41:42adrenergic receptor dominantly
3:41:44is via GS because they
3:41:48increase the
3:41:50cyclic AMP. So, you know, one or two
3:41:53people were telling me in the Telegram
3:41:56group that M2 receptor Google is giving
3:41:58the answer, right? But answer is beta
3:42:00adrenergic receptor because it is GS
3:42:04which will increase the cyclic AMP,
3:42:06right? Acetylcholine via M2 decreases
3:42:09the cyclic AMP. It cannot be GS. GS is
3:42:12stimulatory G protein. So, answer has to
3:42:14be beta adrenergic receptor. This also
3:42:17is a PYT. So, all of you should have got
3:42:19it correct. It take on a cheater. You
3:42:21you have got it correct. I will myself
3:42:23tell you that which one is a new
3:42:24question and that probably some of you
3:42:27might have got wrong. I just may I'm not
3:42:29sure what kind of picture was given.
3:42:31This I have just made through the recall
3:42:34of the students only. So again you will
3:42:37have to help me out case may more than
3:42:39one correct option was there you only
3:42:41one I had to choose because I have made
3:42:43up the options according to more than
3:42:44one correct. Right? So please let me
3:42:47know more than one correct was there or
3:42:49only one option was there. If only one
3:42:51was there maybe I can change one or two
3:42:52the options. Yes, think about it.
3:43:06I in heart though
3:43:08Okay, okay. Thank you Devan. Thank you.
3:43:10Thank you Devner. 48 DD yes, yes. This
3:43:12question is given in the uh
3:43:15I tell more than one correct okay I'm
3:43:16only doing I've taken your point. More
3:43:17than one correct I've taken your point.
3:43:19Okay. So if it's me if there is more
3:43:21than one correct then remember this is
3:43:22exactly question of the TND. It is also
3:43:25a PYQ only changed into a new question.
3:43:28This is also given in my workbook which
3:43:30in which if you take the post class test
3:43:32all of I make I make you all do those
3:43:35questions in the class also in the
3:43:36online batch also. So exact same figure
3:43:39here the only thing is yes okay thank
3:43:41you. The only figure is that we have to
3:43:44follow this should be the cationic
3:43:46particles. It will have maximum
3:43:49filterability. This should be neutral.
3:43:52It will be intermediate and this should
3:43:54be anionic. That means in any case X
3:43:59will be Y and more than Y will be more
3:44:01than Z. Now Y has more filterability
3:44:04than Z. That is not the
3:44:07Y has more filterability than X. That is
3:44:09false.
3:44:10X represents positively charged
3:44:12molecule.
3:44:15Yes, X represents positively charged
3:44:17molecule. So, B and D options are same,
3:44:20so maybe I can change it.
3:44:23Y represents positively charged
3:44:25molecule. Okay. Y has more filterability
3:44:29than Z. This is true.
3:44:31X represents positively charged
3:44:33molecule. This is true. So, we can go
3:44:35with C and D. I hope all of you got it
3:44:38correct, right? Yes. Okay, Devan. Thank
3:44:40you, Devnath. Thank you. So, it is the
3:44:42exact question and all of you have got
3:44:44it correct. I can see that. Yes.
3:44:46I will not say you have happy faces with
3:44:48happy chat. I would have done push over
3:44:51subject is going on. What happened?
3:44:52Physiology, physiology. Right? So, yes.
3:44:56So, I don't want to take too much of
3:44:57your time in the question which I have
3:44:58confusion. Only that we will spend a
3:45:00little bit more time. Which of the
3:45:02following transporters activities
3:45:03increase during oral rehydration therapy
3:45:06in diarrhea? Yes, this again is an easy
3:45:09one. No the further discussion is
3:45:11required. Oral ORS is the basis Uh-huh,
3:45:15NHC acid Devnath, ORS, oral rehydration
3:45:17solution in diarrhea. In diarrhea, you
3:45:20are giving SGLT1, one, not two. Two is
3:45:23in PCT. What happened, Muralidharan? Two
3:45:26is in PCT. This is the basis behind ORS.
3:45:29Just follow the GIT absorption chapter
3:45:31in GIT. I always write along with SGLT1,
3:45:35secondary active. This is the basis
3:45:37behind giving ORS in the management of
3:45:40diarrhea, especially in infants and
3:45:41children, right?
3:45:44Maybe this should you should not have
3:45:45got wrong.
3:45:48But theoretically it was written. Okay,
3:45:50okay, fine. But thank you so much. So,
3:45:51if I change one, CFTR is naturally the
3:45:54wrong answer. SGLT2 was also given.
3:45:56Okay.
3:46:00But which molecule is theoretically
3:46:01related to Sorry, I'll write the
3:46:03question. Which molecule is
3:46:05theoretically is related to
3:46:12ORS may be that to please be there if
3:46:14you get that. Please tell me what is
3:46:15meant to
3:46:16cut the water tell me what was given I
3:46:18did
3:46:19eliminate the water yes yes okay please
3:46:21then tell me what was there instead of
3:46:23water is
3:46:24Fine vibrio okay anything else vibrio
3:46:28please try to recap exact question
3:46:31Yes no SGLT2 okay thank you but what was
3:46:34about vibrio if water is was not there
3:46:37Which molecule is theoretically related
3:46:39to decrease in stool secretion that is
3:46:41not making sense?
3:46:51Which molecule
3:46:54is theoretically decreased
3:46:57in stool secretion?
3:47:01Actually is most of the students had
3:47:03sent me this one so I was discussing
3:47:05this doesn't matter I'll try to
3:47:06improvise till tomorrow if I can get
3:47:09some better choices so anyone please who
3:47:11can recap something better either tell
3:47:13me right now or please tell me by
3:47:15tomorrow.
3:47:17Which molecule diarrhea come connect
3:47:19okay.
3:47:22Which molecule will
3:47:25decrease the
3:47:29diarrhea okay which is should be given
3:47:30to prevent losses again answer is SGLT1
3:47:32only because when you give the you can
3:47:35commonly give ORS to decrease the
3:47:39diarrhea incidence and ORS
3:47:42basis is SGLT1 okay I got your point but
3:47:45the answer would be SGLT1 only after
3:47:47eating rice there was diarrhea okay.
3:47:51I'll write it down and maybe
3:47:55Okay history was given of okay now I got
3:47:58it now I got it thank you after eating
3:48:01rice so history of diarrhea okay thank
3:48:04you thank you thank you so much everyone
3:48:06answer again SGLT1 only Answer will be
3:48:08SGLT1, okay. I got your question. I will
3:48:10reframe it tomorrow when we'll do the
3:48:12proper recall. Thank you so much. I got
3:48:14the question. Basically, history of
3:48:15Vibrio cholera infection or history of
3:48:17diarrhea was given after eating rice and
3:48:19then the it was asked that what should
3:48:21be given which will reduce the water
3:48:23loss or reduce the incidence of
3:48:24diarrhea. So, we are we need to give ORS
3:48:26and ORS principle is based upon SGLT1,
3:48:29sodium glucose linked transporter one.
3:48:31Okay, thank you so much for completing
3:48:32the question, everyone. Thank you.
3:48:35Which of the following areas I might
3:48:37leak the leak the after eating rice. We
3:48:39will get that.
3:48:40Subha Jain, I I have written the same
3:48:42thing. Thank you. Thank you. Thank you.
3:48:43SGLT2 I have removed, dear. Thank you.
3:48:45SGLT2 I'm removing. SGLT2 is removed,
3:48:48right? Thank you.
3:48:50After eating rice, yes. Which of the
3:48:52following areas in CNS neurons
3:48:53regenerate and increase in number? This
3:48:56again you will have to help me out. Many
3:48:58many different answers I'm getting from
3:49:00students, please. Yes. On my WhatsApp
3:49:02number as well.
3:49:05I I
3:49:07NHE3 will diarrhea loss come correct,
3:49:09but mainly you are giving ORS.
3:49:14Okay, thank you Muralidharan. Thank you
3:49:16so much. I I I have noted it down. Thank
3:49:18you.
3:49:19Dentate gyrus was given. Hippocampus was
3:49:22not given. Okay.
3:49:25Then I will remove the hippocampus.
3:49:28Anything else which you can recap? New
3:49:31neurons and dentate was in option. The
3:49:33new neurons to do it is not making
3:49:35sense. Which of the following areas
3:49:36which areas can regenerate? I have
3:49:38hippocampus I have removed. Thank you so
3:49:39much. Hippocampus is not there. Or but I
3:49:42have anything else? Anything else you
3:49:43can help me? Locus ceruleus is
3:49:45absolutely wrong answer. Substantia
3:49:47is wrong answer. Hippocampus may
3:49:50be a way and as you are saying. So,
3:49:52remember this is also an overlapping
3:49:54actually question with anatomy. These
3:49:55are the three areas which is dentate
3:49:58gyrus, right? Which should be the answer
3:50:00here. Otherwise, you should know
3:50:02olfactory bulb, subventricular area, and
3:50:05dentate gyrus. These are the three areas
3:50:07which can regenerate.
3:50:09Okay, thank you. Anterior horn of spinal
3:50:12cord is not the correct answer per se,
3:50:15but if the dentate gyrus was not given
3:50:18and the options was locus ceruleus,
3:50:19substantia hippocampus, then I
3:50:22yes, new neurons are formed in Answer
3:50:24same right now. New neurons are formed
3:50:26in regeneration here. It is same. Sure,
3:50:28but it is same.
3:50:29These are the three place These are the
3:50:32three areas where the regeneration
3:50:34occurs in CNS. Yes, I'm getting your
3:50:36point. Which area can produce new
3:50:38neuron? Okay, thank you.
3:50:40Which area can produce new neurons?
3:50:45How to basically the question is about
3:50:47regeneration? Answer will be same. The
3:50:49three areas are commonly involved in
3:50:51regeneration. Olfactory bulb,
3:50:53subventricular zone or areas, and the uh
3:50:56dentate gyrus. Okay, anterior horn of
3:50:58spinal cord option was there. Dentate
3:51:00gyrus, okay. Then the answer is dentate
3:51:02gyrus. Let's Let's get over with it.
3:51:03Then the answer is dentate gyrus, but
3:51:05for future remember olfactory bulb and
3:51:07subventricular areas are also the areas
3:51:09where regeneration can occur. Yes, it is
3:51:11a good question.
3:51:12Loss of hand-eye coordination is This is
3:51:15a new question. This the Dr. Saurabh
3:51:17might also discuss this agar abhi
3:51:19ophthalmology ka recall nahi hua. He
3:51:20also did uh you know, might do this
3:51:23because there are two or three questions
3:51:24of the special senses this time. So,
3:51:27loss of hand-eye coordination. Yes, uh
3:51:31Swayam Swaroop Mishra, I have noted the
3:51:33question. Thank you so much. Thank you.
3:51:34Yes, loss of hand-eye coordination is
3:51:36associated with lesion of
3:51:39This is actually the straight-away
3:51:41question. Here, the answer is parietal
3:51:43lobe.
3:51:44Yes, absolutely correct. Very good.
3:51:46Devnar, Xavier, yes, wonderful. Yes,
3:51:48parietal lobe is the answer. No
3:51:50confusion here. Any option could be
3:51:52there, but answer is parietal lobe,
3:51:53right? This is This is a straightforward
3:51:55one. Although, it's a new question.
3:51:59Yes, inferior parietal lobe, very good.
3:52:01I was about to just say that inferior
3:52:03parietal lobe is absolutely correct
3:52:04answer, but here only parietal was
3:52:05given. This is again very easy. Neuro
3:52:08praxia is caused by I think or Dr.
3:52:10Tushar also might do the same with you.
3:52:12Orthopedics faculty is also going to
3:52:14discuss the same. I even don't need to
3:52:16tell you, everyone would have got it
3:52:17correct. I'm 100% sure. Physiological
3:52:20disruption of the conduction without any
3:52:24anatomical injury to the nerve. Neuro
3:52:26praxia like sleeping foot syndrome. You
3:52:29are sitting cross-legged on any
3:52:31religious place, then as you get up, you
3:52:34feel that you can't move your lower
3:52:36limb. That is sleeping foot or as we say
3:52:38physiological conduction block. Yes.
3:52:41Parietal answer a parietal is the answer
3:52:43to the earlier one, no confusion.
3:52:45Endoneurium is cut. Okay,
3:52:47endoneurium is cut, but please remember
3:52:49it is again wrong. It's again wrong.
3:52:54Endoneurium is cut.
3:52:56You know, this is again wrong because
3:52:58only physiological disruption of nerve
3:53:00impulse conduction. This is the neuro
3:53:02praxia. Axonotmesis and neurotmesis is
3:53:05different. This is only physiological
3:53:07conduction block. Okay, endomysial
3:53:09involvement option was also there.
3:53:12Endometrium is cut. Endoneurium is cut.
3:53:15Okay. Endomysial involvement. I'm
3:53:17writing it down for tomorrow. Proper
3:53:19recall. Thank you. Answer remains the
3:53:21same.
3:53:25Okay.
3:53:26Fine, fine, fine. Thank you. Thank you
3:53:29so much. Who told me this? Yes, thank
3:53:31you. Thank you.
3:53:33Thank you so much. You are Yes, totally
3:53:36helping me out. Really like that dress.
3:53:39Thank you so much. Which of the
3:53:41following is seen in a person when he
3:53:42goes to a dark room? I still about to
3:53:45hear more than one correct definitely
3:53:46option would have been there. Can you
3:53:48recall the options here? Because this
3:53:50was again confusing to many. Which of
3:53:52the following is seen as a person goes
3:53:54in a dark room? Basically, question is
3:53:56about dark adaptation.
3:53:58Again, overlapping with ophthalmology.
3:54:00He might also discuss, but we can
3:54:02straight away do the answer. It's an
3:54:03easy one. When you go to a dark room,
3:54:05dark adaptation, this is true. Pupil
3:54:08size will, of course, increase. There
3:54:11will be increased sensitivity to light.
3:54:14Very good. Absolutely correct. Yes. And
3:54:17tell me of from one and four, which is
3:54:19right? Because that is actually more
3:54:20than one correct answer. Which is right?
3:54:23Don't say one. Retinal pigment will not
3:54:25change to vitamin A. Retinal opsin opsin
3:54:27changes to photopigment.
3:54:34I did it so much. Thanks. Thank you so
3:54:36much. They spot on option. Thank you.
3:54:37Then thank you. Yes, this is also true.
3:54:40No, no, no, no. I have not gathered
3:54:42anything. You are the people who have
3:54:44helped me out, right? So, I cannot take
3:54:46the credit. You are the You are my
3:54:48students who are the dear students who
3:54:49have sent me.
3:54:52Yes, yes. Pupil dilatation will be
3:54:54there. Because as soon as he goes from
3:54:56light to dark, initially the pupil size
3:54:58dilatation will be there. So, I'll write
3:55:00down Muralidharan. So, there was
3:55:06No, retinal pigment changes to vitamin
3:55:08A.
3:55:10Yes, retinal opsin changes to
3:55:12photosensitive pigments. Absolutely
3:55:13correct, Soham Suru. This should This is
3:55:15actually true. So, the answer should be
3:55:17two, three, and four. First will be
3:55:19false. Yes, first will be false. Pupil
3:55:22size will increase, of course.
3:55:27This is now again an overlapping with
3:55:29medicine question, but you can tell me
3:55:32right away. It's an easy one. Match the
3:55:33following disorders with acid-base
3:55:35conditions with acid-base disorders.
3:55:38Yes, let's do that straight away.
3:55:39Respiratory acidosis.
3:55:41Respiratory acidosis.
3:55:45Instead of first option, sir, visual
3:55:47acuity decreased. Okay, but that is
3:55:49wrong. That is wrong. If this is given,
3:55:51let me write for two further proper
3:55:54questions. Thank you so much. Visual
3:55:57acuity decreases. It is wrong. It is
3:55:59wrong. Visual acuity decreases is wrong.
3:56:02Even if the option is instead of this,
3:56:04that is wrong. Answer remains same.
3:56:07Okay, person remains in dark room for
3:56:09long time.
3:56:16For long time. Okay. This I will then
3:56:19again re-address. Yes, CHPS option.
3:56:23Fine, let's see that. So, respiratory
3:56:25acidosis
3:56:27Respiratory acidosis bronchopneumonia.
3:56:32Respiratory alkalosis hyperventilation.
3:56:36Metabolic acidosis
3:56:41ethylene glycol poisoning and metabolic
3:56:44alkalosis persistent vomiting. You do I
3:56:47everyone would have got correct. And I
3:56:49know you sub say what I I can I will not
3:56:52say I can see your happy faces, but I
3:56:54can say I can see your happy chats,
3:56:56right? So, this all of you have got
3:56:57correctly. Good. Very good. Yes, nice.
3:56:59Yeah, I say what I please this please
3:57:01tell me what was the right option. This
3:57:03is an interesting question. This is I
3:57:05have taught you this in B2B beyond the
3:57:08workbook.
3:57:09Okay, Xavier instead of persistent
3:57:12vomiting pyloric stenosis was there.
3:57:15Okay.
3:57:17Okay, thank you. CHPS.
3:57:20Okay.
3:57:22Pyloric stenosis was given. Okay, thank
3:57:25you Abhishek.
3:57:28Yes, please help me out in question
3:57:30number 10. Biphasic flow
3:57:34in the right coronary artery is due to.
3:57:36Can you tell me the options here? This
3:57:38is a question where some of you have got
3:57:40it wrong, although should not have. This
3:57:42is also taught in B2B beyond the
3:57:45workbook because it is in more of an
3:57:47INICET oriented question.
3:57:51Achha, pyloric stenosis was option.
3:57:53Okay.
3:57:55Okay, I'm noting it down. I will be
3:57:57re-addressing these queries tomorrow and
3:57:59I will take the proper recall. Okay,
3:58:00yes, yes, I have changed. Thank you,
3:58:02Abhishek. Pyloric stenosis I have done
3:58:04instead of persistent vomiting. I have
3:58:06written it. Don't worry. We'll do it
3:58:07tomorrow. But tell me please recall.
3:58:10Today I don't want to stress you too
3:58:11much, right? So, biphasic flow in right
3:58:13coronary artery is due to
3:58:15uh difference in left and right coronary
3:58:18artery was the question. Thickness to
3:58:20agaya na? Increased right ventricular
3:58:22okay thickness. Fine. Okay. So, one
3:58:24option was high pressure in right
3:58:26ventricle during systole. Nahi to maine
3:58:28likha hua hai na? This I have written.
3:58:32Uh this is
3:58:34wrong.
3:58:36Right ventricular thickness. Okay.
3:58:40Right ventricular thickness. Any other
3:58:42option which you can recap?
3:58:47Yes, very good, very good. Isme bas itna
3:58:49hi yaad hai and it's sahi yaad hai
3:58:50aapko, Xavier. Bilkul, you have you have
3:58:51hit the you know reduction in pressure
3:58:53in systole. Basically, dekhiye what the
3:58:55logic here is. So, if I make a very,
3:58:57very crude kind of picture right away
3:58:59although we're doing it properly
3:59:00tomorrow. But if you just see uh answer
3:59:03actually amongst the given options and
3:59:04the logic is
3:59:06if suppose this is left atrium, left
3:59:08ventricle, right atrium.
3:59:12Okay, question was reduced
3:59:14reduced right ventricular flow.
3:59:19Low pressure in right ventricular in
3:59:21systole. If this option was there, this
3:59:23is correct. RCA nahi tha. Right coronary
3:59:26artery nahi tha na? I have not written
3:59:27also. So, dekhiye the basic logic is
3:59:29that what we say is
3:59:31the
3:59:32RCA, right coronary artery and left
3:59:35coronary artery, they are originating
3:59:37from coronary
3:59:40ostia,
3:59:42which are the openings located behind
3:59:44the aortic valve. So, here a very simple
3:59:46logic is there that suppose,
3:59:49you know, let's say this is the
3:59:52representation of the
3:59:56aortic valve, right? Suppose I say this
3:59:59is the representation of aorta and this
4:00:03is your aortic valve. So, what we are
4:00:06saying is that the vessels, which is the
4:00:09right and the one option was momentary
4:00:12reversal in flow during early systole in
4:00:14right ventricle. Okay, reversal of flow
4:00:21Ha ha, what about medicine may over RC
4:00:23while inferior MI? I'll leave it for him
4:00:25to discuss. Reversal of flow during
4:00:28early systole.
4:00:30Reversal of flow in
4:00:33early systole.
4:00:36Early systole kiss me? Anything can you
4:00:38remember? Reversal of flow in early
4:00:41systole in which? In right? It is
4:00:43written. Reversal of flow in early
4:00:45systole is another option. Okay, thank
4:00:47you. Reversal of flow in early option.
4:00:51During early systole in right ventricle.
4:00:54Okay, basically the logic is very
4:00:56simple. Just follow. This is the same
4:00:57picture I usually draw. Just see this.
4:00:59Suppose this is, let's say, it's a crude
4:01:01picture will help us to understand.
4:01:03Suppose this is the
4:01:04LCA, left coronary artery, and let's say
4:01:07this is the representation of right
4:01:10coronary artery. The basic logic is that
4:01:12if I want to make the blood enter any
4:01:15ventricle during systole and diastole,
4:01:17then the left coronary artery pressure
4:01:21and the right coronary artery pressure
4:01:24will be same as
4:01:27aortic pressure. So, now the problem is
4:01:30that if I have the left ventricle versus
4:01:33the right ventricle, right? This is the
4:01:35systole
4:01:37and this is the
4:01:39diastole, right? So, basically and then
4:01:42you can tell me more about the options.
4:01:44So, reversal flow was there, okay.
4:01:46Doesn't matter, doesn't matter. Just
4:01:47read up quickly. So, just see this. Left
4:01:49ventricle, the pressure in the systole
4:01:51in the
4:01:53left ventricle, right? So, what will be
4:01:55there? We already know the answer is
4:01:57121.
4:01:58And during diastole it is zero. Right
4:02:00ventricle, it is nearly 25. Diastole is
4:02:03zero, right? But problem is that aorta
4:02:09has a pressure of
4:02:12120 and 80. So, what we are simply
4:02:15saying is that the CPP, which is the
4:02:19Yes, B is correct answer if the options
4:02:21were there. Then you should be happy.
4:02:23Coronary perfusion pressure is nothing
4:02:27but the pressure of the aorta, which is
4:02:30same as LCA and same as right coronary
4:02:35artery. That means Please see this
4:02:37quickly now. In the left ventricle, the
4:02:39coronary perfusion pressure in systole
4:02:41would be 121
4:02:44minus 120. That is minus one. Minus one
4:02:48means blood
4:02:50perfusion to the left ventricle will
4:02:52only occur during diastole because it is
4:02:5580 minus zero, right? I hope you have
4:02:59understood. Okay, for future also I'm
4:03:01just revising with you. Right ventricle,
4:03:03may just see the logic. Right ventricle,
4:03:05it is What should be the perfusion
4:03:07pressure? 120 minus 25,
4:03:11which is 95. 95. So, there cannot be
4:03:15reversal of flow.
4:03:17And this is again 80 minus zero, 80. So,
4:03:21positive pressure coronary perfusion
4:03:23pressure is nothing but LCA or RCA
4:03:27pressure minus left ventricular pressure
4:03:31or right ventricular pressure, right?
4:03:33Yes, okay. Great great midway, thank
4:03:35you. So, if I follow this logic, the
4:03:38best answer is low pressure in right
4:03:40ventricle, right?
4:03:42Yes, absolutely correct, Julie.
4:03:44Increased permeability of glomerular
4:03:46capillaries will lead to This again, you
4:03:49all of you should have got correct.
4:03:50Increased permeability of glomerular
4:03:52capillaries will lead to the appearance
4:03:54of Yes.
4:03:56Yes, all of you have have to get it
4:03:58correct. These three are freely
4:04:01filtered.
4:04:03Freely filtered.
4:04:07Shabana, tell me I'm planning planning
4:04:09to do that. So, within a few days,
4:04:12within probably 3 to 4 days, I was just
4:04:14waiting for INICET to happen. So, I will
4:04:16share
4:04:17the
4:04:18WhatsApp link in the Telegram group of
4:04:21DAMS and the WhatsApp group of our DAMS
4:04:23and then every day I will give you 10
4:04:25practice questions till NEET PG, right?
4:04:27That that is my plan. So, don't worry.
4:04:29Answer So, remember glucose, ketones,
4:04:33and uric acids are freely filtered.
4:04:39They are freely filtered. So, answer has
4:04:42to be proteins. Absolutely right. Renin
4:04:45is secreted in response to again
4:04:48so many times, you know, I have been
4:04:50telling you in cardiovascular system
4:04:53I will do that, don't worry. In
4:04:54cardiovascular system when I discuss
4:04:56RAS, if you look at the workbook,
4:04:58stimuli which increase renin, I always
4:05:00illustrate sympathetic stimulation via
4:05:02beta 1 JG cells. And remember
4:05:04hypovolemia, hypotension, decreased
4:05:07sodium, so reduced renal perfusion
4:05:09pressure because there are intrarenal
4:05:11baroreceptors in the Yes, JG cells.
4:05:15Reduced renal perfusion pressure.
4:05:17Elevated sodium may over macular densa
4:05:20may It has to be decreased sodium in the
4:05:22macular densa for releasing
4:05:27renin.
4:05:34Basically, Ritika, what we are saying is
4:05:37glucose, ketones, and uric acid are
4:05:39freely filtered, but they will be
4:05:42reabsorbed. Proteins
4:05:45can come out in during increased
4:05:47permeability. Ritika, if you remember
4:05:49glomerulonephritis,
4:05:51dissipation of negative charge, increase
4:05:54in permeability. This also I do in the
4:05:56class. I got up workbook they can get I
4:05:58have made you write down. I have made
4:06:00you write down this.
4:06:02Right? Shall we let's move to 13.
4:06:06Hyperpolarization during sensory
4:06:09transduction. I don't think I got it
4:06:11right or wrong. Don't worry too much. I
4:06:12don't don't cry over split split milk.
4:06:15You know, so please I don't
4:06:18We don't worry. Don't worry, please.
4:06:20I witness We have so many people in the
4:06:21chat. I don't think it's a big deal.
4:06:23Don't worry, right? Hyperpolarization
4:06:25during sensory transduction, remember
4:06:27only answer is
4:06:31Pressure probably wasn't there. No, no,
4:06:33no. This can't be happening. Okay,
4:06:34doesn't matter.
4:06:35Pressure may not have been there. Dear,
4:06:37it doesn't matter. I just want to add it
4:06:38in. It doesn't matter. Answer reduced
4:06:40renal perfusion will also be the answer
4:06:42then. You know?
4:06:43Here it is the only exception. This also
4:06:45I keep on telling you. Here visual
4:06:47receptor in the eye, there is
4:06:49hyperpolarization
4:06:51which is causing the excitation of the
4:06:55Yes.
4:06:56Ganglion cells thereby producing the
4:06:59action potential. So, it is
4:07:00hyperpolarization. Only visual receptor.
4:07:03Yes, only visual. Remaining are
4:07:04absolutely wrong.
4:07:06Emotional prosody of emotional prosody
4:07:08of speech is mainly a function of which
4:07:11area of the brain?
4:07:13I hear this I think And medicine faculty
4:07:16might also discuss, but still you can
4:07:19tell me the answer. Yes.
4:07:21Emotional prosody of speech.
4:07:25And these are I hope the choices were
4:07:27correct because this I have asked many
4:07:29students. They are saying yes, cingulate
4:07:31gyrus was given.
4:07:35I don't know. Very nice.
4:07:38I am telling you myself now. I got
4:07:39thinking in the B2B, you know, beyond
4:07:41the workbook Xavier. When I teach in
4:07:43beyond the workbook special senses,
4:07:45although I have taught in only 2 and 1/2
4:07:47hours, but you will you know believe
4:07:50that out of 2 and 1/2 hour discussion,
4:07:52almost three questions have come today.
4:07:54So visual cycle is a very hot topic and
4:07:56specially also hyperpolarization I keep
4:07:58on telling again and again. So this is
4:08:00these are expected question.
4:08:03Posterior inferior parietal lobe was
4:08:05given. Okay, posterior inferior
4:08:08not parietal. Fine, I'll change it.
4:08:10Posterior inferior parietal, but I think
4:08:12answers sub sahi hai. Answer aap log
4:08:14mujhe sahi bata rahe hai.
4:08:16Broca's area was one of the options.
4:08:18Okay.
4:08:25Broca's area was option instead of Can
4:08:28you please recall instead of Broca's
4:08:29area was the option instead of
4:08:32What was missing?
4:08:34Cingulate gyrus was given. Frontal lobe
4:08:36also was one of the options. Okay.
