CMS 2012 Paper Solutions - 1

Q1. Answer - (c)

The Roth Spo is a white-centered hemorrhage. Actually, it is a cotton wool spot surrounded by hemorrhage. The cotton wool comes from ischemic bursting of axons; the small hemorrhage comes from ischemic bursting of a pre-capillary arteriole.
White-centered retinal hemorrhages (Roth's spots) are considered pathognomonic for subacute bacterial endocarditis, but they also appear in leukemia, diabetes, and many other conditions.

Q2. Answer - (a)

Anterior STEMI results from occlusion of the left anterior descending artery (LAD).

Anterior myocardial infarction carries the worst prognosis of all infarct locations, mostly due to larger infarct size.

Q3. Answer -(b)

KALA-AZAR (VISCERAL LEISHMANIASIS)

·         Kala-azar, caused by Leishmania donovani (rarely by L. tropica), is characterised by fever, loss of weight and appetite, splenohepatomegaly, leucopenia and pigmentation of the skin (kala-azar means ‘black fever’).

·         It may be endemic, epidemic or sporadic. Humans are the only reservoir of infection in Indian kala-azar.

·         Leishmania parasites, which target and persist in tissue macrophages, are transmitted by the bite of female phlebotomine sandflies. While probing for a blood meal, sandflies regurgitate the parasite's flagellated promastigote stage into the host's skin.

·          Promastigotes bind to receptors on macrophages, are phagocytized, and transform within phagolysosomes into nonflagellated amastigotes (Fig. 205-1), which replicate and infect additional macrophages. Amastigotes ingested by sandflies transform back into infective promastigotes. Other modes of transmission include congenital and parenteral (e.g., by blood transfusion or needle sharing).

·         Post–kala-azar dermal leishmaniasis (PKDL) is a syndrome characterized by skin lesions (including macules, papules, nodules, and patches) that are typically most prominent on the face and that develop during or after therapy for visceral leishmaniasis. In Sudan, PKDL is noted in ~50% of patients from 0 to 6 months after therapy and usually heals spontaneously. In contrast, in India, PKDL is noted in ~5–10% of patients, occurring several years after treatment and usually requiring further therapy. PKDL can be confused with miliaria rubra, syphilis, yaws, and leprosy.