4:08:43Achha, cingulate [snorts] gyrus actually
4:08:45should be the answer. Frontal lobe I'm
4:08:46not very sure was there or not. So I'll
4:08:49put a question mark, right? But
4:08:51cingulate gyrus as some of you are
4:08:53telling that is actually the answer,
4:08:55right?
4:08:59Chalo, so this brings us to the end. So
4:09:01I will say that
4:09:03I am I can make out that
4:09:06out of these 14 questions which I have
4:09:08been able to get up. So if any there is
4:09:11any other more question, help me out.
4:09:13You have my number, right? And I can
4:09:15feel
4:09:16that
4:09:18at least lot of you have got 10 correct,
4:09:20right? And some of you have even got 12
4:09:22to 13 correct. That is really excellent,
4:09:24I would say, right? I think this time
4:09:26surgery was difficult, you know, what
4:09:27the feedback has been given.
4:09:29Take care. God bless you all. Thank you
4:09:31so much. And we will do a formal recall
4:09:34in a one or two days, right? Thank you
4:09:36so much. Thank you.
4:09:38Yes.
4:09:42Cardiac muscle biopsy also one question.
4:09:45Please help
4:09:47Xavier if you can help me out. And that
4:09:50may be a question to neither Xavier if I
4:09:51hope it was not anatomy. Daily MCQ I'm
4:09:53going to start within three four days
4:09:55only. Don't worry. Papain pepsin I will
4:09:57biochemistry person will do. Meissner
4:09:59Pacinian question though. Are you ready?
4:10:01Please please tell me what was the
4:10:02question of Meissner Pacinian Dr.
4:10:05Pracker. Yes.
4:10:07If you can recall Pracker, please send
4:10:09me on my WhatsApp number. Cardiac muscle
4:10:12biopsy and Meissner Pacinian corpuscle
4:10:14question also. This nobody has told me
4:10:15till now. Yes, Pacinian okay. What was
4:10:18the question
4:10:20please
4:10:21what was the question?
4:10:23I don't know path question though. Okay,
4:10:25okay, take it take it take it.
4:10:27Take it. I'll take your leave. Thank you
4:10:29so much. Thank you.
4:10:30Yes.
4:10:33I think I got junction
4:10:35onion skin pick was given Pacinian and
4:10:37that's it. Onion skin pick though I have
4:10:40given in the workbook also. I keep on
4:10:42telling you onion skin pick
4:10:44ticket ticket onion onion skin pick
4:10:46method Pacinian no no other option. So
4:10:48that everybody has got correct.
4:10:50So you go go go. Take care.
4:10:54See the recall then chill today and even
4:10:55tomorrow also you can take a little
4:10:57break, right? Thank you so much. Thank
4:10:59you.
4:11:02Hello everyone. How are you guys?
4:11:04So we are going to discuss now the
4:11:06anatomy recall questions of today's
4:11:09uh you know paper.
4:11:11So, these questions as we all know,
4:11:13these are all recall based. So, I'm
4:11:16basically collecting the uh language and
4:11:19the you know mode of the question which
4:11:20was asked. And there can be some
4:11:22differences from the real question. So,
4:11:24you guys can always you know tell me
4:11:26that if there is any change in the
4:11:28language of the question or any option
4:11:30which was not there or some picture is
4:11:32So, accordingly we will make the final
4:11:34program, okay? So, this is what I could
4:11:36get. This question was there
4:11:40you know some students have recalled
4:11:41that this question was there.
4:11:43So,
4:11:48if you can also tell me yes if it is
4:11:50what there.
4:11:59This question was there, right? Which is
4:12:01the only abductor of the larynx? So, we
4:12:03all know posterior cricoarytenoid is the
4:12:05answer here, right? Posterior
4:12:07cricoarytenoid, this is the you know uh
4:12:10diagram where we can see that this is
4:12:12the posterior cricoarytenoid muscle over
4:12:15here.
4:12:16Okay? And uh
4:12:17this is posterior cricoarytenoid muscle
4:12:19over here. This is a lateral
4:12:21cricoarytenoid. Between the thyroid and
4:12:23the arytenoid this is thyroarytenoid and
4:12:25this one is the transverse arytenoid
4:12:27muscle, but answer will be yes, of
4:12:29course, posterior cricoarytenoid will be
4:12:31there, okay? So, accordingly we will
4:12:34mark the answer. This is the answer over
4:12:36here, posterior cricoarytenoid.
4:12:39Okay, beta?
4:12:40Now, uh this question some students were
4:12:43saying that external oblique muscle was
4:12:45there, but some students were saying
4:12:46internal oblique was there. So, you
4:12:48know, as per that
4:12:50image that answer will be there. If this
4:12:52question was there, this is the image
4:12:54over here. You can see that this muscle
4:12:57is
4:12:58this muscle is coming from the lower
4:13:01eight ribs and then the aponeurosis is
4:13:04coming over here. You can see that this
4:13:06muscle is coming from the lower eight
4:13:09ribs. Okay. And you can see that this is
4:13:12coming as aponeurosis over here, right?
4:13:15And lower down in the aponeurosis it
4:13:17makes the inguinal ligament. Okay?
4:13:21It makes the inguinal ligament over
4:13:23here. Can you see that?
4:13:26Okay, so that will be the our answer.
4:13:29Quadratus lumborum was also there.
4:13:31Quadratus lumborum, that's okay. Option
4:13:33was transversus abdominis. That is
4:13:36making the linea alba. So linea alba
4:13:38will be contributed by all the muscles,
4:13:40okay? Linea alba will be contributed by
4:13:42all the muscles.
4:13:43Okay? If you can also you know
4:13:46it depends. If the muscle was taking
4:13:49origin from the posterior border was
4:13:50free, there are certain points. There
4:13:53are certain points based on which we can
4:13:54identify. Posterior border is free for
4:13:57only external oblique muscle. Otherwise,
4:13:59we have the attachment here from the
4:14:01thoracolumbar fascia for the internal
4:14:03oblique as well as the transversus
4:14:04abdominis muscle. And lower eight ribs
4:14:06is for the external oblique muscle,
4:14:07okay? And the internal oblique and
4:14:10transversus abdominis they are mainly
4:14:11taking origin from the bony part over
4:14:13here.
4:14:14Yes, I had removed my
4:14:16video for that. I wanted to show you the
4:14:19you know image behind me, that's why.
4:14:20Now I hope I'm visible.
4:14:23Take care. The posterior border if it
4:14:25was free, then it is external oblique. I
4:14:27think based on all these features, if
4:14:29you see it, then answer will be A.
4:14:32But as I said, this is purely on recall
4:14:35basis. If you change the language, if
4:14:37you change the image, answer will be
4:14:38different.
4:14:39All right, dear friends. Let's move on.
4:14:43And this question was there in adult CNS
4:14:46where the neurogenesis will take place.
4:14:49And I got these choices. Is the question
4:14:52and the choices are correct?
4:14:54And if you want to add any more choice
4:14:56over here.
4:15:10Okay, so dentate gyrus among these
4:15:12option why actually the neurogenesis
4:15:15will take it will involve the three
4:15:16places are there, okay, around the
4:15:18lateral ventricle hippocampus for the
4:15:21new you know learning and new memory
4:15:23formation and uh amygdala also for the
4:15:26emotions. Basically the limbic system
4:15:28they have been asking the questions. So
4:15:30if the hippocampus was in choice that
4:15:32should be the best answer hippocampus or
4:15:34amygdala, but if hippocampus is not
4:15:36there the dentate gyrus is a part of
4:15:39hippocampal formation. Okay, again a
4:15:41part of the limbic system which is
4:15:43involved in the emotions. So we can
4:15:45among the given option we can take the
4:15:46dentate gyrus also.
4:15:49Substantia was the fourth option
4:15:51then you know substantia
4:15:55is not where we have the neurogenesis
4:15:57taking place. It is confirmed although
4:15:59it is confirmed with the dopamine
4:16:01formation but neurogenesis
4:16:03uh will not take place right as such.
4:16:06Now this question was there which is
4:16:08attached to the Eustachian tube, okay?
4:16:10Does muscle which is attached to the
4:16:12Eustachian tube
4:16:15Okay? Now among these muscles like the
4:16:18Eustachian tube we have you know uh
4:16:21tensor veli palatini will be there among
4:16:24the options with a Please confirm. Look
4:16:26at the options and this image the
4:16:28sagittal section was given and let me
4:16:31also tell you that among these option
4:16:33this muscle was there tensor veli
4:16:34palatini that you have marked.
4:16:37Mostly students have recalled that it
4:16:39was the tensor veli palatini muscle
4:16:41which was there in the option and it was
4:16:45the correct answer. What do you think?
4:16:47Superior constrictor was one of those
4:16:49option not the inferior constrictor.
4:16:51Okay, Superior constrictor was there,
4:16:53all right?
4:16:55Superior constrictor. Levator veli
4:16:58palatini was also there.
4:17:09Okay.
4:17:11All right. Now, let me tell you one
4:17:13thing.
4:17:14There's a little bit catch over there.
4:17:16If we talk about
4:17:17Eustachian tube cartilage part where
4:17:20which muscle is attached. Now, there can
4:17:22be three possible four possible answers,
4:17:24but among these options let we have let
4:17:27me explain this way. If the muscle is
4:17:29laterally if lateral part of the
4:17:32Eustachian tube if it is attached, okay?
4:17:35Then you can see it is the
4:17:37this is the tensor veli palatini muscle
4:17:39if it is in the lateral aspect. But if
4:17:41it is in the inferior aspect of the
4:17:44Eustachian tube, then it is the levator
4:17:46veli palatini. So, tensor will be
4:17:48lateral, levator will be below. And one
4:17:52muscle is above, that is tensor tympani.
4:17:54That is tensor tympani. So, both tensor
4:17:56are attached here. Tensor palatini is
4:17:59also attached to the lateral border of
4:18:01the Eustachian tube. Tensor tympani is
4:18:03also attached to the upper border. You
4:18:05can see this is the tensor tympani
4:18:07muscle which is attached above the
4:18:09Eustachian tube. So, if you look at the
4:18:11Eustachian tube laterally we have tensor
4:18:13palatini, above we have tensor tympani,
4:18:15below we have levator veli palatini. So,
4:18:18now
4:18:20you have to tell me beta which was
4:18:24They have shown some pad of fat and a
4:18:26muscle above.
4:18:28If muscle above is there, then it should
4:18:30be tensor tympani beta.
4:18:33If it is below,
4:18:35then it is levator.
4:18:37But if it is on the sideways or in that
4:18:40line of the Eustachian tube, if you see
4:18:43above is the tensor tympani, below is
4:18:45the levator palatini. If it is on the
4:18:47lateral aspect or in the same line, then
4:18:49it will be tensor palatini, beta.
4:18:52Lateral aspect.
4:18:55Now, what do What What do you suggest?
4:18:57What should be the answer?
4:19:00It was like below.
4:19:05Lateral was asked.
4:19:07If what It was more or less in the same
4:19:09line also, it will be considered lateral
4:19:10aspect, then it will be tensor veli
4:19:13palatini.
4:19:19The direction of the muscle was given.
4:19:22Which was the direction, beta?
4:19:25Tensor tympani was not an option, so
4:19:27that's ruled out. Above is not an
4:19:28option, you know? So, we are looking at
4:19:30either tensor veli palatini or the
4:19:32levator veli palatini, correct? So,
4:19:34tensor veli palatini, if the muscle was
4:19:36above or in the line, that we will
4:19:37consider tensor veli palatini. If the
4:19:39muscle was below the Eustachian tube,
4:19:42then it will be levator veli palatini.
4:19:44It was lateral. If, as per you guys,
4:19:46your guys are saying that it was
4:19:48lateral, it has to be tensor veli
4:19:50palatini, beta. Better answer in that
4:19:53line. So, see what you guys are telling
4:19:55me, that it was along that line or it is
4:19:58a lateral aspect, not below, then we
4:20:01will consider tensor veli palatini
4:20:03better choice. Okay, more appropriate
4:20:05answer will be
4:20:07tensor veli palatini, beta. Okay?
4:20:11Yes. Okay, in that case, it will be
4:20:13because you check this diagram. In that
4:20:16line only, we have this muscle, you
4:20:17know? It is going in the same line.
4:20:20Below, we have levator veli palatini,
4:20:22correct? So, this is giving a clear
4:20:24indication, you know?
4:20:28And tensor tympani, as you have told
4:20:31that it was not even an option, correct?
4:20:36All right.
4:20:39Now, this question was there where organ
4:20:42with the embryological origin was asked.
4:20:44It is I think was quite easy type
4:20:46question. This time anatomy was not that
4:20:49much tough compared to the previous
4:20:50exams. Now thyroid is coming from the
4:20:53endoderm, you know.
4:20:55This is a straightforward type question
4:20:58over here.
4:21:01And
4:21:04Then we have kidney. Kidney was
4:21:10It will come from the urogenital system
4:21:12comes from the intermediate mesoderm. So
4:21:14A with the
4:21:15A with two,
4:21:17B with three,
4:21:19and C with one. This will be the answer.
4:21:24Okay?
4:21:30Yes, beta.
4:21:32Those who have missed that previous
4:21:34question, let me quickly tell you
4:21:35tomorrow you will be again coming with a
4:21:37proper recall, okay? But I'll quickly
4:21:39let me tell you. Even though today we
4:21:42are discussing only question answer and
4:21:43basically trying to recollect the proper
4:21:45option, but as you guys have told me
4:21:48that let me summarize.
4:21:50As per your recall that you are saying
4:21:52tensor tympani was not there in the
4:21:54option. Had it been in the option, we
4:21:56would have looked at the muscle above,
4:21:58but it is not in the option, so we are
4:21:59not considering that. Now coming to the
4:22:02other muscles in line or in the lateral
4:22:04aspect, that is tensor palatini muscle.
4:22:07But you can see this diagram.
4:22:10We This is the marked muscle which is
4:22:12below. That below portion we can see
4:22:14over here, below. And this is in line.
4:22:16Can you see that?
4:22:17That This is the muscle in line or the
4:22:19lateral aspect. This is the tensor
4:22:21palatini muscle. Levator palatini will
4:22:23be below.
4:22:25Okay? So even though both options were
4:22:27there, if the muscle was in the lateral
4:22:29aspect or in line with the tube, most
4:22:31most likely tensor palatini better
4:22:33option as seems from the
4:22:37recall.
4:22:38I hope that makes sense.
4:22:42Okay.
4:22:43Now, dear friends, one question was
4:22:44there with respect organs and with
4:22:46respect to the feature. This question
4:22:48was there with the choices, beta.
4:22:50This question with the choices was
4:22:52there.
4:22:55Now, you you see this this type of
4:22:57question you must have marked correct.
4:22:59But, what really happens when we are you
4:23:01know we find some question to be very
4:23:03difficult, we only tend to memorize
4:23:05those question. Okay, that question was
4:23:07there.
4:23:08We image 30 difficult choice was there.
4:23:11So, come become easy question
4:23:14we have marked the correct answer, but
4:23:15we we tend to forget it because we mark
4:23:18it and we move forward. And these
4:23:21question were also give you the marks.
4:23:24And [snorts] believe me that you guys
4:23:25have done everything good. Okay, so
4:23:28don't worry now because paper has
4:23:30already been submitted. Okay, we can't
4:23:32change the choices. So, just be happy
4:23:35and think on the positive note. Okay,
4:23:37pray to God everything is going to be
4:23:38fine. Okay, and really looking forward
4:23:42to meet you guys on the other side once
4:23:43you have write the INI exam. You really
4:23:45deserve it. Okay, but once you have
4:23:47crack the exam, once you get a good
4:23:48rank, don't forget to send me a message.
4:23:50Okay, I'll be waiting for your message
4:23:52to hear from you guys and we'll
4:23:54celebrate your success. All right?
4:23:56Now, ilium as we know it's a Peyer's
4:23:58patches. So, A meets with the three.
4:24:00Okay, these two are ruled out.
4:24:03And transverse colon we have the taeniae
4:24:06coli that's a feature. So, B with the
4:24:09two. This one. Okay, C duodenum.
4:24:13Duodenum is having the villi small
4:24:14intestine part esophagus this one. So, C
4:24:17will be our answer.
4:24:21Very good, beta. Muralidharan and all
4:24:24other dear students who have done
4:24:26majority of the questions correct means
4:24:28they good thing. Good start that I will
4:24:30say. Okay, also with good uh you know,
4:24:33rhythm in the other subjects, you guys
4:24:35are going to rock. Okay?
4:24:37Now, this question was also there. I
4:24:39really hope that see, I whenever I
4:24:42discuss the important [snorts] question,
4:24:43I always tell blood supply of the heart
4:24:45as important. So, this question was
4:24:46there.
4:24:47And I really hope that you must have
4:24:48remembered the 3D orientation of the
4:24:50heart that I described in the class.
4:24:52And now, then I tell you that anterior
4:24:55aspect of the left ventricle, that is
4:24:57LAD artery, left marginal artery in the
4:24:59lateral aspect, but posterior aspect we
4:25:02have PIVA. And I usually we crack a joke
4:25:05also on the PIVA in the class. I hope
4:25:07you remember the PIVA. So, PIVA
4:25:10is the correct answer, but PIVA is not
4:25:12given. Definite answer is right coronary
4:25:14artery.
4:25:15There is no, you know, doubt about that.
4:25:17And now, beta,
4:25:18so yes, okay. So, ECG was given. Very
4:25:22good. So, it is a Of course, it is an
4:25:24integrated question. ECG was given where
4:25:26you have to identify inferior wall MI.
4:25:29Okay, I could only this recall that
4:25:32inferior wall was marked. Okay.
4:25:42Okay, extra characteristic with oxytocin
4:25:45cells were there.
4:25:48PIVA and right coronary both should not
4:25:50be given. If PIVA is there, that should
4:25:52be the specific answer, beta.
4:25:54But I believe they should not give the
4:25:55PIVA and right coronary together.
4:25:59Both are given, then PIVA should be the
4:26:00correct answer, better answer.
4:26:06PIVA originating from the left
4:26:09How come?
4:26:15ECG is given. Okay.
4:26:18All right.
4:26:32>> So right now what we are saying is you
4:26:34know
4:26:35half of you are saying PVO was given,
4:26:37half of you are saying PVO was not
4:26:38given. Actually, you have seen the
4:26:39paper, I have not seen the paper. I can
4:26:41tell you if depending upon the choices
4:26:44PVO was there, that's the best answer.
4:26:46Not there, right given right coronary
4:26:48artery should be the answer.
4:26:50So I have given you both.
4:26:52Okay? Now, what was really in the exam
4:26:56that I don't know. Depending upon the
4:26:58options given, that will be the answer.
4:27:00If PVO was given, that's the best
4:27:01answer. If it was not given, then the
4:27:03right coronary artery.
4:27:05PVO may be coming from the left coronary
4:27:08artery, that's okay. But even if it is
4:27:09coming from the left coronary artery, it
4:27:11will be supplying the same territory.
4:27:13The territory won't change. Only the
4:27:14dominance will change, okay? And that
4:27:16hardly matters. You're trying to say
4:27:18your right coronary artery will be
4:27:19always the PVO if at all it is coming
4:27:21now, that should be supplying the
4:27:23inferior wall MI. The inferior wall if
4:27:25it is there.
4:27:30Now this type of question was there.
4:27:33Which of the following remnant of the
4:27:34embryological hindgut?
4:27:37Embryological hindgut and retrorectal
4:27:40area.
4:27:41If these two hints were there,
4:28:00tell me this retrorectal area
4:28:04embryological hindgut.
4:28:08All right, I consider but I if it is not
4:28:10given, we will take this.
4:28:17So posterior See See inferior wall MI,
4:28:19usually we consider right coronary
4:28:21artery because PVO is the one who is
4:28:23supplying over there. Of course, we have
4:28:25other branches of the right coronary
4:28:26artery also supplying over there. So,
4:28:28we'll take
4:28:31If we take a Piva coming from the left
4:28:33coronary artery, Piva will be supplying
4:28:36the inferior wall. Yes, but the rest of
4:28:38the branches of the right coronary will
4:28:39be also supplying over there in the
4:28:41inferior wall.
4:28:42Okay?
4:28:51All right. Now, in this option, tail gut
4:28:54cyst should be the better answer. Why?
4:28:55Because retrorectal area and it is a
4:28:59remnant of the embryological hindgut.
4:29:01Others are not the embryological hindgut
4:29:04remnants. Okay?
4:29:08Presacral or retrorectal area
4:29:10presacral or retrorectal area are same.
4:29:14Okay? And embryological hindgut is tail
4:29:17gut cyst.
4:29:18Okay? Chordoma is not coming from the
4:29:20hindgut. They're coming from the
4:29:21notochord. Epidermoid cyst and the
4:29:24dermoid cyst and the soft tissue cysts
4:29:25are there, right? As you know in the
4:29:28dermatology that you have studied.
4:29:33Now, there was one histological slide.
4:29:35Some students have recalled that thymus
4:29:37was there. Some students are telling
4:29:38that sublingual gland was there.
4:29:40So, I did not get any picture from the
4:29:42students. So, I need
4:29:45a favor from you guys. Please send me
4:29:47the picture.
4:29:48Whatever similar picture you can find
4:29:50close to the real picture, if you can
4:29:52send me in the DM, I'll be using that.
4:29:57And if you can tell me what
4:29:59gland was actually there, thymus or
4:30:01sublingual.
4:30:24>> Sublingual.
4:30:29Okay, so sublingual was there. Okay.
4:30:33Sublingual gland was there even though
4:30:36option had pancreas also.
4:30:43Thyroid.
4:30:51Septa in the nuclei like surrounding.
4:30:58Pancreas, thyroid, sublingual.
4:31:01Liver was also there. Okay, one option
4:31:04was liver.
4:31:05So thymus was not at all there.
4:31:08Sublingual, pancreas, thyroid, and liver
4:31:10was there, right?
4:31:12Okay, thymus was not there.
4:31:15So among these an answer was sublingual
4:31:16gland.
4:31:19Islets were not shown.
4:31:21Striated ducts were there because
4:31:23pancreas in the gland can be ruled out
4:31:25from the striated ducts. If the striated
4:31:26ducts are there, then it is sublingual
4:31:28gland. Striated ducts are not there,
4:31:30then it is pancreas. Liver will be
4:31:32altogether not looking similar.
4:31:37Thyroid is the answer. What are you
4:31:39saying?
4:31:40Majority of the students are saying
4:31:42Majority of the students are saying that
4:31:44sublingual gland is answer.
4:31:47Thyroid.
4:31:52Okay, what was there? Answer, what is
4:31:54your What do you think was the choice?
4:31:56Okay, I got the options, but what was
4:31:58the
4:31:59you know,
4:32:00correct answer? Thyroid.
4:32:08Arrow marked on the colloid. Okay.
4:32:16No colloid, no follicle.
4:32:21Actually, students are telling as per
4:32:22their choices, whatever they have marked
4:32:24now, accordingly they are telling that
4:32:26colloid was there, some are saying
4:32:27colloid was not there. That is a little
4:32:30bit problem when we try to take the
4:32:31recall.
4:32:34Okay, so I'll wait
4:32:37I got the options now, and if I will be
4:32:39really thankful to you guys if you guys
4:32:42can send me a close picture to that real
4:32:45exam. Okay, beta?
4:32:47So, that is all that I had got the all
4:32:49the recall, ticket. And tomorrow
4:32:54most likely tomorrow, okay, or day
4:32:55after, max, I'll be preparing the final
4:32:58thing, okay?
4:34:43>> Sorry. Sorry, guys. There was some issue
4:34:46with audio. My audio This one got
4:34:48disconnected. Okay. Yeah, so I'm able to
4:34:51see Sorry. Sorry. Yeah, yeah, I'm back
4:34:54now. I'm back.
4:35:00Okay. So, yeah, everything is all right
4:35:02now. Okay, pathol
4:35:04full his two slides. Okay.
4:35:07Let's look at all those. So, but I I
4:35:09couldn't get so many recalls. Yeah, I'm
4:35:12great. I'm great. How are you? And I
4:35:13hope all the questions that came in
4:35:16I and I CET, you were able to solve them
4:35:19with the help of your knowledge. If
4:35:21knowledge did not work out, I had shown
4:35:23so many of the tricks and how to, you
4:35:25know, approach a question. I'm sure you
4:35:27would have done well with that, right?
4:35:29Okay. So, first question, let me just
4:35:32talk about this question now. So, please
4:35:33look at this.
4:35:34Anything anytime if you want to change,
4:35:36you can please always. Yeah, good
4:35:38evening, everyone. So, this was the
4:35:40first question. Please confirm this.
4:35:42Patient has hemoglobin 7, MCV 68, serum
4:35:45ferritin is low. Only these three were
4:35:47given.
4:35:49Image was goblet cells, and options were
4:35:51adenocarcinoma. Okay. So, somebody is
4:35:54telling. So, let us recall this one by
4:35:55one. Sorry, guys. One by one, let us
4:35:57recall one by one.
4:35:58I'm I hope all of you are able to see
4:36:00the first one. Yeah. Hemoglobin This was
4:36:02there. Yeah, hemoglobin was nine. Okay,
4:36:04I'll just change. Please keep telling me
4:36:05if there is anything. Hemoglobin nine
4:36:07eight doesn't matter really. Most
4:36:09important thing was serum ferritin is
4:36:11low. This was the most important. Serum
4:36:13ferritin is low means definitely only
4:36:16one diagnosis. What is that only one
4:36:17diagnosis? Iron deficiency anemia, isn't
4:36:20it? So, iron deficiency anemia, that is
4:36:22a correct.
4:36:24Okay, next question. Please tell me now,
4:36:26is it the correct recall? Uh did they
4:36:28give image of prostatic biopsy or did
4:36:30they give any pattern or they had given
4:36:32straight away? Prostatic biopsy shows
4:36:34adenocarcinoma. Gleason score is 4 + 4 8
4:36:36is what this was this the question?
4:36:38Please tell me now. And what is the
4:36:40Gleason's grade group? They had asked
4:36:41this, right?
4:36:44Uh okay, B12 folate megaloblastic was
4:36:47given. Okay, so this was megaloblastic
4:36:49anemia.
4:36:52Okay.
4:36:57Okay, yeah. So, yeah, correct answer to
4:36:59this is four. Very good. We had
4:37:01discussed this in the class. 4 + 4 is 8.
4:37:038 will be what? Score of four. Nine and
4:37:0610 will be four of score of five, isn't
4:37:08it?
4:37:09Yeah. So,
4:37:10patho Okay, so they gave 4 + 4 is equal
4:37:13to 8. Okay, okay, okay. No, no, no, no,
4:37:15no. 4 + 4 is it's a surgery people are
4:37:17not going to do Gleason scoring, guys.
4:37:19So, I know this is
4:37:224 + 4 is equal to 8. It will be grade
4:37:24group four. New Gleason's grade group
4:37:26four. So, what is the answer for
4:37:28different grade groups we discussed?
4:37:30Grade group Okay, score of six will be
4:37:32grade group one. Score of seven. 3 + 4
4:37:34is equal to seven, grade group two. 4 +
4:37:373 is equal to seven, grade group three.
4:37:38Score of eight. Any score of eight. 4 +
4:37:414, 5 + 3, 3 + 5. All of them will be
4:37:44grade group four. And a nine or 10 will
4:37:46be grade group five, right? Yeah. So,
4:37:49this is
4:37:50Yeah. Next. So, please confirm this. Was
4:37:53there a question like this or or had you
4:37:55know, this I'm not fully recalled
4:37:57properly, I guess.
4:37:58Please tell me now. Liver biopsies as
4:38:01follows. What is the likely stain used
4:38:03and the diagnosis? Was this a question?
4:38:05Yeah?
4:38:06>> [clears throat]
4:38:07>> Was this a question?
4:38:10So, liver biopsy. This This is a Mason
4:38:12trichrome stain, basically. So, I I've
4:38:14not fully
4:38:16recollected the question here. Please
4:38:18tell me now, was there such question
4:38:19asked? First question First thing is
4:38:21that So, was there a question asked like
4:38:23this?
4:38:25Okay. So, not the same image, of course.
4:38:28Not the same image, I know that. That is
4:38:30fine, but still image might not be
4:38:34exactly the same.
4:38:36Only stain was asked, not the diagnosis.
4:38:38Okay. Yeah, tell me now, what is likely
4:38:40stain used? Okay. Yeah, tell me now,
4:38:42what is the stain now? Of course, they
4:38:43had given one Van Gieson, I guess.
4:38:47Van Gieson would have been given. Yeah.
4:38:51Then, Mason trichrome would have been
4:38:53given, right?
4:38:54Mason trichrome. Okay, cirrhosis was
4:38:57given.
4:39:00Okay. Okay, liver biopsy of a alcoholic
4:39:02patient. Okay. Liver biopsy of an
4:39:05alcoholic patient suspected of
4:39:08cirrhosis, right?
4:39:09Biopsy of an alcoholic patient
4:39:12suspected of cirrhosis.
4:39:18So, I think now this makes the question
4:39:20correct.
4:39:21Yeah, one more option was methylene
4:39:23blue. That is not the answer.
4:39:27Then, one more would have been Prussian
4:39:28blue, also, I guess, right? Oh, no, PAS
4:39:30was given. Okay. Yeah. So, what is the
4:39:33answer to this question?
4:39:39Yes, answer to this is Mason trichrome.
4:39:41This is a special stain for fibrosis,
4:39:43Mason trichrome. Very good. Next, please
4:39:46tell me now, what else was there? One
4:39:48more question I have got to know is
4:39:49this, histology of MI. These were the
4:39:52unfortunately, as of now I have been
4:39:54able to you know histology of MI has
4:39:57given below likely diagnosis. Again,
4:39:59image might not have been the same. So,
4:40:01what is the question asked? This is of
4:40:02course the waviness of fibers are there.
4:40:04Then loss of nuclei there is karyolysis
4:40:07coagulative necrosis. In between there
4:40:09are neutrophils, isn't it? Yeah, so in
4:40:11between there are neutrophils. Was this
4:40:13the question asked? Answer is this will
4:40:14be 3 days, right? Yes, this will be 3
4:40:17days.
4:40:20Yes. So, neutrophil with coagulative
4:40:22necrosis.
4:40:23Neutrophil asked okay on histology there
4:40:26was no image.
4:40:28No image on this. No image that
4:40:30described the image.
4:40:32Was there image or no image? Okay, 1 to
4:40:353 days was there?
4:40:411 to 3 days was there?
4:40:43Okay, options were 1 to 3 days. That
4:40:45would okay.
4:40:47Anything 3 to 4 days was there? If that
4:40:49was the case then I would be answering
4:40:51that.
4:40:521 to 3 days, 5 to 7 it won't be answer.
4:40:555 to 7 it won't be answer. 7 to 10 also
4:40:57won't be answer.
4:40:59Image was there or no or they described
4:41:01the image?
4:41:03Image was there. Okay. Okay. Okay. Okay.
4:41:05Okay. Okay. Yeah. So, now 7 to 10 and
4:41:08one more was 0 to 4. Okay. Now, this
4:41:10will be answer will be what then? Tell
4:41:12me now.
4:41:13Yes, 0 to 4. Answer will be 1 to 3 days.
4:41:16This will be the answer. Okay. On yeah,
4:41:19option one 1 to 3 days. That will be the
4:41:21correct answer. Best would have been
4:41:22somewhere around 3 days. Somewhere
4:41:24around 3 days, right? Yeah. So, now
4:41:26please guys please tell me now what were
4:41:28the other question? One by one I want to
4:41:29take one by one. Whoever types the first
4:41:31one I will end up taking that question
4:41:33first and we will you know recall that
4:41:35completely. These were the only four
4:41:37which I have got recalled until now.
4:41:39Please please tell me now what is the
4:41:41fourth fifth question? Please tell me.
4:41:44Yeah, there was a image of retic count
4:41:46was given. Image was reticulated was
4:41:48there. Please tell me now.
4:41:50Reticulocyte count image uh methylene
4:41:51blue stain.
4:41:53What was the question?
4:41:59So, what was that question? Please tell
4:42:00me now.
4:42:02Yes. Please uh please tell me what was
4:42:04that question. Methylene blue stain and
4:42:06a reticulocyte count was there.
4:42:07I think there was some image like that.
4:42:09I do not know.
4:42:11So, let me try to bring that image.
4:42:13Yeah, supravital stain. What was the
4:42:14question? Yeah.
4:42:15So, they they asked the image or they
4:42:18asked uh you know uh
4:42:21Yeah, what was the question? Please tell
4:42:22me. Reticulocyte count image. What was
4:42:25the question on that reticulocyte count?
4:42:28Supravital stain. Straight away asked.
4:42:30Which of the following is a supravital?
4:42:32Okay, peripheral smear image was given.
4:42:35Okay.
4:42:36Image of reticulated reticulocyte Okay.
4:42:38Okay. Okay. So, let me try to do that.
4:42:40Okay.
4:42:44Peripheral blood smear of a patient
4:42:48with a
4:42:49special stain is as below.
4:42:51What is the stain?
4:42:56Was this the question?
4:42:59Was this the question? Please tell me
4:43:00now.
4:43:01Okay, this was there. I'll add a image
4:43:03also. Yeah, this is the image I've given
4:43:05you somewhere similar. Although exactly
4:43:08need not be the same image. Don't worry.
4:43:10Yes. So, this was there, right? Yeah,
4:43:12methylene blue. What were the other
4:43:13option? Whatever were the options as
4:43:14well. This is a methylene blue stain,
4:43:16right?
4:43:17Yeah, okay. Giemsa, methylene blue,
4:43:19Leishman was there. Okay, answer is
4:43:21methylene blue.
4:43:22This is a methylene blue stain. Okay,
4:43:24next one. Anybody any other question?
4:43:26Fifth next question.
4:43:28Yes, please try to recall me.
4:43:31Histopath of Barrett's esophagus and
4:43:33option was adenocarcinoma was there.
4:43:35Okay.
4:43:36Yeah. Okay, Barrett's esophagus. That
4:43:38also will do that.
4:43:43Okay, Barrett's esophagus.
4:43:47Okay, good. I'm so quick getting you the
4:43:55Okay, there was an image of goblet cell
4:43:57you are telling me, right?
4:43:59Barrett's esophagus with image of goblet
4:44:01cell.
4:44:02Okay, let me try to see how many few
4:44:04I've got. Okay, I'll I'll I'll use the
4:44:06same image that I've used in the class.
4:44:08I do not know was this the image in
4:44:09exact doesn't matter. Okay, so this was
4:44:12the image, right?
4:44:15Patient the any history was given?
4:44:17Patient presents with heartburn.
4:44:24Patient presents with heartburn. Biopsy
4:44:27of G Junction. Okay.
4:44:31Was this the image? Anyway, doesn't
4:44:33matter.
4:44:34What was the
4:44:36Okay, so this is your Barrett. What was
4:44:38the question on thalassemia? Thal major
4:44:40question, please tell me what was the
4:44:41question on thalassemia major?
4:44:43Please try to recall.
4:44:47Okay, this was not the exact image
4:44:48doesn't matter. Okay, please try to
4:44:50recall the you know the exact question
4:44:53on uh
4:44:55Okay, let me see. I'm changing my image.
4:44:58Let us see.
4:45:02Yeah.
4:45:03So I'm using this image. Please check if
4:45:05this was the image given to you.
4:45:11Okay, you could see columnar cell
4:45:13perfectly. I've changed the image now.
4:45:16Okay, hemoglobin 8 MCV 60 serum ferritin
4:45:19low that we already discussed. That was
4:45:21uh
4:45:22uh you know, that was
4:45:24uh
4:45:24IDA, right? That we already discussed.
4:45:26Okay, now tell me.
4:45:29Okay, question was long-standing chronic
4:45:31inflammatory condition amyloid deposit.
4:45:33Okay, very good. So what is the answer?
4:45:34AA. Long-standing
4:45:38Patient has a long-standing chronic
4:45:40inflammatory disease, what amyloid will
4:45:42be deposited, right?
4:45:44Patient has a
4:45:45long standing
4:45:47chronic inflammatory disease
4:45:50{comma} which type of amyloidosis is
4:45:53seen?
4:45:58Right? This was the question. AA, AL
4:46:01A beta 2 M and what were the other
4:46:04option?
4:46:06Yes?
4:46:12Okay, hepcidin low iron overload present
4:46:14for thalassemia. Okay, that's good.
4:46:16That's good. So
4:46:19Yeah. So next question, okay.
4:46:21Any history for thalassemia?
4:46:24Any history for thalassemia?
4:46:26Yeah, any history was given for
4:46:28thalassemia?
4:46:30A patient presents with anemia,
4:46:32jaundice.
4:46:36A patient presents with anemia,
4:46:38jaundice.
4:46:43Investigation shows low
4:46:47hepcidin
4:46:48and high serum iron levels.
4:46:51What is the likely diagnosis?
4:46:59What is this option? Somebody is telling
4:47:01ineffective erythropoiesis in
4:47:02thalassemia major. What is that
4:47:04question?
4:47:05Systemic iron overload and some other
4:47:07option. Was this question for what?
4:47:11What was the question asked here?
4:47:13Intravascular hemolysis present in one
4:47:16of the option in thalassemia. No, that
4:47:17is Okay, so multiple true false was
4:47:20there?
4:47:21Multiple true false was there in that
4:47:22thalassemia question?
4:47:25What is the multiple Was it a multiple
4:47:26true false type of question?
4:47:31Oh, they had mentioned thal major
4:47:33straight away. Okay. So, true about
4:47:35thalassemia multiple true false, right?
4:47:41True about thalassemia and it was a
4:47:42multiple true false, isn't it?
4:47:44Was that the case?
4:47:46True about thalassemia and then multiple
4:47:48true false. Yes or no? Please.
4:47:57Yeah, true about thalassemia and
4:47:59multiple true false. Was that the
4:48:00question?
4:48:05Okay, multiple correct. Low hepsidin,
4:48:07that is true.
4:48:11That is true. High serum iron, that is
4:48:12also true.
4:48:16Ineffective erythropoiesis.
4:48:18That is also true.
4:48:24Ineffective erythropoiesis was also
4:48:26true.
4:48:27Then whatever was there, intravascular
4:48:29hemolysis, that is false.
4:48:31What else was the other option?
4:48:36False. This is false.
4:48:38Ineffective erythropoiesis, iron
4:48:40overload, hepsidin low, that is correct.
4:48:43Intravascular hemolysis. Fifth one was
4:48:45there or only this many?
4:48:56Okay.
4:48:58Okay. Okay, frontal bossing no direct
4:49:01They gave history of thalassemia. Okay,
4:49:03some people are saying history was
4:49:04there.
4:49:05So, I'll just I do not know. Some people
4:49:08are saying directly thalassemia was
4:49:09there.
4:49:10So, okay. Anyway, let's keep it open.
4:49:17Only these four were there. Okay, so
4:49:19first A, B, C are true in this. One
4:49:22Okay, so one, two, and three are true.
4:49:25Okay, next question. Let me take that
4:49:26question now. Somebody is talking about
4:49:29this. Let us take that. Amyloidosis
4:49:31question is done.
4:49:34No hepsidin. Hepsidin was not there.
4:49:37Somebody is telling Hodgkin lymphoma.
4:49:38What was that question about Hodgkin
4:49:39lymphoma? Hodgkin lymphoma staging. What
4:49:41was the question? Hodgkin lymphoma
4:49:43staging?
4:49:49What was the question on Hodgkin
4:49:50lymphoma staging?
4:50:08Please tell me now what was the question
4:50:09on Hodgkin lymphoma staging?
4:50:16Okay. Oh, X
4:50:18X Okay, it was given Okay, in Hodgkin
4:50:20lymphoma X refers to what? Okay, X
4:50:23refers to bulky disease.
4:50:28Option was there?
4:50:34X denotes usually bulky disease. Yeah,
4:50:36bulky. Yeah, correct. Bulky tumor, bulky
4:50:39disease, whatever.
4:50:42That will be the correct answer. X
4:50:43refers to bulky disease in Hodgkin
4:50:45lymphoma staging.
4:50:51Uh yes.
4:50:56Bulky. Yeah, that was there. That was
4:50:57there. Next is
4:50:59Okay, one more question, medium vessel
4:51:01vasculitis. What was the question? Which
4:51:03of the following is not a medium vessel
4:51:04vasculitis, right? Or which of the
4:51:05following is medium vessel vasculitis?
4:51:08Yep, let tell me.
4:51:10Is not a medium vessel vasculitis?
4:51:18Was this the question? Or which is a the
4:51:20vessel vasculitis.
4:51:23Okay, RSL image was given. Okay. Okay.
4:51:26Okay. Okay. That's good. That's good.
4:51:28Okay, RSL image was there.
4:51:35Okay, I'll take one image of RSL. Let us
4:51:38say this.
4:51:42Okay.
4:51:48Okay, tell me now.
4:51:58Which is not a medium vessel vasculitis?
4:52:00Okay.
4:52:01Bulky tumor then okay, biopsy from
4:52:16Kawasaki was there.
4:52:20Okay, nephron image. So many of you
4:52:22quickly if you if you are so quick, you
4:52:25know, okay, chalo chalo chalo let's do
4:52:26one of them one by one. Okay. Now, which
4:52:29of the following is not a medium vessel
4:52:30vasculitis? Whatever there option, pan
4:52:32was there. Kawasaki was also there in
4:52:34this.
4:52:35Pan was there.
4:52:37Uh lung cavity nodules in the lungs put
4:52:39them negative caseous granuloma within
4:52:42Langerhans cell diagnosis TB. Okay,
4:52:44that's good.
4:52:46So
4:52:48Uh
4:52:49no no caseous granulomas were there.
4:52:51Necrosis was there. ESR is raised. Giant
4:52:54cells are there. A sound patient lung
4:52:56cavity nodules in the lungs put them is
4:52:58negative.
4:52:59What were the other option?
4:53:02Looks like TB. What were the other
4:53:03option? Had Did they give him any image?
4:53:07Oh okay. So lymphadenopathy on both
4:53:09sides of the diaphragm. Biopsy from
4:53:12lymph node.
4:53:14Okay.
4:53:17Biopsy from lymph node I'll make.
4:53:19Who had disease on both side of the
4:53:21diaphragm?
4:53:29Okay.
4:53:33Uh
4:53:35Okay, then histoplasma. So, if there was
4:53:38no TB cases necrosis, then histoplasma.
4:53:41So, yeah, that is the history then it
4:53:43will be histoplasma if no TB.
4:53:49Then histoplasma.
4:53:54So, image was there giant cell and all
4:53:57those image was there or they are
4:53:59described?
4:54:03Yeah, image or
4:54:05description was there?
4:54:14Okay, this was Okay, okay, sorry. Biopsy
4:54:17from lymph node.
4:54:20Okay.
4:54:23Option.
4:54:34Okay, okay, okay, okay, okay. Biopsy was
4:54:36from cervical only. Okay.
4:54:39Mm, okay. So, description was there.
4:54:41Okay, no image was given. Okay.
4:54:43Caseating granuloma was there, what is
4:54:45the diagnosis?
4:54:48Okay.
4:54:56Okay, this will be
4:55:04Okay, histoplasma will be the answer
4:55:05because there is no TB given.
4:55:08Uh Alzheimer's histopath slide was
4:55:10given.
4:55:11They would have given uh what? Cerebral
4:55:13amyloid angiopathy?
4:55:16What was the
4:55:20What was the question? Please tell me
4:55:21now.
4:55:24In Alzheimer, what was the question
4:55:25asked on Alzheimer? What was the
4:55:26question asked on
4:55:28Alzheimer histopath?
4:55:31Sarcoid was there, but sarcoid won't be
4:55:33the answer.
4:55:35Yeah, caseating granuloma if there is no
4:55:36TB then histoplasma or even nocardia
4:55:39also.
4:55:40Histoplasma, nocardia, both of them.
4:55:45Okay.
4:55:46Alzheimer histopath slide, what was the
4:55:48question? Please tell me now.
4:55:51Yeah, what was the question on Alzheimer
4:55:53histopath slide?
4:56:00Uh yes.
4:56:02Wegener
4:56:04No, Weg- Why not Wegener? Wegener will
4:56:07not have caseating granulomas.
4:56:09Wegener will not be having caseating
4:56:11granuloma.
4:56:16In that
4:56:22Okay.
4:56:24Yeah, so in Wegener you don't get
4:56:26Langhans giant cell. That that will not
4:56:28be there.
4:56:29In Wegener you don't get caseating
4:56:30granuloma.
4:56:33Okay, neuritic plaque image was given.
4:56:35Okay, and they had asked direct
4:56:37diagnosis directly, right? That was a
4:56:39question. Okay.
4:56:46Okay. Neuritic plaque was given and they
4:56:48had asked the diagnosis.
4:56:51Or they had asked anything else about
4:56:54that.
4:56:56Okay, let me see. This was the image
4:56:58given. Some image, let me add one image.
4:57:07So, what was the age given? 70 year?
4:57:18Or 80 or what what age was given? So,
4:57:21some somewhat like this image or
4:57:22somewhat like this?
4:57:25Okay, incomplete penetrance. What was
4:57:27the question asked in incomplete
4:57:28penetrance? Please tell me. Nodal medium
4:57:30muscle vasculitis. Okay, one more option
4:57:32was uh
4:57:35leukocytoclastic vasculitis. Yeah.
4:57:41Buerger.
4:57:46Then one more should be in Kawasaki.
4:57:49Answer would be leukocytoclastic
4:57:50vasculitis. That is a small vessel
4:57:52vasculitis, right?
4:57:55Okay, all
4:57:57uh what was the question asked on
4:57:58incomplete penetrance in genetics?
4:57:59Please tell me now. Incomplete?
4:58:01Yeah, what was the
4:58:03question on incomplete penetrance in
4:58:04genetics?
4:58:07So, which of the following will happen
4:58:08due to incomplete penetrance? Was that
4:58:09the question like that?
4:58:12Which of the following will occur due to
4:58:13incomplete penetrance?
4:58:17Okay.
4:58:19Perineuritic plaques with pictures. Uh
4:58:21that was there. Okay. Image would have
4:58:23been different by the way then.
4:58:36Anyway, I'll I'll I'll try to get the
4:58:38image, whatever image you got. I do not
4:58:40know whether the exact same image or
4:58:41not.
4:58:45Which is microscopic polyangiitis was
4:58:47also there. Okay, please tell me now.
4:58:48Was that a multiple true false type of
4:58:50question? Nodal medium muscle
4:58:51vasculitis.
4:58:53Leukocytoclastic is also not a vascular
4:58:55medium vessel. Microscopic PAN is also
4:58:57not. MPA is also not.
4:59:01Okay.
4:59:04So, So, please tell me was it a multiple
4:59:06true false?
4:59:10Was it a multiple true false?
4:59:21What was the question on oncogene
4:59:23addiction?
4:59:25What was the question on oncogene
4:59:27addiction?
4:59:29Oncogene addiction is nothing but the
4:59:30phenomena for driver mutation we call
4:59:32it, right? So, despite having multiple
4:59:34mutations in a tumor, tumors will be
4:59:37dependent on one important pathway for
4:59:39uh you know, carcinogenesis.
4:59:42Right? That is your That is called as
4:59:44oncogene addiction. What was the
4:59:46question?
4:59:47Berger was not there.
4:59:49Okay. So, which is not a If you are
4:59:52asking me this is not there, then in
4:59:54this somebody is also telling MPA. MPA
4:59:58is also small vessel. Leukocytoclastic
5:00:01is also small vessel.
5:00:03Okay.
5:00:04True statement on oncogene addiction.
5:00:08Yeah, this
5:00:09true statement on oncogene addiction.
5:00:10I'm sure they should have given you
5:00:12uh despite having multiple mutation, the
5:00:15cancers will be heavily dependent on a
5:00:17single oncogene mutation. That should be
5:00:19the answer.
5:00:23Kawasaki, it was Wegener. Okay.
5:00:26So, okay, it was not Kawasaki then
5:00:28Wegener. So, then they should have asked
5:00:30you it is not
5:00:32Then all these the B, C, and D in this
5:00:34are small vessel vasculitis. Which of
5:00:36the following is a medium vessel
5:00:38vasculitis then? They should have been
5:00:39the question.
5:00:41Yeah, define oncogene addiction. So,
5:00:44oncogene addiction is despite having
5:00:45multiple mutations, tumors usually
5:00:49dependent are dependent on one important
5:00:51pathway for carcinogenesis. For example,
5:00:54take example of colorectal carcinoma or
5:00:57any any tumor you take. So, you know,
5:00:59there are so many mutation, P53
5:01:01mutation, Keras mutation, everything,
5:01:03but ultimately they are all dependent on
5:01:05one APC mutation. This is called as
5:01:06addiction.
5:01:08So, these are called addiction. Better
5:01:10we don't use the word addiction, but
5:01:11yes, that is what is addiction.
5:01:15Okay.
5:01:16Which of the following is not a medium
5:01:18vessel vasculitis? PAN, Buerger,
5:01:20granulomatosis with polyangiitis.
5:01:22So, not in this
5:01:24PAN, Buerger, both of them are medium
5:01:26vessel vasculitis. Granulomatosis with
5:01:28polyangiitis definitely not.
5:01:30Uh then uh
5:01:35PAN, Buerger disease, granulomatosis,
5:01:38and one more option, but no Kawasaki.
5:01:43The statement on oncogene.
5:01:45Okay, that's what oncogene addiction.
5:01:54Was this the question?
5:01:56Wegener is a small vessel, but whatever
5:01:58option you are giving, there are many
5:01:59other small vessel.
5:02:02Okay.
5:02:07Okay. So, oncogene addiction.
5:02:10Cancer cells are dependent on
5:02:14one mutation
5:02:18rather uh despite having multiple
5:02:20mutation.
5:02:23That is the meaning.
5:02:32Okay. Which statement is true they
5:02:33asked. This is the definition. I am
5:02:35telling you the definition. You have to
5:02:36tell me what what were the option. So,
5:02:38oncogene addiction refers to cancer
5:02:41cells are dependent on one mutation for
5:02:43carcinogenesis despite having multiple
5:02:45mutations. This will be the definition
5:02:47of oncogene.
5:02:48Okay.
5:02:52Yeah, because of this targeted therapy
5:02:54becomes easier. Because of this targeted
5:02:56therapy becomes easier for us. Because
5:02:59they are heavily dependent on one gene
5:03:01mutation. Although there are multiple
5:03:03mutations, one gene is mutated.
5:03:05Sometimes it's also called driver
5:03:06mutation. Because it drives the
5:03:08carcinogenesis.
5:03:11Okay, formalin fixed tissue for IHC.
5:03:15That is a correct answer for IHC. We
5:03:17discussed this in the class on solid
5:03:19samples. Formalin fixed tissue is used
5:03:22for IHC.
5:03:28For protein detection,
5:03:33IHC, immunohistochemistry, right?
5:03:44And what else was there? Fish. Okay.
5:03:49Fish, we don't detect protein.
5:03:51So, IHC is the correct answer for this.
5:03:54IHC.
5:03:55A tumor is dependent on single oncogene
5:03:57and targeted therapy against that
5:03:59oncogene is therapeutic. Yeah. Uh yes,
5:04:02Akhil only. That is true. Whatever you
5:04:04are saying, that is true. A tumor is
5:04:07dependent on I'll add that. That will be
5:04:09the correct answer then.
5:04:11A tumor is dependent on a single
5:04:14oncogene and targeted therapy against
5:04:17that oncogene will be therapeutic.
5:04:23So, if this was in the option, this is
5:04:25correct. If this was in the option, this
5:04:27will be correct.
5:04:29For oncogene addiction, please tell me.
5:04:33Mechanisms of carcinogenesis in UV rays.
5:04:36Yes, what they had given? Thymine
5:04:38dimers, pyrimidine dimers.
5:04:41Yes?
5:04:44Yeah, what was the option? Pyrimidine
5:04:46dimer. Yeah, correct. Mechanisms of
5:04:48carcinogenesis, pyrimidine dimers.
5:04:52So, that is the correct answer.
5:04:53Mechanism
5:04:55mechanism of carcinogenesis
5:04:59in UV rays.
5:05:04Pyrimidine dimers.
5:05:09That would be the correct answer.
5:05:14Then, what else was there? What else was
5:05:16there? What else was there?
5:05:18Uh
5:05:19mutation and can be exploited for
5:05:21treatment, that is correct. So,
5:05:23ultimately for, you know, oncogene
5:05:26addiction, yes.
5:05:29Tumor is dependent on a single oncogene
5:05:32and targeted therapy against that
5:05:34oncogene can be exploited for
5:05:36therapeutic use.
5:05:44Okay, that is the correct answer.
5:05:48Uh what else was there?
5:05:51Uh
5:05:52what a pedigree What was the question
5:05:53on, you know, sorry guys, I missed it
5:05:55out suddenly again. So, tell me what was
5:05:57that question on incomplete penetrance?
5:05:59What was the question on incomplete
5:06:00penetrance, please?
5:06:05And there was also one question on
5:06:07imprinting also, right?
5:06:09Yeah, please tell me both of them.
5:06:10Genetics question they were there.
5:06:15Uh
5:06:15image of CRISPR was given.
5:06:21What was the question that was? Please
5:06:23tell me now.
5:06:30Disease not present in all generation.
5:06:33Okay, disease not present in all Okay,
5:06:35definition of incomplete, yes, correct.
5:06:37So, then incomplete penetrance refers to
5:06:40no disease, yes, correct.
5:06:43Incomplete penetrance leads to I would
5:06:44say That was the question.
5:06:47Disease not present in
5:06:50autosomal dominant disease not present
5:06:52in all generation. That should have been
5:06:53the best answer.
5:06:56Okay.
5:06:57Okay, true about incomplete.
5:07:04Incomplete penetrance, right?
5:07:09All male affected every member in the
5:07:11family affected. Okay, disease not
5:07:12present. That is the correct answer.
5:07:33Okay.
5:07:34Okay.
5:07:35Uh what was the neonatal heart disease?
5:07:38Neonatal heart disease?
5:07:40That would be a pediatrics question.
5:07:42Pediatrics question. Which of the
5:07:43following is not criteria for Kawasaki?
5:07:47That would be again pediatrics.
5:07:49That would be a pediatrics question.
5:07:50Sorry, guys.
5:07:53Okay.
5:07:54Uh what was the question on uh
5:07:55I I think imprinting disorder. What was
5:07:57the you know question on imprinting
5:08:00disorder? Please tell me. What was the
5:08:01question on imprinting disorder?
5:08:06No, no. Conduction block was asked. That
5:08:08will be conduction block medicine.
5:08:16What what is happening? Sorry, guys. We
5:08:18are talking pathology pathology.
5:08:21So, come back. Come back. Now, let's uh
5:08:26Yeah, please come back.
5:08:28Base excision repair was there. What was
5:08:30the question on base excision repair?
5:08:34Image based question. How image based
5:08:36question on base excision repair?
5:08:38They had given a diagram of base
5:08:40excision.
5:08:44Okay.
5:08:51That anyway that would have been more of
5:08:53biochemistry question. Let's come back.
5:08:55Tell me what was the question asked on
5:08:57uh
5:09:00Yeah, what was the question asked on
5:09:01that uh imprinting disorder? Please tell
5:09:04me what was the imprinting disorder
5:09:05question.
5:09:10Uh alternate generation affected,
5:09:11multiple person in one generation
5:09:13affected, next generation not affected.
5:09:16These were the option. Okay, in this
5:09:18next uh alternate generation affected or
5:09:20multi- No, alternate generation will not
5:09:22be affected. The
5:09:25uh next generation not affected.
5:09:30Okay, mechanism of repair. Question was
5:09:33what is the mechanism of Okay.
5:09:35Single base pair new then single base
5:09:37pair then it will be a base excision.
5:09:41Yeah, that will be anyway biochemistry.
5:09:42They will deal in biochemistry.
5:09:45Okay.
5:09:46Biochemistry.
5:09:48Please tell me uh
5:09:50options were alternate generation
5:09:51affected. No, that is not true. Multiple
5:09:53person in one generation affected
5:09:55because of uh you know incomplete
5:09:57penetrance. No.
5:09:59Uh then uh what else is there? Next
5:10:01generation not affected. No, then in
5:10:03this best answer will be alternate
5:10:04generation affected.
5:10:05Yeah, in this best answer will be
5:10:07alternate generation affected.
5:10:09That will be the best answer in the
5:10:11given option.
5:10:12Uh
5:10:13yes.
5:10:14Neurofibromatosis. What was the
5:10:16neurofibromatosis question? Pathology
5:10:18question?
5:10:19Was it a pathology question?
5:10:21Neurofibromatosis.
5:10:23And also I heard there was one question
5:10:25on imprinting. What was the question on
5:10:27imprinting disorder?
5:10:32NF1 case was there. Clinical case was
5:10:34there.
5:10:37Was it a clinical case?
5:10:41Okay, iris picture skin lesion. Okay,
5:10:43that'll be more medicine question.
5:10:46Okay, IBQ more of medicine question
5:10:48rather than pathological question.
5:10:51Neurofibromatosis, cafe au lait spots
5:10:53were there. Okay, fine.
5:10:57One gender affected more than the other
5:10:59gender. This was for what question?
5:11:01What was that one gender more affected
5:11:03than Okay, there was no imprinting
5:11:04question. Okay, that's good.
5:11:06All males affected. This was there. One
5:11:08gen- one gender affected more, right?
5:11:10This was there.
5:11:20Okay.
5:11:23Okay, next what else was there? You said
5:11:25many images were there. Please tell me
5:11:27now what what else image was there.
5:11:30Uh okay, okay, okay, okay. I am I'm just
5:11:34checking from your this one.
5:11:36Uh if I'm missing out on any question.
5:11:41Mhm, mechanisms of UVs done. IDA already
5:11:45done.
5:11:47Uh okay.
5:11:52Wegener's what Okay, Wegener
5:11:55Yeah, Wegener is a small vessel. We had
5:11:57discussed this.
5:12:09Sorry.
5:12:29Mhm, okay. let me look at any other
5:12:31questions if there are.
5:12:36Any other questions which I have missed?
5:12:39Pacinian corpuscle histopath protein
5:12:41detection in paraffin embedded IHC we
5:12:43discussed that.
5:12:44So, what was Pacinian corpuscle was
5:12:46given?
5:12:48Anyway, more of you know histopath
5:12:51histology question.
5:12:58Minimal change disease. What was the
5:12:59question on minimal change disease?
5:13:02So, Pacinian corpuscle was this the
5:13:04image given to you?
5:13:08Pacinian corpuscle was this such similar
5:13:10image whatever is the image. What was
5:13:12the question on minimal change? And
5:13:14there was one more question on
5:13:16PSGN. Yeah, PSGN what was the question?
5:13:28Yeah, blood transfusion what what was
5:13:29the electrolyte defects?
5:13:37Please tell me what was the
5:13:39Okay, Pacinian corpuscle histopathology
5:13:41was there.
5:13:42So, I'm adding
5:13:44some more like this.
5:13:45I hope.
5:13:54PSGN what was the question? PSGN what
5:13:56was the question?
5:13:58Okay, blood transfusion hyperkalemia
5:14:01hypothermia what all questions were
5:14:02there?
5:14:03Which of the following is not
5:14:07not a
5:14:11What was the question?
5:14:13Histo histology microscopy and IF were
5:14:16given huh?
5:14:18Okay, what was the question? That also
5:14:19please tell me now.
5:14:21PSGN and immunofluorescence was given.
5:14:23Lumpy bumpy deposits they were given.
5:14:27Okay, clinical feature.
5:14:33of PSGN
5:14:36Uh image and IF histopathology, okay.
5:14:40Uh asked What was asked?
5:14:43Image of IF and HP question asked, okay.
5:14:46C3 granular deposits were there, okay.
5:14:48Subepithelial humps were also given,
5:14:50okay. Clinically they had given
5:14:51subepithelial humps also.
5:14:55Okay.
5:14:56Post infection hematuria.
5:14:59Okay, yeah. That's enough. So, yeah.
5:15:02Patient had
5:15:10and granular deposits or lumpy bumpy
5:15:13deposits, right?
5:15:22Yeah. So, they would have given one
5:15:24lumpy bumpy deposit, whatever uh
5:15:28image was there.
5:15:30I'll not be very sure of what image was
5:15:32there, but yes.
5:15:34Uh I'll just try to put one image here.
5:15:36Let me see.
5:15:38Hematuria was there and then this was
5:15:41the image.
5:15:43PSGN, right?
5:15:46This was the image, hopefully.
5:15:48Uh okay, which of the following is a
5:15:50lethal triad? Lethal triad will be
5:15:53hypothermia, acidosis, and
5:15:56Yes, lethal triad would be
5:16:00hyperkalemia, acidosis, and hypothermia.
5:16:10Yes.
5:16:12That Okay, lethal triad that was Okay.
5:16:16Lethal triad was there,
5:16:18yeah. Which is a lethal triad in massive
5:16:21blood transfusion, isn't it?
5:16:30So, you had two
5:16:33components. Okay. So, lethal triad in
5:16:35massive blood transfusion, multiple true
5:16:37false or they had given three of them?
5:16:42Multiple true false was there or three
5:16:44of them were there? So, lethal triad
5:17:01Okay. So, which is a uh part of lethal
5:17:04triad, right?
5:17:06So, then
5:17:08acidosis, hypothermia, and coagulopathy.
5:17:13If there was no uh you know,
5:17:15hyperkalemia with that, then
5:17:17coagulopathy. Hypothermia is there.
5:17:20Then coagulopathy and then acidosis
5:17:21because acidosis eventually leads to
5:17:23hyperkalemia also.
5:17:32Okay, in massive blood transfusion,
5:17:34right? Yes. So, in massive blood
5:17:36transfusion
5:17:41lethal triad
5:17:44hypothermia
5:17:46Was hypothermia there?
5:17:49It should have been there.
5:17:50Hypothermia, acidosis
5:17:55DCO, dilutional coagulopathy.
5:17:59Acidosis was not in the option. If
5:18:01acidosis was not there, look for
5:18:02hyperkalemia.
5:18:04Because acidosis and hyperkalemia are
5:18:06very related related to each other.
5:18:09Uh hypocalcemia doesn't come part of
5:18:12lethal triad, that's why.
5:18:14See,
5:18:15they should have given hypothermia,
5:18:17acidosis, lethal triad is hypothermia,
5:18:20acidosis, coagulopathy or instead of
5:18:22acidosis even if they had given
5:18:23hyperkalemia, I will take that also
5:18:25because acidosis leads to hyperkalemia.
5:18:31Okay.
5:18:34Yeah, what was CMV? What was the
5:18:36question on CMV?
5:18:39So, blood transfusion only one question?
5:18:42Blood transfusion only one to only one
5:18:44question?
5:18:46Okay, acidosis was not in the option
5:18:48then it would be hyperkalemia, either of
5:18:50them. Hypothermia,
5:18:52hyperkalemia, DCO, dilutional
5:18:54coagulopathy.
5:18:57Uh okay, multiple correct only two
5:19:00options were there, okay.
5:19:03Uh okay, and uh diagnosis, what was the
5:19:07question asked? 62 year,
5:19:09increase PTH medicine, they will discuss
5:19:11in endocrine.
5:19:14No, hypocalcemia.
5:19:16No, hypocalcemia is not a part of your
5:19:18lethal triad.
5:19:21Hypocalcemia doesn't cause death.
5:19:23Hyperkalemia can cause death, acidosis
5:19:25eventually leads to hyperkalemia and
5:19:27acidosis can lead to multiple mechanisms
5:19:29of death. Uh hypothermia can lead,
5:19:32although hypothermia is now uh reduced
5:19:34and then coagulopathy, dilutional
5:19:36coagulopathy.
5:19:39Okay.
5:19:42Um incorrectly matched.
5:19:44Bur- EBV, Burkitt, okay. HHV8, Kaposi.
5:19:49HTLV, adult T-cell. CMV, nasopharyngeal.
5:19:52Okay, that is a uh wrongly matched,
5:19:54correct? Mark incorrect, okay, that is
5:19:57incorrectly matched, correct?
5:19:59So, incorrectly matched is your right,
5:20:01CMV doesn't cause carcinomas. Yeah.
5:20:12>> So yes, you are right. Incorrectly
5:20:15matched is right.
5:20:19nasopharyngeal carcinoma
5:20:21CMV
5:20:23next line
5:20:36adult T cell
5:20:40leukemia
5:20:45EBV Burkitt lymphoma
5:20:56HHV8 Kaposi's sarcoma
5:21:06Right? This was there.
5:21:11Okay.
5:21:14Burkitt EBV yes, correct. So
5:21:19So in this answer is nasopharyngeal
5:21:21carcinoma CMV. This is incorrectly
5:21:23matched.
5:21:27Okay. Okay. Okay.
5:21:35What else was there? What else was
5:21:37there? Anything we are missing guys? So
5:21:39we have recollected 20 questions in
5:21:41pathology.
5:21:45Any any further question?
5:21:49Any question which we have missed out?
5:21:51Anything on bleeding disorders? No
5:21:54questions on bleeding disorders?
5:21:56No questions on bleeding disorder? What
5:21:57was the question on wound healing?
5:21:58Somebody told me there was a question on
5:22:00wound healing. Please tell me that also.
5:22:02Was there a question on wound healing?
5:22:06Wound healing question was there?
5:22:10Wound healing.
5:22:15Yes, wound healing question. Wound
5:22:16healing.
5:22:17Was there a question on wound healing?
5:22:18Yeah, so 20 questions we already
5:22:20recollected that is uh we are talking
5:22:2210% of your questions.
5:22:25Yeah, I know uh many of you will not be
5:22:27recollecting may not be recollecting.
5:22:29So, was there any wound healing
5:22:30question? Please tell me. Uh type one
5:22:32type three collagen, what was the
5:22:33question? Please tell me now. What was
5:22:34the question?
5:22:36Ratio of type one to type three?
5:22:38Ratio asked, okay. What age? Three
5:22:40weeks? Three months? What they had
5:22:42asked?
5:22:43Ratio was asked.
5:22:46Okay, ratio was asked when? Please tell
5:22:48me ratio of type three to type one.
5:22:51Okay, multiple correct questions were
5:22:54there in wound healing. What was the
5:22:55question? Please tell me now. So, true
5:22:57about wound healing, right?
5:23:03True about wound healing. Multiple true
5:23:05false, please tell me now. What is the
5:23:07question asked?
5:23:08Options.
5:23:11Options, options, options. Angiogenesis
5:23:13seen in proliferation phase, yeah, that
5:23:15is true.
5:23:16Angiogenesis will be in proliferation
5:23:18phase, that is true.
5:23:25Proliferation, if you remember, we
5:23:27divide them into what? Three
5:23:28proliferation, epithelial proliferation,
5:23:30blood vessel proliferation, fibroblast
5:23:31proliferation.
5:23:33Type three replaces type one.
5:23:35Uh that is false, of course.
5:23:38Type three replaces type one is false.
5:23:42It is type one replaces type three,
5:23:44right? Yeah, this is a false statement.
5:23:46Then,
5:23:48tensile strength depends upon irregular
5:23:50arrangement.
5:23:53Tensile strength depend upon type one
5:23:55irregular arrangement. No, it depends
5:23:58upon Okay, type one collagen random
5:24:00pattern. So, tensile strength depends on
5:24:09irregular or random type one, no?
5:24:12This was the option?
5:24:17No, it will depend upon the parallelly
5:24:19arranged collagen. That is also false.
5:24:22Uh then type three to type one collagen
5:24:24ratio becomes three is to one.
5:24:27What
5:24:28Okay, that is true. Type three to type
5:24:30one
5:24:32Type three to type one becomes three is
5:24:33to one, no?
5:24:37Proliferation phase followed by
5:24:39exudative phase, no that is false again.
5:24:41First exudative phase because first
5:24:43there will be inflammation, exudation
5:24:44will happen, then proliferation will
5:24:45begin.
5:24:47Uh they asked which is true. Yeah,
5:24:48correct. Angiogenesis is in proli- in
5:24:51proliferation phase. That is true
5:24:53statement. First one is true. Type three
5:24:55replaces type one. Was this uh Okay,
5:24:58single best answer was there.
5:25:00Okay.
5:25:01So, early stage haphazard type one
5:25:04collagen forms the tensile strength.
5:25:05Type three to type one collagen ratio
5:25:07three is to one.
5:25:08No, uh please tell me type three to type
5:25:10one collagen ratio three is to one when?
5:25:12Type three to type one three is to one
5:25:14at three weeks is true.
5:25:17If that was a quiz.
5:25:18Proliferation phase followed by
5:25:20exudative phase.
5:25:22Okay, they asked which only one true
5:25:23statement, not multiple true false.
5:25:25Okay.
5:25:26So, I will change these.
5:25:30Sorry, not multiple true false. I will
5:25:32change them, don't worry.
5:25:38I'll change the options, don't worry.
5:25:39Yeah, please tell me now.
5:25:41Angiogenesis option was there, then type
5:25:44one
5:25:45was inverted type three haphazard
5:25:47arrangement of type one proliferative
5:25:50phase followed by angiogenesis.
5:25:53What was the remodeling phase? Type 3 to
5:25:56type 1 ratio is 3:1 in proliferative
5:26:00phase, that is true.
5:26:01Type 3 to type 1 ratio
5:26:04is 3:1 in proliferative phase, that is
5:26:07true.
5:26:08Type 3 to type 1
5:26:10ratio
5:26:12is
5:26:133:1.
5:26:15In proliferative phase, that is true.
5:26:17In remodeling phase, it will change.
5:26:24So, then uh you know
5:26:28No, this was in remodeling phase.
5:26:31So, type 3 to type 1 is 3:1 in
5:26:33proliferative phase or remodeling phase?
5:26:35Please tell me this.
5:26:42And what was this question? Somebody is
5:26:44now Okay. Haphazard arrangement of type
5:26:471, that is false anyway. Depend upon
5:26:50random or haphazard, that is false.
5:26:53One option was remodeling phase. Okay,
5:26:55this was remodeling phase then. Okay, if
5:26:56this was remodeling phase, then this
5:26:59will be false.
5:27:01Remodeling phase, it will be what?
5:27:03Reverse, isn't it? Yeah, type 1 becomes
5:27:06predominant. Angiogenesis is happening
5:27:07in proliferation phase, that is true.
5:27:10So, in the given option that you have
5:27:11given me, two options are false here,
5:27:13right?
5:27:14Uh proliferate angiogenesis
5:27:16the proliferative phase followed by
5:27:18angiogenesis.
5:27:20Uh no, I One option was there which had
5:27:24type 3 replaces type 1. Okay.
5:27:27So, that is also false.
5:27:30Type 3 replaces type 1.
5:27:33That is also true.
5:27:35Proliferative phase is followed by
5:27:36exudative phase.
5:27:38That is also false.
5:27:40Proliferative phase will not be
5:27:41exudative phase. Uh Sorry, what is the
5:27:44word? Proliferative phase is followed by
5:27:48exudative phase, that is false.
5:27:51So, after exudative phase, there will be
5:27:53what?
5:27:57Proliferative phase.
5:27:58So, exudative phase will be followed by
5:28:00proliferative phase. So, now you are
5:28:03giving me five options. One of them
5:28:04should not be there, then. Whatever is
5:28:06there. So, your fifth option also you
5:28:09are giving. That is also false.
5:28:19Followed by exudative.
5:28:23Was this the correct one?
5:28:27Because look, very important,
5:28:29proliferative phase follows exudative
5:28:31phase would be correct answer. Because
5:28:33after exudative phase, there will be
5:28:35proliferative phase.
5:28:37Okay, proliferative phase is followed by
5:28:40exudative phase would be wrong.
5:28:43Proliferative phase is followed by
5:28:45exudative phase would be wrong.
5:28:47If they had written proliferative phase
5:28:49follows exudative phase, that is true.
5:28:55Okay, so now all of you are not able to
5:28:57zero down on what was the So, in this
5:28:59angiogenesis is in proliferative phase.
5:29:01This was given for sure everybody,
5:29:03please tell me.
5:29:07Inflammatory phase followed by exudative
5:29:10phase.
5:29:16Type three replaces type one.
5:29:19Oh, okay. Okay. Okay. In the same one it
5:29:22was there. Type three replaces type one.
5:29:27Uh okay. Okay. I understand. Now I
5:29:29understood this one. Type three Type
5:29:31three replaces type one.
5:29:34And the ratio is This was the full
5:29:36question.
5:29:38Okay.
5:29:40The ratio is 3:1 in remodeling phase,
5:29:43right? This was the question.
5:29:52No, collagen ratio you are telling me in
5:29:54which phase?
5:29:563:1 3:1 between type 3 and type 1
5:30:00will be not in remodeling. This will be
5:30:02in proliferative phase.
5:30:05So, if angiogenesis is happening in
5:30:07proliferative phase, that is correct.
5:30:14Okay.
5:30:18Angiogenesis is in proliferative, that
5:30:20is true. If it is a single best answer,
5:30:22that is the correct answer. All others
5:30:24definitely are looking false because,
5:30:26you know, now
5:30:27you will be having this, you know, error
5:30:29of, you know, recall bias will be there.
5:30:33All of you. Now, you will start
5:30:34thinking, "Okay, this was there. This
5:30:35was there." You start imagining also
5:30:37sometimes, okay? And if it is single
5:30:39best answer, this is the correct one.
5:30:43Option one is the correct one, okay?
5:30:48Yeah. Anything else I missed out?
5:30:49Anything else I missed out?
5:30:52Anything else I missed out? GIT polyps?
5:30:55Any questions on GI polyps?
5:30:57Kidney only one question?
5:30:59Kidney only one question of PSGN?
5:31:03Kidney only one question on PSGN? Please
5:31:04tell me.
5:31:08Only one question of PSGN on
5:31:10uh in pathology? Case control study
5:31:13PSM people will discuss.
5:31:17And were there any questions on
5:31:19immunology? Immunodeficiency disorder?
5:31:21Amyloidosis we discussed one question.
5:31:27Oh, sorry. Thank you. I didn't
5:31:29understand you guys. Yeah, correct. Case
5:31:30control will be there.
5:31:34Anti-Ro antibodies? What was that that
5:31:36question? I think conduction blocks
5:31:38integrated medicine question was there.
5:31:40Medicine people will discuss that. I
5:31:42think conduction block was there, no?
5:31:53Uh okay, newborn cardiac anomaly.
5:31:56Heart block associated with anti row.
5:31:58Okay, that's fine. Medicine or
5:31:59pediatrics, both of them. Newborn
5:32:02pediatrics will be They will be
5:32:03discussing, don't worry.
5:32:06Okay, I think we have taken all the
5:32:08questions. We have tried to recollect
5:32:09all the questions here.
5:32:12Uh amyloidosis question chronic
5:32:13inflammation AA
5:32:15Chronic inflammation was there, right?
5:32:17Patient has a long-standing chronic
5:32:18inflammatory disease AA secondary
5:32:20amyloidosis AA.
5:32:24>> [clears throat]
5:32:26>> Okay. So, thank you, guys. So, I'll be
5:32:28ending the session now.
5:32:31Any more recall? Just last last call
5:32:33Last call for any further recalls which
5:32:35we have missed out.
5:32:38Yeah, quickly. Let me just show you what
5:32:40all we have you know done with. Okay,
5:32:42patient with low serum ferritin, this
5:32:44was IDA. Prostatic biopsy adenocarcinoma
5:32:474 + 4 score 8 grade 4. Liver biopsy
5:32:50Mason trichrome stain, this was you know
5:32:52methylene blue stain.
5:32:54Uh then goblet cell Barrett's esophagus
5:32:56was the diagnosis.
5:32:58Uh amyloidosis AA was there. Beta thal
5:33:00Okay, they had given
5:33:02Somebody mentioned history was given.
5:33:04We'll discuss history that thalassemic
5:33:06faces jaundice was given. Low hepcidin
5:33:08will be there, that is correct. Hepcidin
5:33:10suppression will be there. High serum
5:33:12iron ineffective erythropoiesis. RSL
5:33:14image was given. X stands for bulky
5:33:16disease, we discussed this.
5:33:18Uh secondary amyloidosis AA type.
5:33:21Okay.
5:33:22Yeah, so you're all welcome. All of you
5:33:24are I'm sure all of you would have made
5:33:26diagnosis here. Many of you would have
5:33:28missed this oncogene addiction. Some of
5:33:30you would have taken risk and answered
5:33:32it correct also. This is a very new
5:33:34concept. That is why recently published
5:33:37and actually you know I was not
5:33:39expecting at your level, but anyway it
5:33:41came in as a question now. So, we should
5:33:42not be you know getting into that. So,
5:33:45I'm sure even if you had not answered
5:33:46this don't worry most of them will not
5:33:48be answering those tough question. But
5:33:50the easy ones all we discussed in the
5:33:52class, right? So, UV rays we discussed
5:33:54in the class, incomplete penetrance, IHC
5:33:57we had discussed this uh severe
5:34:00condition with DCO we had discussed PSGN
5:34:03uh all these
5:34:04wound healing uh MI all of them were,
5:34:07right? Yeah, so 21 questions uh we have
5:34:10recollected and any more if they are
5:34:12there finally I'll be doing all uh you
5:34:14know exact recall tomorrow.
5:34:17Yes, thank you guys. Thank you all and
5:34:19I'm sure most of you would have yes
5:34:22uh please mention uh video on oncogene
5:34:25addiction. Yes, I will do that.
5:34:27Okay, uh there's not much in that
5:34:28oncogene addiction. I explained you it
5:34:30is a simple word. Tumors get addicted to
5:34:32certain genes just like you get
5:34:34addicted, I know.
5:34:36So, which long going about to say
5:34:37something that we will put a key to
5:34:39addict with a say tumor we have to say.
5:34:41Okay.
5:34:42Yes.
5:34:43Okay, thank you guys. Thank you. So, I
5:34:46next faculty will be the next teacher
5:34:48will be you know recalling the next
5:34:49subject now. Okay.
5:34:51Thank you.
5:35:01>> Are we live?
5:35:13Are we live?
5:35:21Okay, great.
5:35:23Good evening everyone. Good evening
5:35:24everyone and uh we are going to have a
5:35:26quick uh recall session for uh
5:35:29And I have the chat open in front of me,
5:35:32so it will be smoother now.
5:35:36It will be smoother now.
5:35:43Okay, I hope this is now better.
5:35:45This should be smoother now. Yeah,
5:35:47perfect, perfect. So so we're doing a
5:35:49quick recall starting with the
5:35:52the one of the most simple basic
5:35:54questions that we have.
5:35:57Which of the following does not give a
5:35:59positive Benedict test? This is one of
5:36:01the simple questions. Just like the
5:36:03questions in biochemistry today, the
5:36:04feedback that we got is it for
5:36:07biochemistry it was okay. Those who have
5:36:09attended sessions for them it was simple
5:36:11and easy. So I hope when you go through
5:36:14the questions you feel the same way that
5:36:17yes, biochemistry was something where
5:36:18you're confident and you're able to do
5:36:20it easily. Okay. So starting with the
5:36:23most simple and easy question, which of
5:36:24the following doesn't give the positive
5:36:25Benedict test? In this regard, you know,
5:36:27positive Benedict test is
5:36:30all sugars which give the positive
5:36:31Benedict test are known as reducing
5:36:33sugars. And we have discussed this
5:36:36multiple times that all monosaccharides
5:36:38are reducing. So all monosaccharides are
5:36:41reducing. Along with that, ascorbic
5:36:44acid, amino acid, uric acid, these are
5:36:46also going to give positive Benedict
5:36:48test. So this is also going to give the
5:36:50positive Benedict test. The sucrose and
5:36:53trehalose are non-reducing
5:36:56disaccharides. They're non-reducing
5:36:59disaccharides in contrast to the lactose
5:37:03and maltose. Lactose and maltose, you
5:37:06know, are the
5:37:07the reducing disaccharides. So here the
5:37:09answer is sucrose. Sucrose is not going
5:37:13to give the positive Benedict test. Yes,
5:37:15thank you, Dr. Prabhakar. That's what we
5:37:17have got from most of you that
5:37:19biochemistry was easier than all the
5:37:21other subjects. So let's let's quickly
5:37:22take a look and uh you can feel happy
5:37:25about the answers that you've given to
5:37:27these questions. And you can also help
5:37:29me refine the options that are here.
5:37:32Okay. So, another question, which
5:37:34vitamin plays a role in transamination
5:37:38reaction? Now, transamination is one of
5:37:40the very important reactions in the
5:37:42amino acid metabolism and you know that
5:37:45the enzyme the amino acid which is
5:37:46involved here is the vitamin B6. I hope
5:37:51these options are correct as per your
5:37:53recall. So, vitamin B6 is required for
5:37:55transamination, it is required for
5:37:56deamination, it is required for
5:37:58decarboxylation. In addition to that, it
5:37:59is required for the catecholamine
5:38:01synthesis, it is required in the serine
5:38:03metabolism. It is required in the heme
5:38:05synthesis, it is required in
5:38:07uh the vitamin B3 synthesis, it is
5:38:09required in the sphingolipid synthesis.
5:38:11It is required in the glycogen
5:38:13metabolism by the enzyme glycogen
5:38:15phosphorylase. B6 is one of the most
5:38:17prolific vitamins required by a huge
5:38:19number of enzymes which we routinely
5:38:21discuss in our class. All right? So, if
5:38:24you just took a take quick look at the
5:38:26notes, you'll be able to see we have a
5:38:27list of reactions where vitamin B6 is
5:38:30required as the coenzyme. Pyridoxal
5:38:33phosphate being the most active
5:38:38form of B6, most active form of B6 which
5:38:43is participating in the reactions.
5:38:47Then we had this question, enzyme active
5:38:51in the phosphorylated state and there
5:38:53were various options. Please let me know
5:38:55if these options are correct or not. And
5:39:00one simple one simple guru mantra I've
5:39:02given you that the dephosphorylated
5:39:05state is maintained by insulin. So, you
5:39:09have to look at the enzymes belonging to
5:39:12pathways which are activated by insulin.
5:39:15Okay? You have to you have to look at
5:39:17you have to look at the enzymes
5:39:18belonging to pathways which are
5:39:20activated by insulin. And about
5:39:22activation of pathways, we had said
5:39:24insulin
5:39:25uses glucose. So, all of the all those
5:39:28pathways which make use of glucose are
5:39:29activated by insulin. So, glycogen
5:39:32synthase will use glucose. The PFK2 will
5:39:36actually activate the glycolysis, so it
5:39:38will use glucose.
5:39:39Fructokinase
5:39:41Okay, fructokinase
5:39:43uh ideally it is focused on fructose,
5:39:46and you know that two enzymes of
5:39:47fructose metabolism are unregulated.
5:39:50Okay, two two enzymes two enzymes of
5:39:53fructose metabolism are unregulated. So,
5:39:57the phosphorylation dephosphorylation,
5:39:58which is a mode of action of the
5:40:01hormones, doesn't come into play for
5:40:03fructokinase. Option four was not there.
5:40:05Is the second alternate name that I've
5:40:07written is that one of the options?
5:40:10One, two, and three I also know that
5:40:12most of the students were comfortable
5:40:13with that. About fourth one,
5:40:15pyruvate dehydrogenase Okay, okay. So,
5:40:17if you say pyruvate dehydrogenase, then
5:40:19you have to remember that pyruvate
5:40:20dehydrogenase will also be activated by
5:40:25insulin. PDH was there, then PDH is
5:40:28activated. So, what you have to remember
5:40:30that all the pathways which will use
5:40:32glucose are activated by insulin, and
5:40:34insulin is mainly activating the enzymes
5:40:36in the dephosphorylated state. Okay? So,
5:40:38among the given options, you can see
5:40:40glycogen synthase will be active, PFK2
5:40:42will be active, the PDH will also be
5:40:44active. So, based on that, you can you
5:40:46can choose your options. For PFK, we
5:40:49have one and two. PFK3 we do not have.
5:40:52PDH was uh there, not fructokinase.
5:40:55Okay, we will take out the
5:40:57uh fructokinase and mark the PDH. Okay?
5:41:00So, in in that case, you have to choose
5:41:03among the best options which would have
5:41:05been there. If it said if it said PFK3,
5:41:09then it goes out of the window. But,
5:41:10remember we have PFK 1 and PFK2. We
5:41:13don't have PFK3, okay?
5:41:16Right, PFK2 is part of glycolysis in
5:41:19regulatory terms because PFK2 produces
5:41:22the regulator of PFK1. It is not
5:41:24directly an enzyme of the glycolysis.
5:41:27In options in option three was there.
5:41:31Okay, PFK3 then it is a wrong option. If
5:41:33they're mentioning PFK3, then it is a
5:41:34wrong option. And then it should have
5:41:36been PFK2. In that case, your correct
5:41:38answer will be the glycogen synthase and
5:41:41the PDH. One and four means the
5:41:44combination which will cover the
5:41:46glycogen synthase and the PDH, they will
5:41:49be active in the dephosphorylated state.
5:41:51All right, I hope that makes sense.
5:41:54That makes sense, okay? So, you have to
5:41:57choose the options accordingly. So, what
5:42:00I'll do, I'll replace with the PFK2 by
5:42:02PFK3 and I'll replace fructokinase by
5:42:04PDH. Accordingly, we'll change the
5:42:06options in the final recall. All right,
5:42:08I hope that works.
5:42:13Okay, okay, if
5:42:16Dr. Prakhar is saying PFK2 only was
5:42:19there. So, let's keep this as PFK2 only.
5:42:21Let's keep this as PFK2 only. But but
5:42:23just for your information, I've told you
5:42:26that
5:42:27insulin is going to cause a
5:42:29dephosphorylated state and all pathways
5:42:31which utilize glucose will be activated
5:42:34by insulin.
5:42:36Okay, let's leave it here and go to the
5:42:38next question. I hope that is enough for
5:42:41this question. We move on to next
5:42:42question. Which of the following is
5:42:44active after giving insulin? Please
5:42:47correct me if there is any mistake in
5:42:49this statement or in the options, all
5:42:52right? So, what you have to remember
5:42:54that among the GLUT, the main GLUT
5:42:57series are 1 2 3 4 and 5 and among the
5:43:00SGLT, you have 1 and 2. Out of those out
5:43:03of those, it is the GLUT4, GLUT4
5:43:07which is activated by insulin. Glut 4 is
5:43:11present in cardiac
5:43:16Options had three multiple corrects.
5:43:20Okay.
5:43:23Cardiac [snorts]
5:43:25skeletal
5:43:27and adipose tissue. These are the three
5:43:31places where the Glut 4 is present. Glut
5:43:344 is present at three places, cardiac
5:43:37muscle, skeletal muscle, adipocytes. And
5:43:40Glut 4 will take up the glucose only
5:43:43when glucose is in excess. So, this
5:43:45regulation is mediated by insulin.
5:43:47Insulin is released when glucose levels
5:43:49will rise. So, this is an inbuilt
5:43:51mechanism that these receptors will
5:43:54become active only when glucose level is
5:43:56high. So, Glut 4 in skeletal muscle, in
5:43:59cardiac muscle, in adipocyte is
5:44:01activated by insulin. It is activated by
5:44:04insulin.
5:44:07Okay, if it was match the following,
5:44:08then also you can you can think
5:44:10accordingly. If it was match the
5:44:12following,
5:44:13do others also remember this question as
5:44:16match the following? Was it match the
5:44:19following?
5:44:20A lot of you are mentioning that it was
5:44:22in the form of table. Please please
5:44:24correct me if this was [snorts] given as
5:44:26match the following.
5:44:29Akhila has mentioned that it was match
5:44:31the following.
5:44:35Okay. All right. So, so So, please
5:44:38remember Glut 4 in skeletal muscle,
5:44:40cardiac muscle, adipocytes is regulated
5:44:42by insulin. In this regard, what I
5:44:44always tell you in the class, what you
5:44:45have to remember, that the Glut 4 is
5:44:48also mobilized by calcium. That is how
5:44:51we tell the type 2 DM patients to do the
5:44:53exercise.
5:44:55Okay. Okay, if this question is correct,
5:44:57that's perfectly fine. Let's ignore the
5:44:59match the following. But for the
5:45:01subsequent time, I'm telling you that
5:45:02remember GLUT4 is also activated by
5:45:05calcium. Therefore, when the type 2 DM
5:45:07patients are doing the exercise in the
5:45:08skeletal muscle, calcium levels will
5:45:09rise. So, GLUT4 becomes active and it
5:45:11takes up the glucose in those tissues as
5:45:14well.
5:45:16Okay. Moving on to next question. Moving
5:45:18on to next question. Attachment of
5:45:21primer. Attachment of primer to the DNA
5:45:23strand with telling is correct. To the
5:45:26DNA strand is carried out by which
5:45:30enzyme? Is carried out by which enzyme?
5:45:34Okay. So, here you have to remember that
5:45:36primer, which is there in in the DNA
5:45:39synthesis, this is RNA in nature. This
5:45:42is RNA in nature. And the enzyme which
5:45:45is synthesizing the primer is the enzyme
5:45:49primase, which is actually the RNA
5:45:52polymerase. Please remember the DNA
5:45:54polymerase cannot initiate the process
5:45:57of DNA synthesis. It requires a primer.
5:45:59The primer is RNA in nature when we are
5:46:01doing the DNA replication. And the
5:46:03enzyme which is involved here is the
5:46:05primase. Primase synthesis was asked.
5:46:07Synthesis, okay. So, not attachment. It
5:46:10was synthesis. It was
5:46:13synthesis
5:46:14of primer.
5:46:16Synthesis of primer. Which one is
5:46:19synthesizing the primer? Okay, synthesis
5:46:20of primer is done by Very good. Very
5:46:23good. Thank you for your valuable
5:46:25feedback. Okay, synthesis of primer is
5:46:28done by Okay. DNA polymerase was not One
5:46:31was not there in the option. DNA
5:46:32polymerase two was there in the option.
5:46:33So, that is why I've written the two
5:46:34also. Okay, very good. DNA polymerase
5:46:37two and DNA polymerase three were there
5:46:39in the option. Okay, agreed. DNA
5:46:41polymerase two was given. One was not
5:46:43given. And who synthesized the primer?
5:46:46Two and three were the option. Primer
5:46:47synthesis. And Okay.
5:46:50So, we know the DNA polymerase will not
5:46:52make the primer. Primer synthesized by
5:46:53the primase, which is actually the RNA
5:46:58polymerase. Polymerase in this case is
5:47:01the RNA polymerase that is the primer.
5:47:05Okay? So so I hope you know this.
5:47:07Topoisomerase as all of you know is
5:47:09going to help in relieving
5:47:13the torsional strain. It helps to
5:47:16relieve the torsional strain.
5:47:19Uh
5:47:21It helps to relieve the torsional strain
5:47:23which is created by the helicase enzyme.
5:47:26Please remember
5:47:28the helicase when it is doing the
5:47:29unwinding it creates a torsional strain.
5:47:31Torsional strain has to be removed which
5:47:33is done by the enzyme topoisomerase. If
5:47:35you don't remove the torsional strain,
5:47:37torsional strain can lead to
5:47:38supercoiling which will inhibit the
5:47:42process of replication.
5:47:45Don't worry, one or two questions are
5:47:46wrong, not a problem. But overall, if
5:47:49you've done well, uh that should be good
5:47:51enough. One or two wrong questions, do
5:47:53not worry because some of them were very
5:47:55complicated questions, so don't worry
5:47:57about that. Okay. [snorts]
5:47:59Moving on to next question, this is the
5:48:01recall that I have. Please correct me if
5:48:03there is any mistake in the statement.
5:48:06So patient presents with craniofacial
5:48:08defects, hypotonia, seizures, and very
5:48:12long chain fatty acid accumulation is
5:48:14seen. Can you Can you confirm whether
5:48:16this this part was there or not? Can you
5:48:19confirm whether this part was there or
5:48:21not?
5:48:24Okay. Okay. Dr.
5:48:26Prakhar has already given the answer,
5:48:27but I just want to know from you whether
5:48:29the statement of the question is correct
5:48:31or not.
5:48:33The presentation, yes, lot lot of
5:48:34students said, but the rest part some
5:48:36students mentioned, some students were
5:48:38not able to verify that whether it was
5:48:40there or not. So whether they're
5:48:42mentioning brain autopsy or they were
5:48:43whether they're mentioning the presence
5:48:45of very long chain fatty acid
5:48:46accumulation.
5:48:50Okay. Okay. If the question is correct,
5:48:52if the question is correct, then please
5:48:53remember that accumulation whenever they
5:48:56mention very long chain fatty acid
5:48:58accumulation, there are three locations
5:49:00where the accumulation will happen. It
5:49:02is the CNS, it is the liver, and it is
5:49:06the kidney. Okay, no autopsy. Okay, no
5:49:10autopsy is there. Autopsy is not there.
5:49:11Okay, agree. So, CNS, liver, and kidney,
5:49:14they are the three places where
5:49:15predominantly accumulation of VLCFA will
5:49:18occur, okay? And all of you know that
5:49:20this is the condition known as the
5:49:23Zellweger syndrome. This is what is
5:49:25known as the Zellweger syndrome, where
5:49:28there is defect in the peroxisome.
5:49:30Peroxisome is either empty, means there
5:49:32is transport defect, enzymes are not
5:49:34entering in the peroxisome, or in some
5:49:36cases, the peroxisome is absent.
5:49:41So, either empty or absent peroxisome,
5:49:44okay?
5:49:45Okay, brain accumulation is given, but
5:49:47autopsy is not given. Okay, we'll we'll
5:49:49note that. We'll make that correction in
5:49:50the final record that accumulation of
5:49:53VLCFA is seen in the in the brain
5:49:55tissue. And what is the most likely
5:49:56defect? It is a peroxisomal defect. The
5:49:58two possible defects are either the
5:50:01peroxisome is empty, or the peroxisome
5:50:04is absent. These are the two
5:50:05possibilities. And the main metabolism
5:50:07which is happening in the peroxisome is
5:50:08the very long chain fatty acid. The
5:50:11other metabolism which the peroxisome is
5:50:13doing is you have to remember that the
5:50:16branched fatty acid, branched fatty
5:50:20acid, which is the phytanic acid.
5:50:24Phytanic acid, for which you are doing
5:50:26the alpha oxidation. In which case there
5:50:29will be Refsum's disease. Okay, when the
5:50:31phytanic acid defect is there. But here
5:50:32they are saying the peroxisome, whole of
5:50:34peroxisome is defective. In that case,
5:50:35you are looking at Zellweger syndrome,
5:50:37which is also known as
5:50:38cerebrohepatorenal
5:50:40syndrome. Why? Because CNS, liver, and
5:50:42kidney are involved. So, it is also
5:50:43known as cerebrohepatorenal
5:50:46syndrome.
5:50:47All right. Okay, very good. Peroxisomal
5:50:49biogenesis defect or the transport of
5:50:51the enzymes into the peroxisome that may
5:50:53be defective. Let's move on to the next
5:50:54question.
5:50:56Raised triacylglycerol is seen in all
5:51:00except the options that I have got from
5:51:03you is either it is diabetes mellitus,
5:51:05nephrotic syndrome,
5:51:06abetalipoproteinemia, hypothyroidism,
5:51:07but some students said, "No, sir.
5:51:09Hypothyroidism was not mentioned. High
5:51:10fructose diet was mentioned." So, please
5:51:12verify the options. Please verify if the
5:51:15options are correct and accordingly we
5:51:17can put them in the final recall whether
5:51:20the statement of the question is correct
5:51:21and whether the options are correct or
5:51:24not. So, you are you are saying the
5:51:26peroxisomal
5:51:27biogenesis defect. Okay. Peroxisomal
5:51:31biogenesis defect. All right. All right.
5:51:33Thank you. Thank you very much.
5:51:35Okay. Raised triacylglycerol is seen in
5:51:38all except please look at the options.
5:51:41The nephrotic syndrome hypothyroidism
5:51:43was mentioned. Okay, hypothyroidism was
5:51:45mentioned. Okay.
5:51:49High fructose was also mentioned. Okay.
5:51:52Hypothyroidism was not there.
5:51:53Hypothyroidism was given. That is That
5:51:54is the confusion. Some students said,
5:51:55"Sir, hypothyroidism was given." Some
5:51:57students said, "No, sir. Fructose was
5:51:58given." So, so so you have to clearly
5:52:00tell me which one which one is there.
5:52:05Okay. Let's Let's forget which one was
5:52:07there or not there. I'll just tell you
5:52:09what is happening in each one of them.
5:52:10In diabetes mellitus, what is happening
5:52:12that the mobilization of the body's
5:52:15store of fat is happening which will be
5:52:16packaged by the liver and released in
5:52:19the blood. So, the increased
5:52:21triacylglycerol will be seen in diabetes
5:52:22mellitus. Similarly, in nephrotic
5:52:24syndrome, there's compensatory increased
5:52:26production of the liver proteins.
5:52:27Because of that, there's more production
5:52:29of the VLDL. So, here also you find that
5:52:31increased triacylglycerol will be there.
5:52:33Again, in hypothyroidism, the
5:52:34triacylglycerol levels will be high. And
5:52:37in high fructose diet also, the
5:52:39triacylglycerol levels will be higher.
5:52:41Reason being fructose metabolism is
5:52:43unregulated. So, quickly the fructose
5:52:45getting metabolized in the liver,
5:52:46getting converted into the lipids either
5:52:48by certification or synthesis of fatty
5:52:50acid, and the triacylglycerol levels
5:52:52will be higher due to higher production
5:52:53of the VLDL. Okay? It is only the
5:52:56abetalipoproteinemia
5:52:57where there is less amount of VLDL, less
5:53:01amount of the chylomicron, which are the
5:53:03two main deliverers of the
5:53:04triacylglycerol. So, in
5:53:05abetalipoproteinemia the triacylglycerol
5:53:07level is lower or lower. Okay?
5:53:12So, so what you have to what you have to
5:53:14remember that in abetalipoproteinemia
5:53:16B48, B100 are not being synthesized, so
5:53:18the chylomicron, VLDL both are decreased
5:53:21in amount. They are the main
5:53:22transporters for the triacylglycerol.
5:53:27All right. Okay. Okay. So, so what I
5:53:29will do
5:53:31Tazak Kajon Wanna has said that
5:53:33hypothyroidism was a part of the
5:53:35different question.
5:53:40Okay. Okay. So, Shahbaz Khan is also
5:53:43saying that hypo was not there, it is a
5:53:44different question. So, let's replace
5:53:46the hypo while putting the high fructose
5:53:47diet as the option. And here the correct
5:53:50answer is abetalipoproteinemia, neither
5:53:53the chylomicron nor the VLDL are
5:53:54synthesized. They are the main
5:53:55transporters of the triacylglycerol. So,
5:53:57triacylglycerol level will be decreased,
5:53:59not increased. In all others the
5:54:01triacylglycerol level will be elevated.
5:54:03Okay. Okay. Wonderful. Thank you very
5:54:05much for for your
5:54:07very very valuable feedback. So, that it
5:54:09will help us rectify at the final set of
5:54:13the recall. Thank you very much.
5:54:15Okay. So, that's about the raised TAG.
5:54:17Let's go on to next question. I'll I'll
5:54:19not discuss question. Sir just discussed
5:54:21this question, so I'm not doing that.
5:54:22Patient has
5:54:24HB is low, decreased MCV, decreased
5:54:26ferritin. Sir already discussed that
5:54:27this is the iron deficiency anemia. So,
5:54:29I'll not go into the details of this.
5:54:31What I just want to mention, whenever
5:54:33you get the question on B12 and B9,
5:54:36remember that both of them will present
5:54:39with megaloblastic
5:54:41anemia. So, if you see decreased MCV,
5:54:45these two should be out. Whenever you
5:54:46see decreased MCV, then the B9 and B12
5:54:49deficiency will be out because they are
5:54:51going to cause the megaloblastic
5:54:53anemia. And the important distinction is
5:54:55in the B12 deficiency, you're going to
5:54:58have the neurological deficits, and
5:55:00you're going to have the increased
5:55:02methylmalonic
5:55:05aciduria. So, please remember these two
5:55:07points of distinction. These two points
5:55:09of distinction, yes, they've already
5:55:11discussed in the forum. I'm not going
5:55:12there. I'm just mentioning that how you
5:55:13distinguish between B9 and B12
5:55:15deficiency. All right. Now, here here a
5:55:17lot of ambiguities there. A lot of
5:55:19students said, "Sir, it was CRISPR-Cas."
5:55:21But some students categorically said,
5:55:23"No, sir, it was not CRISPR-Cas. It was
5:55:25talking about the base excision repair
5:55:27defect. It was showing that one of the
5:55:29metal bases is defective, which is being
5:55:31cleaved." So, so you have to please
5:55:33confirm that what was what was the
5:55:36question in this case? One image was
5:55:38given showing the DNA, RNA, and some
5:55:41cleavage and repair, etc., was shown.
5:55:43But you have to tell me whether there
5:55:45was a single base base removal?
5:55:51Was there a single base removal?
5:55:55Was there any label showing the
5:55:56CRISPR-Cas, or was there any label
5:55:58showing the zinc finger? Was the DNA
5:56:00being shown? CRISPR was not there.
5:56:03CRISPR-Cas9 was not there. Because
5:56:05because uh see, I have not seen the
5:56:07image. So, you have to tell me what was
5:56:08there in the image. Okay? So, if you had
5:56:11something like this, DNA is there, and
5:56:14one of the bases one of the bases is
5:56:16getting cleaved,
5:56:18one of the bases is getting cleaved,
5:56:20then this is the base excision repair.
5:56:22But if you have a complicated picture of
5:56:24DNA where the RNA is coming in as a
5:56:26guide,
5:56:29Oh,
5:56:30we had two questions.
5:56:33We had two questions.
5:56:37They are two different questions. One
5:56:39was base excision repair, other one was
5:56:40CRISPR. Okay. Okay. So, did both the
5:56:43question have images?
5:56:48So, if if there is cleavage and single
5:56:50base removal, single base removal
5:56:54All right. All right. Two different
5:56:56images question. All right. So, one
5:56:58question was the base excision repair.
5:57:01All right. The second question, which
5:57:03was showing the loop structure,
5:57:04hairpin-like structure was there, and it
5:57:06was showing
5:57:10a scissor need not be there in the
5:57:12CRISPR Cas. So, what I'll do in the
5:57:14tomorrow's final recall, I'll I'll put
5:57:16in the correct image of the CRISPR Cas,
5:57:18how it should actually look like, and
5:57:21what are the points that you have to
5:57:22see. So, I'll add the image for CRISPR
5:57:24Cas, and I'll show you the image for
5:57:26base excision repair. So, we'll add both
5:57:28these questions both of the these
5:57:30questions
5:57:31in the recall tomorrow. Tomorrow when we
5:57:34are having the recall, I'll add both
5:57:35these questions. If PAM was given in
5:57:37diagram, that should be the CRISPR Cas.
5:57:40Okay, as such CRISPR Cas may same as I
5:57:42checked on
5:57:43net. Shaban Kalyani, wonderful. So, we
5:57:46definitely had a question on CRISPR Cas
5:57:479 image, wonderful. So, that was given
5:57:49in the image, and you're saying that
5:57:51there was another question there was
5:57:52another question where we had the base
5:57:53excision repair effect. So, we'll
5:57:54include both the questions in tomorrow's
5:57:56final recall. So, thank you. Thank you
5:57:59very much. And if somebody is able to
5:58:01recall the statement or the options for
5:58:04the two questions, I'll be very very
5:58:06happy to take that on record.
5:58:09If you're able to remember the options
5:58:11for the two questions, one for the base
5:58:14excision repair image, and the second
5:58:15for the CRISPR Cas image, I'll be very
5:58:17very happy to take those options on
5:58:19record. Thank you very much.
5:58:21Okay. So, we had we had multiple
5:58:24pair the following or which of the
5:58:26following are correct? So, like that
5:58:27we'd multiple questions. One was talking
5:58:29about the properties of the different
5:58:31amino acids, right?
5:58:34One was talking about the properties of
5:58:36the different amino acids. Don't worry,
5:58:39I'll I'll put that question put that
5:58:40question tomorrow and you can then
5:58:43verify which was the correct image.
5:58:46Okay, RNA interference, microRNA
5:58:48synthesis, DNA sequence and CRISPR. All
5:58:50right, wonderful. That should be for the
5:58:52CRISPR cast. That should be for CRISPR
5:58:54cast. Okay, great.
5:58:56Let's Let's look at this the properties
5:58:58of the amino acids. If you remember, we
5:59:01routinely we are going to routinely do
5:59:03the properties of the amino acid based
5:59:05on the R side chain. There we said which
5:59:07one is having the
5:59:10the
5:59:11hydroxyl group, which one is having the
5:59:12basic group, which one is having the
5:59:13acidic group, which which one is having
5:59:16only the carbon hydrogen in the chain.
5:59:19So, like that we've talked about the
5:59:21different properties where we also
5:59:22marked which one is polar, which one is
5:59:24nonpolar, which one is charged, which
5:59:25one is uncharged. So, like that. So,
5:59:27here one of the important things you
5:59:29have to remember first is HLA, okay?
5:59:33Basic histidine and basic lysine. These
5:59:38were two options, okay? Basic histidine,
5:59:40basic lysine, these were two options,
5:59:42wonderful. Nonpolar
5:59:45nonpolar
5:59:47lysine uncharged proline. Uncharged
5:59:50proline, that's what I'm saying.
5:59:51Uncharged proline and nonpolar
5:59:54glutamate option
5:59:55TK TK glutamate option
5:59:58basic lysine
6:00:00basic lysine and arginine or basic
6:00:02lysine and histidine. Basic histidine,
6:00:04basic lysine are two options, not
6:00:05glutamate. TK You have to clear.
6:00:07Uncharged was proline and nonpolar was
6:00:10cysteine, is that correct? Proline basic
6:00:12was given, glutamate was not given.
6:00:14Okay. So, I think options were basic
6:00:17histidine, basic lysine, uncharged polar
6:00:20is proline and nonpolar is cysteine.
6:00:21This is what you saying. So, there the
6:00:23option should be three and four. Option
6:00:25should be three and four. Okay. So,
6:00:27correct answer should be three and four.
6:00:30All right?
6:00:33Okay.
6:00:34Basic proline is not basic. So,
6:00:36remember, proline proline is not basic.
6:00:39It is non-polar. It is non-polar and it
6:00:41is commonly labeled as the
6:00:43imino acid. It is imino acid. It is
6:00:47non-polar, non-charged, non-acidic,
6:00:49non-basic. Okay. For proline, you have
6:00:52to remember that.
6:00:53For the basic amino acids, you have to
6:00:55remember the HLA, histidine, lysine, and
6:00:58arginine. Histidine, lysine, and
6:01:00arginine are the basic amino acid.
6:01:03And for acidic, you have to remember the
6:01:06glutamate
6:01:09and aspartate. Glutamate and aspartate,
6:01:13these are the acidic amino acids. These
6:01:15are the acidic amino acids. Okay?
6:01:23All right. So, so these are some basic
6:01:25points you have to remember that
6:01:27the HLA and are the basic amino acids.
6:01:30The glutamate and aspartate are acidic
6:01:32amino acids. And these are the only five
6:01:35amino acids which are charged at
6:01:39physiological pH.
6:01:41So, if you remember these two points,
6:01:43then lots of questions are solved. So,
6:01:44here also, when we when we say that
6:01:47there is a uncharged polar amino acids,
6:01:50so proline is not not polar. So,
6:01:52immediately you can rule it out. So,
6:01:53based on that, we can mark. So, here
6:01:56here your answer should be three and
6:01:58four, basic histidine and basic lysine.
6:02:02These are the answers that you're going
6:02:03with for the timing. For the timing,
6:02:05these are the questions that we're going
6:02:07with.
6:02:08Javer, yes, I had some students
6:02:11mentioning that. I didn't have the exact
6:02:13statement.
6:02:14So, I'll I'll come back to the statement
6:02:16that you said glycans are synthesized
6:02:17non-template driven pathways modeling
6:02:19branching and variable linkage patterns.
6:02:21And for that question, what I believe is
6:02:23both
6:02:25as a reason assertion and reason both
6:02:27are correct. So, that should be the
6:02:28correct
6:02:30answer as per the different recalls that
6:02:32I've got, but we'll come back to that
6:02:33question in the end. I have that briefly
6:02:35written in my hand. So, we'll we'll come
6:02:38to that again.
6:02:40Okay. Okay. Another question another
6:02:42question talking about the acidosis and
6:02:44alkalosis where you have to correctly
6:02:46match it. So, you know that metabolic
6:02:49acidosis metabolic acidosis is a very
6:02:52well recalled by this mnemonic called
6:02:55mud piles.
6:02:57Where we have the ethylene glycol. Where
6:03:00we have the ethylene glycol. E is for
6:03:02ethylene glycol and ethanol. Okay. So,
6:03:05this one should go with D. One should go
6:03:08with D. Metabolic alkalosis will be when
6:03:11there is loss of S plus vomiting is one
6:03:13of the important causes for metabolic
6:03:14alkalosis. So, 1D, 2B. And respiratory
6:03:18acidosis when when there is difficulty
6:03:20in clearing out the C CO2. So, 3C. And
6:03:25alkalosis when there is large amount of
6:03:27CO2 washout hyperventilation or when
6:03:29there is panic attacks or when there is
6:03:32strenuous exercise when you are doing
6:03:34doing more of hyperventilation. These
6:03:35are the cases where
6:03:38the CO2 washout will happen.
6:03:40So, so please advise if these options
6:03:42are correct or you had some other
6:03:44options. Was this option of severe
6:03:46vomiting there or you had the option of
6:03:49pyloric stenosis? Which one of the
6:03:51following was there there in the
6:03:53question? If you can advise, we can take
6:03:56that on record and put it in the recall
6:03:58for tomorrow.
6:04:00Quickly, please give us the feedback
6:04:02whether severe vomiting was there or the
6:04:03pyloric stenosis was there. Okay.
6:04:10We'll Dr. Dr. Prakhar will come to that
6:04:11question about linoleic acid, safflower
6:04:13oil, etc. Don't worry. We will come to
6:04:15that question.
6:04:20Okay. Okay. Your inputs on this question
6:04:22so that we can quickly go on to the next
6:04:24one. Quick quick input so that we can go
6:04:27on to next one.
6:04:35No comments. Okay, I'll assume that
6:04:36these options pyloric stenosis is given.
6:04:38Okay. Okay. Pyloric stenosis is given.
6:04:41It's equally same when the pyloric
6:04:43stenosis is there, there will be
6:04:44intractable vomiting, right? So, the
6:04:46vomiting is going to be there which is
6:04:47going to cause the metabolic acidosis.
6:04:49Otherwise, the rest of it is same. Rest
6:04:51of it is same. Another another
6:04:54question where you have to do the
6:04:55pairing for this was related to the
6:04:57fatty acids and proteins. I believe
6:04:59there are more options here, but I've
6:05:02not been able to get those options. If
6:05:03somebody can give in those options, that
6:05:05will be great. Okay. So, most essential
6:05:08fatty acid, you know, is the linoleic
6:05:10acid. Most essential is linoleic acid
6:05:12and safflower oil is rich in the
6:05:15essential It is rich in the essential
6:05:18fatty acid. Now, net protein utilization
6:05:21depends on the protein quality and
6:05:24digestibility and amino acid score is a
6:05:27type of protein scoring system. But, if
6:05:30you can tell me some other options, I
6:05:32believe some students said said said we
6:05:34had multiple more than four uh uh
6:05:37options which you had to match. So, if
6:05:39there are more options, please let me
6:05:41know so that we can add to the question.
6:05:43Up to four I could get definitive
6:05:46answers, but for others I could not get
6:05:48any definitive inputs. If there are more
6:05:50valuable inputs, I would be very happy
6:05:52to take them on record. If not, then we
6:05:55move on with the four options. There are
6:05:57no other special MUFA PUFA was mentioned
6:05:59somewhere. Okay. Okay. We had something
6:06:02about MUFA PUFA.
6:06:05MUFA and PUFA. Anything else? Anything
6:06:08else mentioned somewhere?
6:06:10Okay.
6:06:12Net protein utilization. Net protein
6:06:13utilization is protein Okay, also also
6:06:16there. Okay, noted. Anything Anything
6:06:18else? Anything else without
6:06:20besides the
6:06:24Also net protein utilization I told you
6:06:26is dependent on protein quality and
6:06:28digestibility. What is the composition
6:06:29of the protein and what is the
6:06:31digestibility where the best protein
6:06:34net protein utilization score is for the
6:06:36eggs. Okay.
6:06:40Yes, that is the problem. We were not
6:06:42able to recall this question properly.
6:06:44But uh
6:06:45cysteine
6:06:47becomes essential amino acid.
6:06:52Okay. Okay. Achyuta Patel, I'm not sure
6:06:55about what you're trying to tell us.
6:06:57ICMR matched with net protein
6:06:59utilization.
6:07:02You're saying net protein utilization
6:07:04matched with ICMR?
6:07:11Amino score was on the other side. Oh,
6:07:14you're saying that amino acid score was
6:07:16on the other side. It was It was on the
6:07:19other side. Okay.
6:07:22Third question was ICMR NPU. Okay,
6:07:26you're saying that one of them was ICMR
6:07:29NPU. Okay. Okay.
6:07:32Okay, we'll we'll incorporate these
6:07:33comments. We'll incorporate these
6:07:34comments. ICMR matched with net protein
6:07:36utilization. All right.
6:07:38All right. We'll we'll take a look.
6:07:40We'll take a look at the inputs given by
6:07:42you and formulate the question again.
6:07:45But what I have matched, you should
6:07:48notice this conditionally essential
6:07:50amino acid. Conditionally essential
6:07:52amino acid. Okay.
6:07:56Conditionally
6:07:58essential amino acid. Okay.
6:08:07I smell that which NP, okay. Okay,
6:08:09conditionally essential amino acid as
6:08:11you are matched with net protein
6:08:12utilization. Noted, these points are
6:08:14noted. We'll incorporate them in the
6:08:16options, but for the timing please note
6:08:18that these are the correct matches which
6:08:20you should keep in mind that
6:08:22the ideal answer should be linoleic acid
6:08:24and the alpha linolenic acid, but most
6:08:28of the time this second option the alpha
6:08:30linoleic acid is not given in the
6:08:33option. So, if you were to choose one,
6:08:35if you were to choose one, then
6:08:36obviously linoleic acid is definitely
6:08:38the best answer. It is the first type of
6:08:40the
6:08:41omega-6 essential fatty acid which is
6:08:44also the precursor for the arachidonic
6:08:48acid. The main role of the linoleic acid
6:08:50is to get converted into arachidonic
6:08:51acid. This arachidonic acid will then
6:08:53give rise to the eicosanoids.
6:08:58All right, so this is the very important
6:09:00role. Biochemistry tough thing but you
6:09:02say tough thing it is it is just that
6:09:04just slightly they're jumbled up and a
6:09:07little bit of confusion they've created,
6:09:09but I believe they've not given tough
6:09:11questions, okay. And most of them are
6:09:13coming from the previous year's
6:09:14questions. So,
6:09:15it can be a little bit confusing that I
6:09:18can understand.
6:09:19Just cysteine essential cysteine was on
6:09:21the side as I said conditionally
6:09:22essential amino acid. Okay,
6:09:23conditionally essential amino acid and
6:09:26cysteine was there and tyrosine was also
6:09:29there. Right.
6:09:31Understood. Understood. Thank you. Thank
6:09:33you. So, cysteine and tyrosine will be
6:09:36for conditionally essential amino acid.
6:09:39Great.
6:09:40Thank you. Thank you very much.
6:09:43All right, so so this was another match
6:09:45the following list. We had one match the
6:09:47following list for the disorders and the
6:09:49match the following related to the
6:09:51nutrition. Nutrition part I keep telling
6:09:53in the class is very very basic but very
6:09:54very important.
6:09:57Okay, another another important question
6:09:59about effect of uncoupler on the ATP
6:10:02production, the heat production, and
6:10:04oxygen consumption. On these three
6:10:06factors you have to remember. Uncouplers
6:10:08will activate a separate channel from
6:10:10the F1 F1 particle so that oxidation
6:10:12will take place, oxygen consumption will
6:10:14take place, but ATP production will not
6:10:16take place. All this energy will be
6:10:17converted into the heat. So, what
6:10:19happen? ATP production will decrease.
6:10:21ATP production will decrease.
6:10:23Heat production will increase, and
6:10:26oxygen consumption will increase. So,
6:10:28out of this you can see the correct
6:10:30answer is B that ATP production
6:10:32decreases, heat production increases,
6:10:35and oxygen consumption increases.
6:10:39>> [snorts]
6:10:42>> Right.
6:10:46Yes, yes, that is true. INICET is more
6:10:48focused on the genetics, microbiology,
6:10:51and those are the more important focus
6:10:53in the
6:10:54uh NEET exam. Definitely, you are going
6:10:56to get more questions from the IIMs.
6:10:58Inborn errors of metabolism are the more
6:10:59important focus in the NEET exam, but
6:11:02INICET is slightly more focused, or you
6:11:05can say about 35 to 40 % questions
6:11:07coming from the genetics and
6:11:09microbiology section.
6:11:11Yeah, ETC ETC inhibitor was There was a
6:11:15question. This is done by
6:11:19Bears during hibernation. Yes, uncoupler
6:11:20question was there. Uh ETC inhibitor
6:11:23question, can you quickly tell me what
6:11:24was the question on ETC inhibitor?
6:11:27Because no one has till now mentioned
6:11:29ETC inhibitor. This is done by bears.
6:11:31Yes, this is done by bears, but this is
6:11:34also done by the brown adipose tissue in
6:11:36your own body. In addition to that, the
6:11:38body heat body heat is maintained by the
6:11:40activation of uncouplers. Please note,
6:11:42uncouplers uncoupler proteins are
6:11:44physiological proteins in the
6:11:46warm-blooded animals, which is utilized
6:11:47to produce the body heat. Uncouplers are
6:11:49activated by molecules like thyroxine.
6:11:51In the biological sequel the activation
6:11:53is done by the thermogenin which helps
6:11:55to produce the the heat in the body and
6:11:58even the bilirubin is an activator of
6:12:00the uncoupled protein.
6:12:02Talking about exogenous molecules the
6:12:03phenolic compounds are important
6:12:05activators
6:12:06of no ATC question okay because till now
6:12:08I've not got any question on the ETC.
6:12:11Okay so here you know that uncouplers
6:12:13will decrease production of ATP,
6:12:15increase production of heat and increase
6:12:17consumption of the oxygen.
6:12:20So we had this one question I'm not sure
6:12:22about the statement where they had said
6:12:24that person is having loose stools and
6:12:26then the child is given ORS. ORS is
6:12:28affecting absorption of glucose through
6:12:30which of the receptors? I think
6:12:31something like that the question was
6:12:33there. Please please advise if this
6:12:36statement is correct. Please advise if
6:12:38the statement is correct and if the
6:12:40options are correct or not.
6:12:44Oxygen consumption will increase.
6:12:51Agreed. Agreed.
6:12:55SGLT2 was not there in the option. Okay
6:12:57SGLT2 was not there in the option.
6:13:00SGLT1 was there.
6:13:04Is the statement of the question
6:13:05correct? Is the statement of the
6:13:06question correct? And if SGLT2 was not
6:13:09there did we have another GLUT? Maybe
6:13:11GLUT
6:13:122 was there.
6:13:14There's only one SGLT. Okay.
6:13:17Option was sodium potassium ATPase.
6:13:18Sodium potassium Okay I'm sorry. Sodium
6:13:21potassium ATPase. Sodium potassium
6:13:24ATPase. Okay sodium potassium ATPase.
6:13:27Wonderful.
6:13:29Okay early nitrate tolerance developed
6:13:31due to
6:13:35early
6:13:36nitrate
6:13:39tolerance. Let's try to rebuild this
6:13:41question later on. CFTR was an option.
6:13:43SGLT GLUT sodium potassium and CFTR.
6:13:46Okay you're saying [snorts] that CFTR
6:13:48was there in the option.
6:13:52CFTR was there in the option.
6:14:01Okay, so answer answer here is SGLT1.
6:14:03SGLT1 the smallest unit is responsible
6:14:05for taking up the glucose even in
6:14:06diarrhea when you're giving the adequate
6:14:08balanced amount of glucose and the
6:14:10sodium. When you're giving the balanced
6:14:11amount of glucose and the sodium, that
6:14:13is when the intake of the glucose will
6:14:15be there. The answer will be the SGLT1.
6:14:19Okay. So, we had this one question about
6:14:21reason assertion. Reason assertion one
6:14:23question was there which said that
6:14:25glycome has more diversity than
6:14:27proteome. And second was the assertion
6:14:29why the glycome is having more variation
6:14:31because of the variation in the
6:14:32different enzymes. So, here what I could
6:14:34make out from the statements that you
6:14:35remember,
6:14:37you have to mark that both reason
6:14:38assertion are correct. Both reason
6:14:40assertion are correct. Then we also had
6:14:42one question about the true false
6:14:44statement regarding activities of the
6:14:46insulin.
6:14:49Okay, rice history you know that it is
6:14:51going to cause the diarrhea that is that
6:14:53is there. Okay, wonderful.
6:14:56Liver with GLUT4. Okay. History says the
6:14:59child had food which was made one day
6:15:01before. Okay.
6:15:04Food
6:15:05made
6:15:07one day before. Food made one day
6:15:11before, probably rice. Okay.
6:15:14Uh
6:15:15developed diarrhea. And then you have
6:15:17diarrhea.
6:15:19Then you have diarrhea. You have two
6:15:22options, liver with GLUT4. Okay. GLUT4,
6:15:26liver with GLUT4. Okay.
6:15:30And muscle with GLUT4.
6:15:32Okay.
6:15:33And
6:15:35muscle with GLUT4.
6:15:41All right. All right. Surely. So, we had
6:15:43one question talking about the true
6:15:44false statement.
6:15:46I believe the statement which I could
6:15:48get from you was something like this.
6:15:52Explanation which was given in that
6:15:53statement, what I could make out from
6:15:54the students, that explanation the
6:15:57the explanation was the correct
6:15:59reasoning. The reasoning was the correct
6:16:01explanation for the assertion that the
6:16:03variation in glycome is due to the large
6:16:05number of different types of enzymes and
6:16:07genes, variation in the glycation, etc.,
6:16:09which can happen.
6:16:13Reason
6:16:14Assertion Assertion is correct and the
6:16:16reason explanation is also correct.
6:16:18Yeah, yeah, something someone had
6:16:20written before that the glycans are
6:16:22synthesized through non-template driven
6:16:23pathways involving branching and
6:16:25variable linkage patterns. That is the
6:16:26correct explanation. The the reason
6:16:29given for the assertion is correct.
6:16:31Jabir had mentioned previously also. So,
6:16:33please note what Jabir has mentioned in
6:16:35the comments that glycans are
6:16:37synthesized through non-template driven
6:16:38pathways involving branching and
6:16:40variable linkage patterns, which is the
6:16:41correct one.
6:16:42>> [laughter]
6:16:42>> Okay. So, one one more was that true
6:16:44false statements was given where they
6:16:46had mentioned that insulin increases
6:16:48protein synthesis. This is true. The
6:16:50thyroxine decreases BMR. This is false.
6:16:52Thyroxine decreases blood glucose. This
6:16:54is also false. Insulin decreases blood
6:16:56glucose. This is true. Epinephrine
6:16:58increases glycogenolysis. This was true.
6:17:00Glucagon increases gluconeogenesis. This
6:17:02is also true.
6:17:10Yes, base excision image options were
6:17:12pyrimidine dimers, the cytosine to
6:17:14uracil examination, cross-linking.
6:17:17Thyroxine it decreases blood glucose.
6:17:20That is also incorrect. Thyroxine
6:17:22doesn't decrease the blood glucose. It
6:17:24is not having such a profound effect on
6:17:26the blood glucose. It is only having the
6:17:29basal metabolism. So, that that one
6:17:32would also not be correct. It is not
6:17:33having direct action.
6:17:35Okay. So, what you have to remember that
6:17:38it is not decreasing blood glucose and
6:17:40it is not decreasing the BMR.
6:17:45So this the incorrect answer will be
6:17:47thyroxine decreases the BMR if it is
6:17:50mentioned or thyroxine decreases the
6:17:52blood glucose. These are the incorrect
6:17:54statement. Rest all will be correct.
6:17:59All right, anything else? Yes, there was
6:18:01one question on mechanism of
6:18:03carcinogenesis and UV exposure. So that
6:18:06will be the formation of thymidine
6:18:08dimers or the pyrimidine dimers. You
6:18:10know that this is how the xeroderma
6:18:13pigmentosum is happening. All right, so
6:18:16this is one of the most frequently
6:18:17repeated question in DNA damage and DNA
6:18:20repair mechanisms. So
6:18:23Okay, any any of the two, either it can
6:18:24be thymidine dimers or it can be
6:18:26pyrimidine dimers. Any of the two it is
6:18:27given it is same thing. Thymine is a
6:18:29pyrimidine, okay? So either it is a
6:18:31thymidine dimers or it is a pyrimidine
6:18:32dimers it means the same thing. Okay, we
6:18:34are talking about the same thing which
6:18:35is happening due to exposure of UV
6:18:37light. When the UV exposure is there
6:18:38there is formation of the thymidine
6:18:39dimers in the series on one of the
6:18:41chains. So where we have to utilize the
6:18:44nucleotide excision repair. We have to
6:18:47utilize the nucleotide excision repair.
6:18:50And if the repair mechanism is not
6:18:52working properly if this mechanism is
6:18:54not working properly then you are going
6:18:55to get the xeroderma pigmentosum. That
6:18:57is that is okay. A thymidine dimer or
6:18:59thymine dimer or pyrimidine dimer both
6:19:01all all three will be in the same one.
6:19:03No, but this is not part of the basic
6:19:05same question. This is not part of basic
6:19:06same question. This is a different
6:19:07question.
6:19:12All right, all right. Carcinogenesis of
6:19:13UV rays answer will be thymine dimers or
6:19:15the thymidine dimers whichever is there
6:19:17in the question. I think that is all I
6:19:20have for you.
6:19:22That is all that I have for you. Thank
6:19:24you very much and I I presume next
6:19:27faculty is in line to take up with
6:19:30recall. So
6:19:33Mr. Mahendra, if you can just uh
6:19:36take up the next faculty. And I thank
6:19:40you very much for your valuable
6:19:42feedback. And I am sure a lot of you
6:19:45have been able to mark all of them
6:19:47correct. We'll be posting the verified
6:19:49questions as per your feedback tomorrow
6:19:51in the app. So, you can take a look at
6:19:53the app for the verified detailed
6:19:55explanation for the INICET. Thank you
6:19:56very much and take care and best of luck
6:19:58for your results.
6:20:08>> Hello, everybody.
6:20:11Good evening.
6:20:14Good evening, all of you.
6:20:20Good evening.
6:20:23All of you, let me know if I'm audible,
6:20:25visible,
6:20:26and then we'll talk about pediatrics.
6:20:33Audible, visible?
6:20:36So, can we start?
6:20:40Okay. So, guys, how was pediatrics? Huh?
6:20:44So, I think pediatrics
6:20:46uh if I analyze pediatrics in today's
6:20:48INICET, I think there were a few PYTs
6:20:52also, and there were a few, in fact,
6:20:56PYQs also. And guys, if you talk to me,
6:20:59I would again say
6:21:02the questions were directly from
6:21:03multiple lectures of Back to Basics. So,
6:21:06guys, remember that you have to take one
6:21:09text as a gold standard. And I would
6:21:12again say, Back to Basics is a gold
6:21:14standard, and today I'll show you some
6:21:16snapshots from my lectures of Back to
6:21:18Basics and how it was.
6:21:21So, what I'll do today is I'll give you
6:21:23references from the standard textbooks
6:21:26and Back to basics and how it was. Okay?
6:21:30So, let us start from the first question
6:21:33and this was on neonatology and in all
6:21:36of your lectures we talked about
6:21:38neonatal seizures. So, this was an
6:21:40asymptomatic newborn with blood glucose
6:21:43of 38. So, all of you let me know if uh
6:21:47you don't agree with any of the options.
6:21:50And the options were uh breastfeeds and
6:21:53review.
6:21:55Dextrose IV bolus, start IV dextrose
6:21:58infusion, or no need to manage this
6:22:00child.
6:22:01So, all of you do you agree with all
6:22:02these four options?
6:22:05Asymptomatic
6:22:07neonatal hypoglycemia.
6:22:10What to do?
6:22:12Okay. So, uh you agree with me, Prakhar?
6:22:15Exact question?
6:22:17So, uh this is one of a snapshot from my
6:22:19lecture from uh back to basics where I'm
6:22:23talking about the management of neonatal
6:22:25hypoglycemia and every time in my
6:22:27lecture, guys, I tell you symptoms here
6:22:30to bolus then I whether it's
6:22:32hypoglycemia, whether it's hypocalcemia.
6:22:35If there is a symptom, we'll give a
6:22:37bolus. Now, this child is asymptomatic
6:22:39hypoglycemia between
6:22:4120 to 40.
6:22:43Okay? So, we will give breastfeeds,
6:22:45we'll continue breastfeeds, we'll
6:22:47reassess.
6:22:48And on reassessment, if it is still low,
6:22:50then only we'll start a glucose
6:22:52infusion. Okay? So, there is no doubt
6:22:54the answer to this question was to
6:22:56continue breastfeeds and review.
6:22:59Okay, 4 hours after birth. Okay, thank
6:23:02you.
6:23:03Uh so, I'll just correct my question
6:23:04here. Asymptomatic
6:23:074 hours
6:23:09old newborn. Thank you for telling me
6:23:11this.
6:23:12I'll just correct this question. Though,
6:23:13whatever it is, even if it's in the
6:23:15first month of life, answer will be the
6:23:18same.
6:23:19But, just let's
6:23:20improve this question. So, the answer
6:23:23was 4 hours old newborn and
6:23:26will continue breastfeeds and review.
6:23:28Excellent. So, guys, feel free to tell
6:23:30me if there was a change in the question
6:23:32or the answer options, okay?
6:23:34Now, there was a question on complete
6:23:36heart block in a newborn.
6:23:38Which antibody in the mother leads to
6:23:40it? And these were the four antibodies
6:23:42asked.
6:23:45Yes, you're right, Muralidharan. If
6:23:47glucose is less than 20, then according
6:23:49to the aims protocols, we will start him
6:23:51on glucose infusion.
6:23:53So, fetal heart block
6:23:57anti-Ro. And guys, when you look at the
6:24:00congenital heart disease lecture,
6:24:02I'm talking about, you know, very
6:24:03important maternal drugs and I always
6:24:06say lithium to I got it I got it, but I
6:24:09always also talk about maternal
6:24:11Sjogren's and SLE. Remember maternal
6:24:14Sjogren's syndrome has 30 times more
6:24:17risk of complete heart block in the
6:24:19baby. And Dr. Muralidharan, this was a
6:24:22direct question which we always discuss
6:24:24in our lectures. Maternal anti-Ro
6:24:27antibodies or SSA antibodies. And
6:24:30sometimes these newborns may need a
6:24:32pacemaker insertion also. So, there's no
6:24:34doubt the answer was anti-Ro antibodies
6:24:38and I think all of you agree with me.
6:24:41Let me take you to the next question.
6:24:43And
6:24:44next question I always tell you, if you
6:24:46look at any of our DVT lectures, any of
6:24:49our uh revision series, any CBT, every
6:24:54CBT last year had a question by me on
6:24:57Kawasaki disease. Every grand test, I
6:25:00used to talk about Kawasaki disease and
6:25:03leukocytoclastic vasculitis. See, there
6:25:05were two questions on it. Every Every GT
6:25:08we used to talk about this.
6:25:10So, I'll show you a lecture.
6:25:11Uh this is a snapshot of my lecture from
6:25:14back to basics. And can you see on the
6:25:16right side I have a question also not
6:25:19seen in Kawasaki disease. So yeah
6:25:22question to Anna he taught. And see in
6:25:25our lectures also we underline see
6:25:27whatever I have underlined has come.
6:25:30Periungual peeling of fingers and toes.
6:25:33This came in INICT 10 years back.
6:25:36Non-purulent conjunctivitis guys
6:25:39non-purulent. So of course purulent
6:25:42conjunctivitis is not seen.
6:25:45Excellent guys.
6:25:47Let me take you to the next question.
6:25:48There were almost 15 questions related
6:25:50to pediatrics and there was a question
6:25:53where there were cafe au lait spots.
6:25:57There was a neurofibroma on the eyelid.
6:26:00And Lisch nodule in the iris. Am I
6:26:02right?
6:26:04There were these three photographs cafe
6:26:05au lait spots.
6:26:07Neurofibroma on the eyelid. And Lisch
6:26:10nodules in the iris.
6:26:13So this was of course a neurocutaneous
6:26:15syndrome called neurofibromatosis type
6:26:181.
6:26:19In which there Lisch nodules see triad
6:26:22of cafe au lait spots Lisch nodules and
6:26:25neurofibroma neurofibromas.
6:26:30Okay?
6:26:32But on a brown guy instead of a white
6:26:33guy. Okay Dr. Prakhar? Uh
6:26:36yeah. Chahe brown ho chahe white ho
6:26:39answer was neurofibromatosis.
6:26:41Okay? So remember all of you should know
6:26:44about neurocutaneous syndromes. Next
6:26:46time in NEET PG they may ask you about
6:26:48tuberous sclerosis. So please do read
6:26:50about neurocutaneous syndromes
6:26:52especially tuberous sclerosis and
6:26:54neurofibromatosis.
6:26:56This was not tuberous sclerosis there is
6:26:58no doubt Prakhar thank you.
6:27:01Okay. Now
6:27:03refeeding syndrome.
6:27:05Guys this is a very important topic and
6:27:08in fact in the last INICT also I told
6:27:10you and in fact, see how previous year
6:27:14topics come. In the last INICET question
6:27:17was, "What causes the refeeding
6:27:20syndrome?" And we told you, there is a
6:27:22sudden surge of insulin secretion, which
6:27:25causes the refeeding syndrome. Okay.
6:27:29Thank you Akhil and Muralidharan. Okay.
6:27:31Since they
6:27:32they're insisting,
6:27:34I will add, okay, the other options of
6:27:38tuberous sclerosis
6:27:41and Sturge-Weber.
6:27:44Tuberous sclerosis and see
6:27:47Sturge-Weber
6:27:48syndrome.
6:27:50Okay, thank you.
6:27:54And the answer of that question was
6:27:56definitely
6:27:58neurofibromatosis.
6:28:00Thank you. So, let's talk about the
6:28:02INICET May question. In May, they asked
6:28:05about, "What is the pathogenesis of
6:28:07refeeding syndrome?" It's a sudden surge
6:28:09of insulin secretion, which commonly
6:28:11happens used to happen in jails. You
6:28:14know, whenever someone would be released
6:28:15from jail, he would come out, he would
6:28:17go to a restaurant, have a large amount
6:28:19of carbohydrate feed. So,
6:28:21hypophosphatemia
6:28:22is a hallmark. Okay? And yes, they can
6:28:25also have hypokalemia, also
6:28:27hypomagnesemia,
6:28:29but remember, the hallmark is
6:28:31hypophosphatemia.
6:28:33Every textbook talks about hallmark of
6:28:37Okay? Is hypo-
6:28:40phosphatemia. Okay, Down syndrome was
6:28:42also option. Thank you, Shashikiran.
6:28:45Okay. Now, there was a Let me tell me
6:28:47Can you tell me There was a question on
6:28:49meningitis in a 6-weeks-old baby or a
6:28:516-months-old baby?
6:28:54And these were the four options I
6:28:56discussed with multiple students, and
6:28:58they told me these were the four
6:28:59options.
6:29:01So, am I right?
6:29:05So, in a 6-weeks-old,
6:29:08which was dangerous? Of course,
6:29:10hypophosphatemia will be the answer.
6:29:13Okay?
6:29:20Yeah, 6-weeks-old. Okay. So, we
6:29:22discussed at length in our
6:29:23back-to-basics lectures that neonatal,
6:29:26see, less than in fact less than 2
6:29:28months,
6:29:29group B streptococci, E. coli,
6:29:32Klebsiella are common ones. Okay?
6:29:34Listeria causes a very severe and see,
6:29:37can you see I also talk about Listeria
6:29:39in the back-to-basics lectures. So, of
6:29:42course, the answer was Listeria.
6:29:45Okay?
6:29:48We'll come to the CSF question in a
6:29:50while.
6:29:51So, in a 6-weeks-old, answer will be
6:29:53only Listeria. Remember the other other
6:29:55causes of meningitis less than 2 months
6:29:58is Klebsiella,
6:30:00gram-negative bacilli, group B
6:30:02streptococci.
6:30:03A very common question in an ICT is the
6:30:05most common cause of neonatal meningitis
6:30:08in the world. Okay? So, Listeria is the
6:30:11answer. There is no doubt. Rest options
6:30:13are after 2 months of life. Staff, of
6:30:16course,
6:30:17does not cause unless it's a CONS.
6:30:21There was one more question on
6:30:22meningitis. I'll take that.
6:30:25Multiple option correct but still answer
6:30:27will be Listeria only.
6:30:30Listeria only. Rest don't affect a
6:30:336-weeks-old baby.
6:30:35Okay?
6:30:40Upper newborn and each other question
6:30:42that
6:30:46So, remember you should know this table.
6:30:48So, based on this table, okay?
6:30:54Let's go further.
6:30:58Now, this is the question which you are
6:30:59telling me. A patient with fever,
6:31:02malaise,
6:31:03and multiple cranial nerve palsies,
6:31:06hydrocephalus. So, I have a question for
6:31:08you. Did they tell you about the
6:31:09duration of illness?
6:31:12Okay, there were two three organisms in
6:31:14each option.
6:31:15Okay.
6:31:16But, of course,
6:31:18now you know the organisms less than 2
6:31:21months.
6:31:22Okay.
6:31:25So, can you tell me that Was there a
6:31:27question on duration of illness? Did
6:31:29they talk about duration?
6:31:36So,
6:31:37duration was not there, but still
6:31:38remember any meningitis with cranial
6:31:41nerve palsies, hydrocephalus,
6:31:45lymphocytosis, very high protein. So,
6:31:48can you tell me Did they talk about the
6:31:50protein content also of the CSF? See,
6:31:53remember the CSF is
6:31:56protein is very high in TB.
6:31:59It may be even grams. Okay, very good.
6:32:01Thank you. I'll I'll answer right here.
6:32:046-year-old. Anything else, guys?
6:32:08Uh Was there a
6:32:10Did they talk about
6:32:12Did they talk about the CSF protein?
6:32:15Did they tell you the value of the CSF
6:32:17protein?
6:32:19No?
6:32:22So, it was clear-cut, you know,
6:32:23meningitis with cranial nerve palsies,
6:32:26communicating hydrocephalus, everything
6:32:28points towards tuberculosis. That's it,
6:32:30high protein. So, this is a very This is
6:32:33a spotter.
6:32:35Okay. Now, a 12-year-old had upper
6:32:38respiratory infection.
6:32:40What should be done?
6:32:43So, guys, I've been telling this in each
6:32:46class of mine key IMNCI guidelines
6:32:49zarurat here.
6:32:51IMNCI. Okay.
6:32:53So,
6:32:55Thank you, Dr. Nisha. That
6:32:57I mean CI guidelines are always asked.
6:33:01Okay. So, you should know you know
6:33:02mostly what is no pneumonia, what is
6:33:05pneumonia,
6:33:06what is severe pneumonia.
6:33:09So, why would you do chest x-ray? Can
6:33:11you tell me the symptoms of that child?
6:33:14Can you tell me the symptoms of this
6:33:1512-year-old?
6:33:19Cough and cold what what they mentioned.
6:33:23What were the options like? Let's
6:33:25discuss this. 12-year-old with upper
6:33:27respiratory infection, what
6:33:29investigations?
6:33:40Only upper respiratory infection, so we
6:33:43will not do anything.
6:33:44This is what we do every day in our
6:33:46practice, okay? We'll just manage the
6:33:48upper respiratory infection.
6:33:51Okay?
6:33:52Any anything uh
6:33:54mention symptomatic URTI, okay? So, we
6:33:58will not do any investigations.
6:34:00Okay?
6:34:02So, this is not you don't even even need
6:34:04to look at a book for this, you know?
6:34:06Upper respiratory infection, symptomatic
6:34:10means he has khasi zukam, okay? So, why
6:34:13would you go for chest x-ray? Not no
6:34:16need for this.
6:34:17Okay.
6:34:20So,
6:34:21symptomatic is there, okay? I will write
6:34:24see upper respiratory infection
6:34:26symptomatic he told here.
6:34:28Okay?
6:34:30Why would you not do a Why would you say
6:34:32asymptomatic upper respiratory
6:34:33infection? Okay? So, it will
6:34:37be a symptom wala fever, cough and cold
6:34:39are symptoms, and we don't need to do
6:34:42anything here.
6:34:43Okay?
6:34:45Why would you do a chest x-ray for cough
6:34:47and cold?
6:34:49Okay? We will not do that, okay?
6:34:52Now, this was a slightly tricky
6:34:54question. Let's come to this question.
6:34:57A 20-month-old child with normal
6:35:00milestones, except that he can speak
6:35:02only one meaningful word.
6:35:05What to do?
6:35:07What do you think, guys?
6:35:11What do you think?
6:35:13Mhm?
6:35:18What do you think?
6:35:25Do you agree with me about the options?
6:35:35See, 20-month-old should be able to
6:35:39speak at least four to five words.
6:35:42Four to five words at least he should be
6:35:43able to speak.
6:35:44You know, this could be even a speech
6:35:47delay.
6:35:48This could be a hearing defect. So, at
6:35:51least even according to the American
6:35:53Academy of Pediatrics, I will at least
6:35:55do a speech analysis, a hearing
6:35:57assessment. Why do I want to miss that?
6:36:00Okay? In delayed speech in a child.
6:36:02Okay? So, yes, I would
6:36:05I will not just I know there was an
6:36:07option of reassurance here at 5 years.
6:36:11Yes, you're right.
6:36:12I agree with you. Actually, the option
6:36:14was reassurance till 5 years. Guys, do
6:36:17you want to miss
6:36:19hearing impairment till 5 years? Huh?
6:36:22Do you want to miss This is common
6:36:24sense. Why would you miss a hearing
6:36:27impairment till 5 years?
6:36:29I would not.
6:36:30I would at least do a hearing assessment
6:36:32in this child.
6:36:33Okay?
6:36:37And I would look for speech delay also,
6:36:39Dr. Shashikiran, and language.
6:36:42Even if hearing is normal, I would get a
6:36:45pure tone audiometry
6:36:47or better. Okay, Dr. Disha.
6:36:50Dr. Shub.
6:36:53Okay, even if they say hearing is
6:36:54normal, I would still assess the
6:36:56hearing.
6:36:57Okay, even if they say hearing is
6:36:58normal,
6:37:00I would do a formal hearing assessment,
6:37:02no?
6:37:03Parents are saying, "Okay, he can hear
6:37:05well."
6:37:06But still, I would do a formal hearing
6:37:09assessment including looking for the
6:37:12speech assessment, also.
6:37:15Okay?
6:37:17So, this child still needs a formal
6:37:19hearing assessment.
6:37:21Okay?
6:37:24And a speech looking for because I don't
6:37:26want to wait till 5 years for
6:37:28I may be missing something here. Of
6:37:30course, I cannot diagnose autism
6:37:32immediately in this child.
6:37:35Okay?
6:37:38This speech is not normal, Dr.
6:37:39Muralitharan.
6:37:44Okay?
6:37:45This speech is not normal.
6:37:47Okay, Dr. uh Doc.
6:37:49This uh 15-month-old child should be
6:37:51able to speak at least four to five
6:37:53words, no?
6:37:54He's speaking less than four to five
6:37:56words. So, this is not normal as per his
6:37:59development. Okay?
6:38:02So, growth is fine, but I want to look
6:38:04for other defects like speech, language.
6:38:08Now, guys, was there a question on
6:38:10rickets and
6:38:11calcium normals, phosphorus low? Was
6:38:15there a question on this?
6:38:20See, I don't want to waste till waste
6:38:22time till 5 years, Dr. uh
6:38:24Doc here and uh Doc So, I I can't wait
6:38:28till 5 years, and I won't I don't want
6:38:31to lose that patient, you know? Maybe
6:38:33after 5 years, he would be having so
6:38:35much of delay. So, better to do some
6:38:37formal assessment.
6:38:41Okay?
6:38:43As a question to
6:38:45calcium normal phosphorus low
6:38:53So, if calcium is normal see we have
6:38:55discussed at length in all of our
6:38:57classes in nutritional rickets calcium
6:38:59is normal phosphorus is low
6:39:02alkaline phosphatase is high and PTH is
6:39:05high.
6:39:06So, even in osteomalacia this would
6:39:08happen.
6:39:10Okay?
6:39:15Okay. So, what was the extra showing?
6:39:17Okay, adult question that osteomalacia
6:39:19would also have the same features
6:39:21actually.
6:39:22Okay?
6:39:24adult that
6:39:26Okay?
6:39:31So, it could be even vitamin D
6:39:33deficiency with secondary
6:39:34hyperparathyroidism.
6:39:36Okay? So, I would go for that.
6:39:39or osteomalacia they would have the same
6:39:41features.
6:39:43Okay, so okay child was not there. I
6:39:45think that medicine will discuss but it
6:39:47was it could be just a nutritional
6:39:50vitamin D deficiency. I'll
6:39:52not go into the details since you're
6:39:53saying the child may not have that.
6:39:56Now, there was a question on which is
6:39:57not a medium size vasculitis.
6:40:01Okay.
6:40:02And guys
6:40:03in your back to basics and your every
6:40:07you remember this photograph in the DVT
6:40:09booklet right?
6:40:11In the DVT booklet I added this
6:40:13photograph also. Okay? So, we always
6:40:17talked about keep by
6:40:19and in fact there were two questions on
6:40:21this. We have already discussed a
6:40:22question on Kawasaki
6:40:24which I already told you and now let's
6:40:26talk about small vessel vasculitis
6:40:29which is mostly see
6:40:31leukocytoclastic
6:40:33vasculitis
6:40:35is small vessel.
6:40:38Okay?
6:40:39Now,
6:40:40PAN is medium-sized.
6:40:42Wegener's is also medium-sized.
6:40:45Now, Wegener's is if you go back here,
6:40:48you can see Wegener's is small vessel.
6:40:50So, what about uh
6:40:53What were the options of this question?
6:40:56But, you need to remember that
6:40:59Listen to me carefully. Leukocytoclastic
6:41:02vasculitis is purely a small-size
6:41:06vasculitis.
6:41:08Okay?
6:41:10So, remember. Okay, we'll uh
6:41:12We'll leave that Ricketts question.
6:41:13Don't worry.
6:41:14So, leukocytoclastic is purely a small
6:41:18vessel vasculitis.
6:41:19Wegener's is also small vessel.
6:41:27Wegener's I I think yes, Wegener's was
6:41:29not in the option.
6:41:31I also think this was not there.
6:41:34So, that definitely leukocytoclastic
6:41:37vasculitis
6:41:39is small vessel vasculitis. Now, someone
6:41:41is there saying Wegener's was in the
6:41:43option. But, now listen.
6:41:46Best option will be
6:41:48leukocytoclastic.
6:41:49Okay?
6:41:51And yes, actually, the option was
6:41:52granulomatosis
6:41:54with polyangiitis. So, if you see here,
6:41:57microscopic polyangiitis is also small
6:41:59vessel, but it can involve medium size.
6:42:03Okay?
6:42:05Yeah, granulomatosis
6:42:07says with polyangiitis. I would like to
6:42:09add here
6:42:10granulomatosis
6:42:13granulo
6:42:15matosis
6:42:18with polyangiitis.
6:42:20Now, remember, it can involve medium to
6:42:24small vessel.
6:42:25Okay? So, the answer is definitely
6:42:28leukocytoclastic.
6:42:30Okay?
6:42:33Cool.
6:42:34Remember that.
6:42:36Now, there was a question which we
6:42:38always discuss in genetics and in fact
6:42:40in the DVT also, if you would have
6:42:42attended DVT, I talked about this also.
6:42:46A 5-year-old girl with repetitive
6:42:48behavior,
6:42:49slowing of the head growth,
6:42:52regression of milestones in a girl
6:42:59would be Rett syndrome. And we discuss
6:43:01about Rett's in
6:43:03all of our lectures, in in the DVT also,
6:43:06when we talked about genetics in
6:43:08pediatrics, I told you about the
6:43:10X-linked dominant Rett's.
6:43:12Classic girl
6:43:14who is normal till 6 to 18 months and
6:43:16develops decrease in the brain growth,
6:43:18autism,
6:43:20seizures, microcephaly, hand movements,
6:43:23repetitive behavior is Rett syndrome.
6:43:26Girl was there, okay? I will add her
6:43:29girl here.
6:43:30A girl definitely
6:43:33will be Rett syndrome.
6:43:35Okay? So, no points for guessing this
6:43:37one.
6:43:38We discuss this in every platform.
6:43:41Okay?
6:43:42Even if you were not a damn student, you
6:43:45were just a DVT student, we discussed
6:43:47this in DVT as well.
6:43:50Let's go further and let's talk about I
6:43:53know this was an adult patient who
6:43:56underwent splenectomy.
6:43:57So, guys,
6:43:59can you tell me the options of this
6:44:00question?
6:44:02If a splenectomized patient comes to
6:44:04you, he's at risk of which meningitis?
6:44:06So, can you tell me the options?
6:44:10Can you tell me the options?
6:44:17So, of course, they are at risk of
6:44:18encapsulated organisms.
6:44:20Okay, 20-month-old. Thank you, then it
6:44:23becomes a pediatrics question.
6:44:2620-month-old patient.
6:44:29E. coli
6:44:31Clostridium difficile
6:44:35Of course, not possible.
6:44:39And Mycoplasma
6:44:42So, if you are a DAMS regular student,
6:44:46every time in my lecture, you know, I
6:44:48talk about Shah Rukh Khan that even Shah
6:44:51Rukh Khan in this movie
6:44:53goes to Kajol with Harrison's textbook
6:44:56in his hand and he says key
6:44:59if a child gets a splenectomy, he's at
6:45:00risk of capsulated organisms.
6:45:03Okay, like Neisseria, H. influenza, and
6:45:06strep pneumonia. So, we should vaccinate
6:45:09patients who are undergoing splenectomy
6:45:11at least 2 weeks prior.
6:45:14So, of course, answer was strep
6:45:15pneumonia.
6:45:18Okay?
6:45:20Okay, even if it's an adult, Dr.
6:45:22Prakhar, answer is strep pneumonia.
6:45:25Okay? Don't fight, Akshay and Prakhar.
6:45:28Even if it's an adult
6:45:30Okay?
6:45:31We should vaccinate them. And in fact,
6:45:34this is a very old AIMS question. And in
6:45:36fact, to add to that, Dr. DGH, you
6:45:40should at least vaccinate them if you if
6:45:42it's a planned surgery, you should
6:45:44vaccinate them at least 2 weeks prior.
6:45:48Okay? 2 weeks prior at least.
6:45:51Before a planned splenectomy. But here,
6:45:55this lady got a road traffic accident,
6:45:57so we don't have time for it. So, we'll
6:45:58just give a
6:46:00pneumococcal vaccination.
6:46:02Okay.
6:46:04It's okay. Adult him.
6:46:06Okay. Now, there was a question on a
6:46:0812-year-old child
6:46:10who post sore throat got swelling,
6:46:13hematuria, and they showed a diffuse
6:46:17proliferation
6:46:19of the endothelial cells and a starry
6:46:21sky pattern.
6:46:23Guys, was electron microscopy also
6:46:26shown?
6:46:28Was this picture of electron microscopy
6:46:30also shown?
6:46:32Subepithelial humps were also shown.
6:46:37Huh?
6:46:39So, subepithelial humps are classic of
6:46:41post-infectious GN.
6:46:44Uh
6:46:45mostly will say post if we don't have a
6:46:48clear-cut evidence of Streptococcus,
6:46:49we'll say post-infectious
6:46:51glomerulonephritis.
6:46:53Okay, they showed subepithelial
6:46:55deposits.
6:46:58So, this is post-infectious
6:47:00glomerulonephritis.
6:47:02Cool.
6:47:04Now, a very nice question and I
6:47:06I would show you how we discuss about
6:47:08this in our lecture also. Was this
6:47:10question in your exam, all of you?
6:47:12In 17-alpha-hydroxylase
6:47:15deficiency, what is not low?
6:47:21Guys, remember back to basics is the
6:47:23gold standard. Please follow that. It is
6:47:26very concise. It is not like 200 hours
6:47:29of lectures. So, please look at your
6:47:32back to basics lectures for your NEET PG
6:47:34also. Okay? So, they are your gold
6:47:37standard.
6:47:38And if you just revise them and okay, in
6:47:41the last few days you go to your DBT and
6:47:43your revision series, but please do look
6:47:45at back to basics. So, in your back to
6:47:48basics, I have just a
6:47:5015-minute lecture on CAH.
6:47:52Just 15 minute. Okay?
6:47:56And uh uh
6:47:57I will show you here 17-alpha.
6:48:0317-alpha is here. Okay?
6:48:05This is 17-alpha.
6:48:10So, in 17-alpha, what will happen? Can
6:48:12you see this red line? Now, pregnenolone
6:48:14will be high.
6:48:17Mineralocorticoids will be high.
6:48:20So, because of the mineralocorticoids,
6:48:21renin will be low.
6:48:24Okay?
6:48:25Can you Can you now understand? Now,
6:48:27renin will be low because
6:48:28mineralocorticoids are high.
6:48:30And pregnenolone will be high.
6:48:33Now, cortisol is low, testosterone is
6:48:35low, androgens and estrogens are low.
6:48:39So,
6:48:40all are low, but pregnenolone is high.
6:48:43If you just remember this picture, which
6:48:45I discussed at length in a very short
6:48:48lecture on CH.
6:48:50It's 15 to 18-minute lecture only
6:48:53on the back to basics.
6:48:56Yes, okay, it was a multiple option
6:48:58correct question, but the answer was
6:49:00only pregnenolone.
6:49:02Okay?
6:49:03And if aldosterone is in the option,
6:49:05Akhil, then aldosterone will be high,
6:49:07you know?
6:49:08So, let me correct that. Very good.
6:49:10Thank you, Akhil. Uh
6:49:12if aldosterone is also in the option,
6:49:16suppose aldosterone is also in the
6:49:18option,
6:49:19then aldosterone will be high, you know?
6:49:23Can you see this?
6:49:25So, aldosterone will be high then.
6:49:29Okay, thank you, Akhil. So, if
6:49:31aldosterone was also
6:49:33in the option, then aldosterone will be
6:49:35high. So, just imagine this, okay?
6:49:38Just imagine this. I'll just
6:49:41put a pen here and write write this.
6:49:4417-alpha hydroxylase.
6:49:46Okay?
6:49:48And I'll keep this.
6:49:50Okay, fine?
6:49:53So, remember these are basics which we
6:49:55always discuss about in all of our
6:49:57lectures. Now, this was a difficult
6:50:00question indeed. Um
6:50:02In our back to basics,
6:50:04I always talk about a genetic syndrome
6:50:07of febrile seizure, called Dravet
6:50:10syndrome. You remember? If you look at
6:50:12my lecture on back to basics on febrile
6:50:14seizures,
6:50:16I start with Dravet syndrome. That it's
6:50:18a genetic febrile seizure epilepsy.
6:50:21And we talk about the treatment of
6:50:24Dravet syndrome as valproate,
6:50:26clobazam, fenfluramine,
6:50:29stiripentol.
6:50:31So, the question was, in Dravet
6:50:33syndrome, fenfluramine is added,
6:50:36what should be monitored?
6:50:38So, guys, can you tell me some what are
6:50:39what are the options in this question?
6:50:41Because I couldn't get hold of the other
6:50:44options.
6:50:47Side effect is pulmonary artery
6:50:49hypertension and valvular defects,
6:50:52which are rare these days, but
6:50:54echocardiography should be done. Yes,
6:50:57excellent. Valve abnormalities was the
6:50:59answer.
6:51:00Yes, Xavier.
6:51:01So, valve abnormalities is the answer of
6:51:04this question.
6:51:05Okay, which is though rare these days,
6:51:08but this is the answer of this question.
6:51:11So, echocardiography
6:51:13should be done to look for valve
6:51:15anomalies. Liver function tests are not
6:51:17so important.
6:51:19Agranulocytosis.
6:51:21So, there are rare side effects, but the
6:51:23most feared side effect is pulmonary
6:51:25hypertension, artery hypertension, and
6:51:28valve abnormalities.
6:51:31Okay, complete blood count should be
6:51:32done.
6:51:33LFT should be done.
6:51:36Ophthalmic reference.
6:51:38So, of course, the answer is the most
6:51:41feared side effect of fenfluramine is
6:51:43valve abnormalities.
6:51:46Okay?
6:51:47So, yeah, this was a slightly difficult
6:51:49question, though we discussed about
6:51:51fenfluramine, but side effects are also
6:51:53important. Okay? Now, my last question
6:51:56is, a child got diarrhea after taking
6:51:59rice.
6:52:00After taking rice.
6:52:03Which channel modulation is done
6:52:06with the ORS?
6:52:08So, see, after rice, within I was
6:52:11listening to your biochemistry lecture
6:52:12just now, within 24 hours of a cooked
6:52:15rice, you know, it could be cholera.
6:52:18And you know how
6:52:20ORS came into being? In fact, the
6:52:21doctor, one of the doctor who discovered
6:52:25who made, you know,
6:52:26ORS from Bangladesh, he recently expired
6:52:29last week. Uh
6:52:30so,
6:52:32this is how we explain to our undergrads
6:52:35in DAMS. In DAMS, we have a
6:52:38a whole module for undergrads for a
6:52:41foundation batch. So, see, whenever
6:52:44there is a cholera toxin,
6:52:46let's read this. It activates the cyclic
6:52:50AMP-dependent ATPases.
6:52:53And this cyclic AMP blocks the sodium
6:52:55chloride channels, sodium hydrogen
6:52:57channels.
6:53:00So, cyclic AMP blocks the sodium
6:53:01chloride channels,
6:53:03sodium hydrogen channels, and there is
6:53:05more secretion of chloride, so watery
6:53:07diarrhea happens.
6:53:09Okay?
6:53:10Now, all these channels are blocked,
6:53:11guys. Sodium chloride, sodium hydrogen.
6:53:14So, this is a cartoon which I show to
6:53:16all undergrads of
6:53:17DAMS.
6:53:19So, now the sodium glucose-based
6:53:22transport
6:53:23is not based on cyclic AMP.
6:53:26Okay? So, cholera toxin
6:53:29cyclic AMP-dependent
6:53:31Now, sodium glucose transport is not
6:53:33dependent on cyclic AMP. So, the answer
6:53:35was SGLT1.
6:53:37So, remember, it's a sodium glucose
6:53:39symport. So, ORS takes the advantage of
6:53:42sodium glucose symport via SGLT1.
6:53:46Okay?
6:53:48Cool.
6:53:50But I just thought I'll show you that
6:53:51cartoon, Xavier. It will help you
6:53:54remember that. This cartoon is very
6:53:56important that sodium glucose symport
6:53:58helps in the absorption of sodium.
6:54:00Glucose helps in the absorption of
6:54:02sodium into the intestinal cell.
6:54:06Okay?
6:54:07So guys, these were almost 15 questions
6:54:09which we discussed related to
6:54:10pediatrics, and I hope uh
6:54:15I was able to solve your questions.
6:54:19Any other question?
6:54:22Any other questions?
6:54:31And can you tell me the options of that?
6:54:38Yes, I think there was a question on
6:54:40which does not cause cyanosis Which
6:54:42causes cyanosis, huh?
6:54:45Uh hold on. There was a question on
6:54:47which causes cyanosis.
6:54:50So yes, thank you for telling that
6:54:52question. I'll just add that.
6:54:55Cyanosis
6:54:56is seen in
6:54:58And I think they one option was partial
6:55:00anomalous pulmonary venous connection,
6:55:02which is acyanotic defect.
6:55:05AV septal defect, which is seen in
6:55:06Down's syndrome patients.
6:55:09Okay? Which is
6:55:14Yeah, which is also acyanotic. I think
6:55:16pulmonary AV fistula.
6:55:19I know.
6:55:21Pulmonary
6:55:23AV fistula
6:55:25or malformation.
6:55:27Okay?
6:55:29So this is a cyanotic defect. Okay? So
6:55:31pulmonary AV malformation is a cyanotic
6:55:35defect.
6:55:36Okay, I don't know if there was any
6:55:37other option, guys.
6:55:40Uh ASD ASD was also there.
6:55:43AVSD was also there.
6:55:49So a communication within the lung
6:55:52pulmonary AV fistula will will cause
6:55:55cyanosis.
6:55:57Okay? So that will cause cyanosis
6:55:59because of a
6:56:00shunting within the lungs.
6:56:0317-year-old
6:56:12HPS was also there. So, then of course
6:56:15sickling can also cause a sickling
6:56:17crisis can also cause cyanosis.
6:56:22Okay? So, all of you please Can you
6:56:24please
6:56:25send me the question which we can
6:56:28discuss later on
6:56:29because we don't have
6:56:31exact options on this cyanotic heart
6:56:33disease.
6:56:37Now, someone is saying HBS was there.
6:56:39Someone is not saying. So, remember
6:56:42pulmonary AV fistulas can be cyanotic.
6:56:45And I'll discuss that with you.
6:56:48And I'll get back
6:56:50with
6:56:51Yeah, that was another question. Okay.
6:56:55PAPVC, partial anomalous pulmonary
6:56:57venous connection is acyanotic.
6:57:00I think TAPVC was
6:57:02TAPVC option or partial anomalous.
6:57:06See, total anomalous is cyanotic.
6:57:08There's no doubt about it.
6:57:09But partial anomalous is acyanotic.
6:57:14If total anomalous was there,
6:57:16definitely it's cyanotic. There's no
6:57:18doubt about this. Total anomalous is
6:57:21cyanotic.
6:57:23Pulmonary AV fistula is cyanotic.
6:57:27Okay?
6:57:33Okay?
6:57:35Now, someone is saying PAPVC. So, I'll
6:57:37get back and I'll have more
6:57:40more options with you guys and then
6:57:42we'll discuss. Okay?
6:57:45Thank you.
6:57:46So, I'll leave this to the next faculty.
6:57:49Thank you, guys. And I hope you found
6:57:52pediatric lectures helpful.
6:57:54Thank you and good night.
6:57:59You guys settle between PAPVC was there
6:58:01or TAPVC? PAPVC is acyanotic. TAPVC is
6:58:05cyanotic. Thank you.
6:58:25>> Good evening, students.
6:58:30Today,
6:58:31discussing
6:58:32the recall of
6:58:34respiratory medicine and acid-base
6:58:37balance.
6:58:40So, I had only few questions
6:58:43from the students. The number one was
6:58:47predominant.
6:58:49What is the mechanism of action of
6:58:52predominant?
6:58:54So, recently we have
6:58:56discussed under
6:58:59BB module
6:59:01within the YouTube session.
6:59:03Predominant is a nitroimidazole.
6:59:07And the main mechanism of action is
6:59:09generation of nitric oxide and
6:59:12inhibition of mycolic acid synthesis.
6:59:17Was this
6:59:18there, students?
6:59:19Mechanism of predominant.
6:59:22Was it asked?
6:59:26Then, I think
6:59:28there was another question on TB.
6:59:32So, it was
6:59:33TB spine previously. What is the next
6:59:36best test?
6:59:37See, generally for any extra pulmonary
6:59:40TB,
6:59:42the best test is usually tissue. So,
6:59:45tissue
6:59:47you should send it for
6:59:50CBNAAT
6:59:52culture.
6:59:54This is number one.
6:59:56Number two is histopathological
6:59:59examination.
7:00:02So, this is uh
7:00:03always in uh
7:00:05TB.
7:00:06Number one is
7:00:08culture.
7:00:10Because most of the extra pulmonary TB
7:00:13you find the organisms in the tissue.
7:00:16You send the tissue.
7:00:18Take the biopsy.
7:00:20First is CBNAAT or culture. Next is
7:00:23histopathological
7:00:24examination.
7:00:27And
7:00:29next question I think it was based on
7:00:32ABG.
7:00:33As per the options that I had, this
7:00:36should be the
7:00:38correct arrangement.
7:00:40Metabolic acidosis
7:00:43is generally caused by
7:00:46ethylene
7:00:50glycol
7:00:53poisoning.
7:00:57Metabolic
7:00:59alkalosis
7:01:04vomiting related
7:01:09respiratory
7:01:11alkalosis
7:01:14is
7:01:16hyperventilation.
7:01:20Then
7:01:22what was suggestive of
7:01:24respiratory acidosis, students? What was
7:01:28Okay.
7:01:29Any alcohol, methanol you're saying. Any
7:01:31alcohol will generally cause high anion
7:01:34gap metabolic acidosis.
7:01:37So, please help me to complete this
7:01:39question.
7:01:42Okay. Pyloric stenosis related vomiting.
7:01:47This was given.
7:01:52So, what was given for respiratory
7:01:55acidosis?
7:01:59Pneumonia. Okay.
7:02:01Pneumonia. See, pneumonia generally
7:02:03causes type 1 respiratory failure.
7:02:06So, in rare instances, when there is
7:02:08severe pneumonia, especially in
7:02:10children, their respiratory
7:02:13muscles will undergo fatigue quickly. In
7:02:16that situation, they can quickly go into
7:02:19respiratory acidosis.
7:02:21Especially in children, we come across
7:02:24bronchopneumonia severe form.
7:02:28There can be respiratory muscle fatigue
7:02:32because of tachypnea
7:02:35and increased respiratory rate.
7:02:40Were there any other questions on ABG?
7:02:43Any questions on ABG, students?
7:02:50Please let me know.
7:02:52Any questions, direct questions on ABG,
7:02:53because this everything we day in and
7:02:56day out discuss in the class and
7:02:59respiratory alkalosis, hyperventilation,
7:03:01this was also discussed in DVT.
7:03:06Where we have discussed that there can
7:03:09also be hypocalcemia like picture.
7:03:17Okay, only one question from ABG. Okay,
7:03:20in one question itself, they have asked
7:03:23your knowledge on metabolic acidosis,
7:03:25alkalosis, respiratory alkalosis,
7:03:27respiratory acidosis. Then,
7:03:30what about core respiratory medicine?
7:03:35Uh Uh,
7:03:36any disease that you can remember? I
7:03:38know you're all uh tired students and
7:03:41moreover
7:03:42this year
7:03:44uh, medicine paper is more of clinical
7:03:47scenario based.
7:03:49I know it will be a bit difficult for
7:03:50you to
7:03:52remember that clinical scenario. At
7:03:54least roughly you can make out the name
7:03:57of the disease
7:03:59and what was asked.
7:04:03So, one question was asked about foreign
7:04:05body.
7:04:07Uh, thank you, Dr. Vivek. Yes, foreign
7:04:11body and right main bronchus. Usually
7:04:14most common will be right side.
7:04:19And was there any segments asked?
7:04:25Segments.
7:04:29So, okay, reasoning, assertion reason.
7:04:31Why in right main bronchus? Because this
7:04:33was again discussed in near back to
7:04:35basics and classes, regular classes.
7:04:39It is short, it is stout, it is bit
7:04:42straight. Three S's you have to know.
7:04:46Why the foreign body settles down in
7:04:48right main bro- I mean, to the right
7:04:50side.
7:04:52Yeah, it is in line with trachea. That's
7:04:54why it is straight. Because if this is
7:04:56your trachea, it appears as if it has
7:04:59straightly arisen from your trachea.
7:05:03So, it is stout. Stout means wide.
7:05:10It's stout means wide.
7:05:12Okay, it is not longer.
7:05:15So, longer is left main bronchus. This
7:05:19is not longer.
7:05:20It is shorter.
7:05:22Stout means wider.
7:05:24Straight means in line with trachea.
7:05:26Okay, got it.
7:05:28So, these three you should mark.
7:05:30So, it is not longer.
7:05:33Then
7:05:35any other questions?
7:05:38Any diseases such as Was there any
7:05:41question on ARDS?
7:05:44Those are all favorite topics of I&I.
7:05:48Pulmonary embolism, pulmonary
7:05:49hypertension
7:05:52any question on pneumonia?
7:05:56ILD
7:05:58sleep
7:06:01lung cancer. Okay, Assam patient with
7:06:04lung cavities. Yeah.
7:06:07Sputum negative
7:06:10lung cavity
7:06:15The cavity itself
7:06:17is highly infective. Cavity with sputum
7:06:20negative, most probably
7:06:23TB will not be the diagnosis, but they
7:06:26have given Assam.
7:06:29Assam is endemic to histoplasma.
7:06:34TB like picture, endemic area can be
7:06:37histoplasmosis.
7:06:40Oh my god, not even a
7:06:43single chest x-ray. Okay.
7:06:48Yes, sarcoidosis having cavities less
7:06:51likely.
7:06:55Sarcoidosis having cavities less likely.
7:06:59Then any other questions on these
7:07:01topics? ARDS, pulmonary embolism,
7:07:05pulmonary hypertension, pneumonia, ILD
7:07:08sleep, lung cancer.
7:07:12Those were as the questions that we
7:07:14could recollect in respiratory medicine.
7:07:17I think most of you could answer
7:07:19extrapulmonary TB.
7:07:21The best sample is always the tissue
7:07:24whenever you can take it.
7:07:26And the third question, ABG was
7:07:28straightforward. Fourth question again
7:07:30ABG was straightforward. Fourth
7:07:32question, again discussed in class.
7:07:34Why aspiration on right side short,
7:07:37stout, and straight?
7:07:41Okay.
7:07:57So, any other questions, or else I'll
7:08:00pass on to next faculty for discussion.
7:08:15Yeah, decontamination for
7:08:19TB was asked. I think it this will be
7:08:21discussed in microbiology.
7:08:25Yes, decontamination.
7:08:33Okay, students. I think if there are
7:08:37no more questions,
7:08:39I would like to wind up.
7:08:42So, all of you take good rest and take
7:08:46care. Good night, students. Over to next
7:08:48faculty.
7:11:38>> Hello.
7:11:45Hello.
7:11:59Okay,
7:12:00so okay. So, we are live let us start.
7:12:03Done.
7:12:05Okay, guys. Good evening all of you.
7:12:07Welcome to this discussion of PSM for
7:12:09the ICT May 2026.
7:12:13As both me and sir together, we will be
7:12:15discussing the questions. Now, please
7:12:17understand this is just a recall. So,
7:12:21but overall paper if you ask us, both of
7:12:23us agree that it was a classic ICT paper
7:12:26where a heavy weightage was given to
7:12:29epidemiology.
7:12:31So, that is how PSM always starts that
7:12:33either they put up a lot of questions
7:12:36from epidemiology or statistics. And
7:12:39that's what they did. Probably only
7:12:41one question which was probably out of
7:12:43the normal things which we teach in our
7:12:46classes was the MCH scorecard. So, I'll
7:12:49go be putting it up close.
7:12:51Otherwise, if you ask us out of the 12
7:12:53questions, I got up in Mira or circle
7:12:55class attend here. We would expect you
7:12:58to get 11 out of 12 for sure. Okay. So,
7:13:01that is what we would expect. Yes,
7:13:04over to you for your introductory marks
7:13:06and then we'll start discussing. All
7:13:08right. So, hi sir. Hi everyone.
7:13:10This typical uh,
7:13:12paper PSM, majority of the questions
7:13:14they were from epidemiology, odds ratio,
7:13:16positive predictive value.
7:13:18And they were very, uh, you know, doable
7:13:20questions. Yes, uh, like sir said that
7:13:24Remancha scorecard, we don't expect at
7:13:27the undergraduate level that, uh, this
7:13:30is very, uh, you know, a must know for
7:13:32undergraduate level. So, uh, some
7:13:34questions in your exam, you need not to
7:13:37panic when they come. And, uh, this
7:13:39Remancha scorecard was one of that
7:13:42topic.
7:13:43Right. The problem here is when you are
7:13:46not able to do the questions like odds
7:13:48ratio, positive predictive value, then
7:13:49it is a problem. But, this
7:13:52Remancha scorecard, yes, that was an
7:13:55outlier question.
7:13:58>> Chalo, let us start. So, sabse pehla
7:14:00question was calculation of odds ratio.
7:14:02You cannot expect an easier question
7:14:03than this. So, it was just a cross
7:14:05product. So, 80 into 60 divided by 20
7:14:07into 50 agar karoge, answer six aata.
7:14:11Second question.
7:14:13>> Now, uh, guys, nested case control
7:14:16study, if you remember, uh, in my class
7:14:18also I have told you in reality, nested
7:14:21case control study is not a case control
7:14:23study, it is a cohort study because we
7:14:25are doing a follow-up. Whenever we are
7:14:27doing a follow-up, we get, whenever we
7:14:29do a follow-up, we get incidence. And
7:14:31when we have incidence, we can, uh,
7:14:34calculate relative risk directly as
7:14:37well.
7:14:37So, here the reason they are giving
7:14:39nested case control study can accurately
7:14:41calculate relative risk. Yes, because
7:14:43this is a follow-up study, we can
7:14:44calculate.
7:14:46And, uh, assertion they are giving is it
7:14:48uses data of incidence from the cohort.
7:14:50Yes, that is also true. So, here both R
7:14:52and A are true, and A is the correct
7:14:54explanation, right?
7:14:56So, here both A and R and R are true.
7:15:01>> Third question.
7:15:02Study done across 10 countries on
7:15:03alcohol consumption and cirrhosis. There
7:15:05was a graph. It was basically a positive
7:15:07correlation graph. Now, this is not a
7:15:09statistics question. You basically not
7:15:11ecological study cannot class may be
7:15:14tell you it is correlational study
7:15:16because ecological study gives you that
7:15:18scatter plot. So, your statistics
7:15:20question may
7:15:21the keyword was correlation making the
7:15:23answer as ecological study.
7:15:26Next question.
7:15:27I'm coming to relevance of checking
7:15:29heterogeneity in meta-analysis. Guys,
7:15:31please understand in meta-analysis we
7:15:33are including various studies and then
7:15:36we are doing a
7:15:37systematic review and then we are doing
7:15:39a statistical method to calculate to
7:15:42find the meta-analysis, right? To find
7:15:43the meta-analysis. Now, these studies
7:15:46they are different from each other.
7:15:47So, here heterogeneity heterogeneity it
7:15:50tells us about how these studies are
7:15:53different from each other. Point number
7:15:55two, I square stats is used to calculate
7:15:58the heterogeneity. Point number three,
7:16:00depending upon the heterogeneity we go
7:16:03for a fixed model or a random model,
7:16:06right? Fixed model or a random model.
7:16:08So, all of these these three points are
7:16:10very important regarding heterogeneity
7:16:12in meta-analysis.
7:16:15Next question. If X percentage of the
7:16:18stroke in a population is due to
7:16:19hypertension and removing hypertension
7:16:21would cure, what is the example? Again
7:16:24here, they used a keyword population.
7:16:26So, basically it is population
7:16:28attributable risk. So, if you ask us out
7:16:31of these five questions
7:16:33two of them were all about picking up
7:16:35the keyword and that is what both me and
7:16:37sir have done it in the DVD and that is
7:16:40where you should understand that
7:16:41concepts plus revision made a huge
7:16:44difference in AP questions this time in
7:16:47INICT. Question number six.
7:16:50Now guys, simple simple simple question
7:16:53positive predictive value. I feel odds
7:16:55ratio and positive predictive value
7:16:56these two were the
7:16:58easiest of the questions. And for the
7:17:01positive predictive value, the simple
7:17:03thing which we have told you also that
7:17:07true positive divided by all the
7:17:09positive on screening test, right? I
7:17:10always say true positive divided by T
7:17:12plus. So, here 90 divided by 90 plus 50.
7:17:17So, you can say 90 divided by 140. So,
7:17:20the correct answer will be approx 65%.
7:17:24>> Question number seven. An outbreak
7:17:26investigation showed a graph with
7:17:28multiple successive peak separated by
7:17:31intervals approximately equal to the
7:17:33incubation period suggesting a person to
7:17:35person spread. Which of the following
7:17:37accurately describes the infection? Now,
7:17:39this classically is an example of a
7:17:42propagated epidemic. Now, why can't it
7:17:45be option number D, food poisoning?
7:17:46Because in a food poisoning, you have a
7:17:48point source epidemic. So, see in the
7:17:50class, we normally teach you that types
7:17:53of epidemic point source likhte
7:17:55uska graph banate example likhte. Here,
7:17:57they just flip the question and that is
7:17:59the reason the answer to this question
7:18:01was typhoid.
7:18:05>> Now, vaccine with efficacy 85% and
7:18:08effectiveness 90%.
7:18:10What does that mean? See, guys, efficacy
7:18:13is something which is in the lab.
7:18:17Effectiveness is in the population,
7:18:20right? So, here 95% chances of that the
7:18:24those who receive the vaccine will not
7:18:26be affected. 85% of those who receive
7:18:29the vaccine will not be affected if
7:18:30those do not receive it in the clinical
7:18:33trial.
7:18:34And protection depends on disease rate
7:18:36and enough to protect transmission. So,
7:18:39uh I think there there is uh there is uh
7:18:42I I think there is, you know,
7:18:45the exact recall options because there
7:18:48are various uh there are various recall
7:18:50of this option. But what I want to tell
7:18:53you is efficacy is something which is in
7:18:56the lab. Effectiveness is in the real
7:18:59life. So, what do you people think that
7:19:01all of these question options A, B, C,
7:19:03D, they are correct or is there any
7:19:05change in any option?
7:19:07Efficacy was 90%. Okay. So, I am noting
7:19:11it down Dr. I am noting changes because
7:19:14there is one student who is telling
7:19:15efficacy was given 90%.
7:19:18And effectiveness was given 85%, right?
7:19:21So, we will correct it. We will correct.
7:19:23Okay, sir has already corrected it.
7:19:25Right?
7:19:31All right.
7:19:33Efficacy was 95 and effectiveness was
7:19:3785. Okay.
7:19:40So, the gist is
7:19:42efficacy in the lab, effectiveness in
7:19:44real life. Okay, let's proceed to next
7:19:46question.
7:19:48>> Gardasil vaccine, correct statement
7:19:50about it. Now, actually, this was a
7:19:52mixture of two guidelines which they
7:19:54have given, WHO and Indian guidelines.
7:19:56Now, let us first understand there's a
7:19:58difference between the Indian guideline
7:20:00which was launched on the 28th of
7:20:03February. Now, the Indian guideline say
7:20:05that we use Gardasil for
7:20:08for only 14-year female.
7:20:12And it is a single dose.
7:20:16The aim is to cover 90% population.
7:20:20And even if you give the vaccine,
7:20:23screening will be needed because we are
7:20:26giving single dose. But when we talk
7:20:28about WHO, WHO guidelines say that the
7:20:30target age group is 9 to 14 years.
7:20:33WHO definitely recommends multiple
7:20:36doses, not a single dose. Yes. Even WHO
7:20:40says that the aim of vaccination program
7:20:42is to cover 90% of population below the
7:20:4515 years. So, this is more of a khichdi
7:20:47question where
7:20:49some students said "Sir, WHO guideline
7:20:51the other some said Indian guideline the
7:20:52other." So, jo bhi ho, according to the
7:20:55you have to mark the answer to it. Okay?
7:20:58>> All right. So, I want to
7:21:00So, I want to add few points here
7:21:02because
7:21:04there are two things which you have
7:21:05correctly said, but I want to tell you
7:21:08that
7:21:09the Indian guideline
7:21:11Indian guideline does not say single
7:21:13dose is better. That is under HPV
7:21:17campaign, like MR campaign, GE campaign,
7:21:20polio campaign. It was HPV campaign, and
7:21:24in that campaign, we are only going to
7:21:26give one dose.
7:21:27Now, second thing, here the point C, 90%
7:21:31of population, the aim of vaccination.
7:21:32Guys, if you remember in our class and
7:21:35DVT also, I have already told you 90 70
7:21:3890. And the mnemonic which I told you
7:21:40was VST.
7:21:4390% vaccinate, 70% screen, and 90 but
7:21:47you know, 90 70 90, it is there in our
7:21:50DVT as well. Right? So, option C is
7:21:54according to that WHO guideline, 90 70
7:21:5790.
7:21:58And yes, the answer given by sir is
7:22:01exactly correct. I was just adding two
7:22:03more points, right? From our DVT.
7:22:07Next.
7:22:08>> Okay. Now, this was the scorecard. Now,
7:22:10let me make it very simple. Now, this is
7:22:12a color coded scorecard.
7:22:15Now, if you get a green color, it means
7:22:18it is less than 20% below. That means
7:22:22acha theek hai.
7:22:23Like IMR agar desh ka hamara 30 hai,
7:22:26usse 20% kam hai. 20% matlab around 24
7:22:30se kam hai to acha hai, green.
7:22:32Yellow in the range of 20% below and 20%
7:22:36more. So, IMR agar 30 hai, so 24 to 36
7:22:39agar aaya to yellow color. Agar 36 ke
7:22:42upar hai, then red color. Simple example
7:22:45to explain you this color coding. Okay?
7:22:48Done?
7:22:49Now, they had put up these options in
7:22:52which probably one option was TFR more
7:22:54than 20% of national average.
7:22:57Definitely, it makes it a red color.
7:22:59Because 20% of come reduce time up is
7:23:02good. There is no doubt. MMR less than
7:23:0420% is also good. Okay?
7:23:07Next question, components of attitude.
7:23:10Guys, if I talk about components of
7:23:12attitude, there are three components and
7:23:15this is known as ABC.
7:23:17Affective, behavior, cognitive. Right.
7:23:21So, if the option was like if if
7:23:25anywhere in the option was these three
7:23:27terms, ABC. This is the mnemonic for the
7:23:31attitude, ABC.
7:23:34Affect or affective, then behavior,
7:23:38and then
7:23:40cognition. Was it there? Was these three
7:23:42options were there? Because earlier when
7:23:44we got the recall, me and Dr. Sidharth,
7:23:46we were discussing. The first recall we
7:23:49got was knowledge income. I was like,
7:23:53"Dr. Sidharth, are you sure the attitude
7:23:55was there or something HDI or PKLI they
7:23:57they want to ask?"
7:23:59So, was it there?
7:24:02Affect, behavior, and cognition.
7:24:07Yes, Dr. Prabhakar. Dr. Prakhar.
7:24:10Knowledge income life expectancy. We
7:24:12would mark blindly HDI, right?
7:24:15Yes. Affective response social. No, Dr.
7:24:18Jayvir, no. It is ABC. ABC. Always
7:24:22remember for attitude, it is ABC.
7:24:25Affective, what my emotions say. My
7:24:27attitude depend on my emotions,
7:24:29affective. My attitude depends on my
7:24:31behavior. Cognition, my attitude also
7:24:34depends on how much I know, right? So,
7:24:37if I don't know the subject and I'm here
7:24:39in front of you, there will be a
7:24:40different attitude. There will be a
7:24:42different attitude of mind. But if I
7:24:44know my subject, my cognitive domain is
7:24:47high, then I will be having I will be
7:24:49carrying a different attitude, right?
7:24:51So, A always remember A B C attitude.
7:24:55Right?
7:24:56Done.
7:24:57All Yes, Dr. Many of they are saying
7:25:00that ABC was mentioned affect behavior
7:25:02and cognition. So, let's mark this
7:25:04answer A B and C.
7:25:06Okay, coming to the next question.
7:25:08>> Yes,
7:25:09Dr. Please.
7:25:11>> Okay, sir. I'm coming to the next
7:25:12question, please.
7:25:13Pearl Index, please, sir.
7:25:19You are taking the question?
7:25:20>> No, you you, sir. Your turn, sir. Okay,
7:25:22Pearl Index. Basically, we know that
7:25:24it's a contraceptive failure. It is
7:25:26number of pregnancies, accidental
7:25:28pregnancies plus 100 women years. So, it
7:25:31was a straightforward question which we
7:25:32could get.
7:25:34So, guys, these were the 12 questions.
7:25:35We can see many of you have given us
7:25:37suggestions to change the option. We
7:25:39have tried to change it. Even still, if
7:25:42there is some other changes, please feel
7:25:45free to reach out to both of us so that
7:25:47we would be able to edit and provide you
7:25:50of more
7:25:52accurate recall and discussion video on
7:25:55Monday. Yes? Please feel free to reach
7:25:58out. That's all from my side. Over to
7:26:00you, Dr. Kashish.
7:26:01>> Okay. Sir, there is one student who is
7:26:03asking ABC was not in the sequence. BCA
7:26:06was there, behavior. Right? So, any any
7:26:09can be anything can be there. ABC I was
7:26:12just telling you for a mnemonic. But
7:26:14yeah, they can also mention BAC,
7:26:15behavior, affect, and cognition. That is
7:26:17also true.
7:26:19If the sequence was not in ABC, it was
7:26:21behavior, affect, and cognition, that
7:26:24also is also correct. But I am just
7:26:26telling you the ABC of the component.
7:26:28Just a mnemonic.
7:26:30Okay.
7:26:31>> Sir is mentioning the mnemonic. Sir is
7:26:34And the question was component. So, the
7:26:36sequence may be changed.
7:26:38ABC or [clears throat] BCO CAB or
7:26:40Chilega but the voting that is what sir
7:26:42is telling ticket.
7:26:43>> Yes, I'm just telling the mnemonic.
7:26:45And and so they mentioned national plus
7:26:48WHO guideline national plus WHO for HPV
7:26:51Dr. Vivek.
7:26:54National plus WHO you are talking in
7:26:56context of HPV Dr. Vivek.
7:26:59>> Okay.
7:27:01I got donor type to boss you to the
7:27:03tricky or tiger top of a movie like the
7:27:05answer all four of them to give it.
7:27:11Meta-analysis question assessment of
7:27:13heterogeneity is useful for
7:27:16>> We have already discussed that.
7:27:17>> Yes, we have already discussed.
7:27:21To check variability to check variation
7:27:24in different publication. Yes.
7:27:26Heterogeneity itself it means there is a
7:27:29difference there is a difference in the
7:27:31studies.
7:27:38Done?
7:27:42Okay. So I guess guys thank you. Thank
7:27:46you for your patient support.
7:27:48And I know it has been a long day. So
7:27:50see you guys. Bye-bye. Just sleep well.
7:27:53There is a lot coming up from Monday.
7:27:56Take a day off tomorrow. Enjoy your
7:27:58Sunday and let us get back off from
7:28:01Monday with both me and Kush sir and we
7:28:03again restart together for the NEET
7:28:05preparation and rock the show. Bye-bye.
7:28:08Goodnight.
7:28:09>> Okay everyone. Goodnight. Goodnight sir.
7:28:11Goodnight everyone.
7:29:25>> All right.
7:30:10All right. I hope now it is okay.
7:30:17I yeah, yeah, yeah. No, no, it's okay.
7:30:19All right. So, I I know this time the
7:30:21questions have come a little bit here
7:30:23and from here and there.
7:30:25But it really one or two questions in
7:30:26ophthalmology and I know you're tired.
7:30:31And I'll wrap it off quickly because it
7:30:34was a long day and long recall. So, let
7:30:36us see what are the ophthal-
7:30:38ophthalmology questions this time in May
7:30:402026 uh INICET.
7:30:43I think [snorts] one or some questions
7:30:44I've got six questions. Usually 10
7:30:46questions come, but I've got six till
7:30:47now and maybe I'll get it
7:30:51afterwards. Just let me know what are
7:30:53the options. I think uh
7:30:55Now, the audible is okay.
7:30:58Now, the audio is okay, right? So, this
7:31:00question I think
7:31:01the age I don't know, but it was I think
7:31:03a female who comes to you with painful
7:31:06eye movements and there was a uh RPD.
7:31:08They should have written uh relative
7:31:10afferent pupillary defect as a full
7:31:11name. That means there's a partial optic
7:31:13nerve changes, but there's no changes in
7:31:16the optic disc.
7:31:17So, I think there's no problem. Maybe in
7:31:19options there can be AION. Some people
7:31:22have told students have told me that
7:31:23there is
7:31:24arteritic ischemic optic neuropathy was
7:31:26in the options.
7:31:31Yeah, yeah. Now, now the mic is okay.
7:31:34Now, it's okay.
7:31:37I think you're seeing the lag version,
7:31:39don't worry. So,
7:31:41answer
7:31:42uh
7:31:43is pain on eye movements particularly
7:31:45that is in demyelination multiple
7:31:47sclerosis and because of SRN MRN
7:31:50involvement there is painful eye
7:31:51movements. It has been This has been
7:31:53discussed multiple times, so this should
7:31:54not have been made wrong. I don't think
7:31:56so. Last option was AION. Yes, Saurabh
7:31:59Pathak, I know that. So, that is uh
7:32:02uh I will correct. Uh
7:32:05Other than that, papilledema was in the
7:32:06options. CRAO maybe
7:32:08Some says optic neuritis, some says
7:32:09AION. So, I will check that. Uh
7:32:13This question may D ki jagah acute
7:32:15papillary acute papillary nahi hoga
7:32:16acute ischemic optic neuropathy hoga. Ya
7:32:18papillitis hoga maybe optic neuritis ki
7:32:20jagah. Maybe they have given papillitis.
7:32:23But answer is retrobulbar neuritis. That
7:32:24is a demyelination of the neuritis
7:32:26particularly in females.
7:32:28Sudden painful loss of vision yes with
7:32:30painful eye movements was there
7:32:31actually.
7:32:32So this question with there was
7:32:34no much doubt.
7:32:36There have been doubts in some other
7:32:38questions.
7:32:39So let us go to the next one. This
7:32:41answer is retrobulbar neuritis multiple
7:32:42sclerosis will be the answer.
7:32:45And this question is an anatomy question
7:32:47of the glaucoma
7:32:49angle of anterior chamber is also
7:32:52was doable. The trabecular meshwork has
7:32:53all the components except
7:32:55I think these were the options.
7:32:57Uveal, uveoscleral canalicular is the
7:32:59maximum resistance, corneoscleral and
7:33:02uveal. There is uveoscleral pathway not
7:33:04uveoscleral meshwork.
7:33:06That is the answer of this question.
7:33:07That is an anatomy question.
7:33:10There are three types of trabecular
7:33:12meshwork. The maximum resistance are in
7:33:13the juxtacanalicular Juxtacanalicular
7:33:15means that is close to the Schlemm's
7:33:17canal. Now one student said that one
7:33:18option has Schlemm's canal.
7:33:21So that option has Schlemm's canal yes
7:33:23or no I don't know.
7:33:25So Sahil Agarwal is also saying canal
7:33:27options. So which is not in the option?
7:33:29This was not in the option because uveal
7:33:31has to be there.
7:33:32Juxtacanalicular has to be there,
7:33:33corneoscleral has to be there so
7:33:34Schlemm's canal is the answer actually
7:33:36of this.
7:33:38It was multiple correct. Okay fine. So
7:33:39there was a e options and it was a
7:33:41multiple correct.
7:33:44Right. That was multiple correct. Okay
7:33:45fine.
7:33:46So ABC like that ABD AD like that. Okay.
7:33:50So uveal, juxtacanalicular and
7:33:52corneoscleral. So there were I think e
7:33:54is a five six options. So these three
7:33:56uveal, juxtacanalicular and
7:33:57corneoscleral were in the options. That
7:33:59was correct. Okay fine.
7:34:00So that is also doable. Two questions I
7:34:01think are doable.
7:34:04Now you took but I have not got So let
7:34:06us do this afterwards.
7:34:08Let us do this afterwards. Let us take
7:34:10care of uh
7:34:12Uh maybe this question first because
7:34:14this is a skin question and there was a
7:34:16pupil also. There was a pupil iris some
7:34:19nodules were there.
7:34:20And that was a that was also doable
7:34:22question. Maybe pediatric people say
7:34:23that's their question. This is cafe au
7:34:25lait spots.
7:34:28So that is a straight away question.
7:34:30Maybe there was a
7:34:31plexiform neurofibroma. Three pictures
7:34:33were there some says. So that is
7:34:36uh neurofibromatosis.
7:34:42The multiple choice may yeah NF man FN
7:34:44NF1 was
7:34:46Fourth option was that. I don't know
7:34:48what was the fourth option.
7:34:55If anyone knows the fourth option, let
7:34:56me know.
7:35:00Okay, now let's come to three questions
7:35:02were doable. Three fourth okay okay.
7:35:05This was still okay okay. Accommodation
7:35:07power of seven year old means a child.
7:35:09The mega somebody I one option was many
7:35:11students have got D option is only D.
7:35:31I just some students told that one
7:35:32option was five diopters.
7:35:38Answer is got 14 diopters.
7:35:45But factual question
7:35:47is a factual question.
7:35:5514 10 7 or D to 100 because you don't
7:35:58you don't have to remember that. If
7:35:59there is an option like that you will
7:36:00remember that.
7:36:02So 14 10 5 14 10 7.
7:36:14I
7:36:18The four questions are still okay. This
7:36:19is
7:36:20logics
7:36:25But I don't know what are the options.
7:36:26You say that you say
7:36:27person has kept in dark room for a very
7:36:29long time.
7:36:31Which of the following changes are
7:36:32observed? The one is definitely very
7:36:34very easy. There's dilatation of
7:36:41Very good.
7:36:46options that would you be able to
7:36:47because I've not got correct options of
7:36:49this. This is what I need actually.
7:37:01diameter
7:37:03Diameter increase.
7:37:07diameter
7:37:14What diameter increase?
7:37:16Increase
7:37:20increase in
7:37:22sensitivity to light.
7:37:30I don't know what the exact options are
7:37:32or what the answer is. I don't know
7:37:33diameter of the pupil increase. I don't
7:37:34know. Okay.
7:37:36What dilatation of the diameter of pupil
7:37:38increase with the dilatation of pupil.
7:37:40That is the same thing. option two
7:37:42correct option two three
7:37:44Retinal and option converted to
7:37:45photosensitive pigments option is yes.
7:37:47Retinal and option
7:37:50The screenshot you can do that. I don't
7:37:51know what that is.
7:37:54You guys will hold that okay. All trans
7:37:56is converted to 11 cis in dark.
7:38:05>> All trans is converted to 11 cis in
7:38:09dark.
7:38:10And 11 cis converts with option joints
7:38:13to form adoption adoption.
7:38:14Increase in sensitivity to light.
7:38:18Actually rod sensitivity
7:38:23Option and retinal convert into vitamin
7:38:25A. You have to believe it. You have to
7:38:26believe it. Option and retinal.
7:38:29Option and retinal.
7:38:40I'll ask that.
7:38:54Match the lens and the correction factor
7:38:57a correction factor
7:38:59Yeah, what I have to say.
7:39:02But I will tell you what you have to do.
7:39:05What do they expect you to answer this
7:39:07question?
7:39:08What is a magnification? The
7:39:11magnification formula power of eye of
7:39:12patient by power of lens. What is the
7:39:14correction factor?
7:39:15It's 60 diopter.
7:39:1860 160
7:39:19because the magnification is 1.
7:39:21The correction factor is 1. The
7:39:22correction factor logic
7:39:24formula the formula
7:39:26power of eye of patient by power of the
7:39:27lens. The magnification is 1 to
7:39:29correction factor 1.
7:39:32I have 90 1.3
7:39:3578 1.1
7:39:37of your question but I don't know what
7:39:39you mean. I don't know
7:39:40your level. I don't know.
7:39:42The last option I don't know what you
7:39:44mean. I don't know.
7:39:46I have a telegram group. I will show you
7:39:48the home. I have a telegram group.
7:39:50I will show you
7:39:52the home.
7:39:53This is the home. This is the home.
7:39:55I will show you the home.
7:39:56This is the home. I will show you the
7:39:58home. This is the home. I will show you
7:40:00the home.
7:40:01I will show you the home. This is the
7:40:01home.
7:40:04Resident money but I didn't manage but I
7:40:06had Yeah, resident go to
7:40:08Resident Course may I have told this
7:40:10That this is 90 70 860 magnification
7:40:13formula. Formula to make a video that I
7:40:14don't know. I need I need exam to be
7:40:16honest with you guys.
7:40:17But correction factor may But I don't
7:40:19know how how can they ask correction
7:40:21factor?
7:40:22You tell me if I ask this question to
7:40:24resident.
7:40:25Will you not about that point? I can
7:40:27make a video that I don't know. I think
7:40:28it's 60 out of 60 61 of that. You can
7:40:31make a video that I don't know. 60 out
7:40:32of 60 61 I think it's going to be I
7:40:33don't know I remember this only. So how
7:40:35can I expect you to remember this 1.3
7:40:361.1?
7:40:38So you make a video that I don't know.
7:40:39These questions could be done in this
7:40:41question has to be left. I don't know
7:40:42why why have they given you Yeah. Speak
7:40:45a video that I don't know. They have all
7:40:46the video. For I don't know I don't
7:40:48know.
7:40:49I don't know I think it's a video that I
7:40:50don't know.
7:40:51I got six. Any other
7:40:53I got six. I don't know I think it's a
7:40:54video that I don't know.
7:40:56I don't know I think it's a video that I
7:40:57don't know. Any other question other
7:40:59than this six questions?
7:41:01I don't know I think it's a video that I
7:41:02don't
7:41:05I think it's a I don't know I think it's
7:41:07a video that I don't know. I think it's
7:41:08a video that I don't know. Any other
7:41:10questions? I don't know I think it's a
7:41:11video that I don't know. I think it's a
7:41:12video that I don't I don't know I think
7:41:13it's a
7:41:14I don't know I think it's a video that
7:41:19I don't know I think it's a video that I
7:41:20don't know.
7:41:23I don't know I think it's a video that I
7:41:24don't know. I don't know I don't know I
7:41:26think
7:41:28I don't
7:41:29I don't know I think it's a video that I
7:41:30don't know.
7:41:32Right?
7:41:49Huh?
7:41:52I I don't know I think it's I don't know
7:41:54I think it's a video that I don't know.
7:41:55I think it's a video that I don't know.
7:41:57I don't know I think it's a video that I
7:41:58don't know.
7:42:00Depolarization to what do you call this
7:42:01one?
7:42:02I'll come with a correct
7:42:04What are physical is about column give
7:42:05okay child at home.
7:42:08What was that class two questions at
7:42:11J V J and I have a key world cycle two
7:42:13questions there.
7:42:15You told me first time you said it like
7:42:16that.
7:42:17Or hyper polarization induced
7:42:19transaction season sensory pathway all
7:42:20factory all factory good factory maker
7:42:22going to be a vestibular you can get a
7:42:24year gone to You can become good at ENT
7:42:26while I
7:42:27What do you call that? What do you call
7:42:29that?
7:42:31I want to FLR what a type you okay.
7:42:34So take it any other questions and let
7:42:35me know in my telegram group or
7:42:37individual well as rest.
7:42:40Doesn't matter if you are if you think
7:42:42that this question key past year to 99%
7:42:45have passed this question. Is there any
7:42:47two cases you can see over the whole
7:42:48year as a question?
7:42:50So three child questions so you can have
7:42:51solved out of six two questions I still
7:42:53give you leeway. And those questions are
7:42:55going to make good at solving it but I
7:42:57don't know how can I expect you to
7:42:58answer. Those questions have to be left
7:43:00doesn't matter. So take it as the off
7:43:02day of the exam doesn't matter other
7:43:03lucky subjects will be as same. So lucky
7:43:05subject will be as same.
7:43:07Okay it's a
7:43:08Don't worry about all this.
7:43:11Hello.
7:43:13Thank you. Thank you very much.
7:43:15And I hope you will do well.
7:43:17I hope such questions won't come later
7:43:19on.
7:43:20Thanks a lot. I hope all subjects are
7:43:21done or if any other subject is left
7:43:24they will join soon.
7:43:26Okay J V okay.
7:43:28I will check I will check that.

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