Answer should be Manipulation and casting(Ponseti method)

Ref
1. 5-Minute Orthopaedic Consult

2. Current diagnosis & treatment in orthopedics - 4th edition

Chapter 11. Pediatric Orthopedic Surgery -Topic : Foot Disorders Congenital Clubfoot

Conservative Treatment - Clubfoot always requires treatment, which should begin at birth. The initial
approach is passive manipulation and positioning to the corrected position. In the United States, the
majority of orthopedists use serial manipulation and casting, usually at 1-week intervals in the first month of
life, and at 1- to 2-week intervals thereafter. In other parts of the world, strapping (with adhesive tape) or
splinting with a variety of braces are popular methods (in addition to serial casting) for maintaining the
manipulated correction. When casting is performed, there is agreement that specific techniques are more likely
to be successful (Ponseti method). Even when the deformity responds to casting, there is usually sufficient
Achilles tightness that a heel cord lengthening needs to be done at 4 weeks or later to facilitate cast correction.

3. Campbell's Operative Orthopaedics - 10th & 11th Ed

Volume 2 - Part VIII - C H A P T E R 26 - Congenital Anomalies of Lower Extremity Clubfoot
NONOPERATIVE TREATMENT
The initial treatment of clubfoot is nonoperative. Various treatment regimens have been proposed, including the
use of corrective splinting, taping, and casting. Treatment consists of weekly serial manipulation and casting
during the first 6 weeks of life, followed by manipulation and casting every other week until the foot is
clinically and roentgenographically corrected. With experience, the clinician is able to predict which feet will
respond to nonsurgical treatment. The more rigid the initial deformity, the more likely that surgical treatment
will be required.

Answer should be 46 XX as in other option it was 45XX and 46XY,not 46XX and 46XY.
Ref
1. Textbook of obstetrics -Author -Dutta - 6th Ed - Pg No 194
2. Williams Obstetrics - 23rd edition - Chapter 11
Ploidy - The chromosomal composition of complete moles is usually diploid and of paternal origin. About 85
percent are 46,XX with both sets of chromosomes paternal in origin (Wolf and Lage, 1995). Termed
androgenesis, the ovum is fertilized by a haploid sperm, which duplicates its own chromosomes after meiosis.
The chromosomes of the ovum are either absent or inactivated. In other complete moles, the chromosomal
pattern may be 46,XY due to dispermic fertilization (Bagshawe and Lawler, 1982).

Answer should be medulla as Salivary center & nuclei located in medulla.

Ref 1. Gray's anatomy 39th Ed - Fig 19.1
2. Ganong physiology 23rd Ed - Fig 26.3

3. USMLE Road Map Physiology - By James N. Pasley - 2nd Ed - Page 117

http://books.google.com/books?id=uiKpBsFx0b8C&pg=PA117&dq=salivation+center&hl=e
n&ei=OidRTarzL8izrAfvtszICA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDs
Q6AEwAg#v=onepage&q=salivation%20center&f=false
Excessive salivation occurs prior to vomiting. The medullary vomiting center and
salivation center are located close together in the medulla.
4. http://flipper.diff.org/app/items/info/367
The secretion of saliva is controlled by a salivary center composed of nuclei in the medulla
5.http://webcache.googleusercontent.com/search?q=cache:N15nL4-e120J:www.humannervous-system.com/human-brainencephalon/+salivary+center+situated+in+medulla+hypothalamus&cd=3&hl=en&ct=clnk
&gl=in&source=www.google.co.in
(b) Medulla oblongata (Myelencephalon). It is posterior most part of brain and is located beneath the
cerebellum. It is with a cavity called fourth ventricle or myelocoel which is continuous with central canal of
spinal cord. Roof of medulla oblongata is thin, non-nervous and forms posterior choroid plexus.
Functions: It controls involuntary functions of body through a number of centers like cardiac centers (heart
beat); respiratory centers (rate of respiration); vasomotor centers (contraction of blood vessels); salivary
centers (secretion of saliva) etc. It also controls coughing, sneezing, vomiting, urinating, defecation, blood
pressure, gut peristalsis, swallowing of food, etc.

http://webcache.googleusercontent.com/search?q=cache:jUIeV0NTVEJ:thalamus.wustl.edu/course/hypoANS.html+salivary+center+situated+in+med
ulla+hypothalamus&cd=6&hl=en&ct=clnk&gl=in&source=www.google.co.in
Salivatory nuclei - These nuclei in the medulla send axons to the salivary glands via the
VIIth and IXth nerves.

Answer should be Staphylococcus Aureus.

Ref.
1. All India Ophthalmology Society (AIOS)Article - AIIMS
http://www.aios.org/cmefiles/CME_11_1.pdf

"few bacteria namely Niesseria, Corynebactrium, Hemophilus and. Listeria can invade
an intact epithelium"
2. MRCOPHTH (MRCOphth, ophthalmology examination in UK)
http://www.mrcophth.com/MRCOphth/122.html

3. Parson 20th ed page 187 ,21st Ed -Pg No 194

4. Kanski - 6th ed page 254

Answer should be height/age.

Ref
1. OPG 6th Ed- Pg No 101
2. Park 19th Ed- Pg No 434
3. Nelson 18e, Chap 14
"Weight for height below the 5th percentile remains the single best growth chart indicator of acute
undernutrition. A BMI less than the 5th percentile also indicates that a child is underweight. Brief periods of
weight loss or poor weight gain are usually rapidly corrected and do not permanently affect size.
Children who have been chronically malnourished may be short as well as thin, so that their weight-for-height
curves may appear relatively normal. Chronic, severe undernutrition in infancy may depress head growth, an
ominous predictor of later cognitive disability."
4. http://www.adbi.org/discussion-

paper/2005/01/14/869.malnutrition.poverty.indonesia/measuring.malnutrition/
Wasting (Weight for Height) is a measure of acute or short-term exposure to a negative environment. It is
sensitive to changes in calorie intake or the effects of disease. Wasting can be calculated without knowing the
age of a child. Weight for height (WFH) is a measure of current body mass. It is the best index to use to reflect
wasting malnutrition, when it is difficult to determine the exact ages of the children being measured.
Stunting (Height for age) is a measure of linear growth. Stunting refers to shortness, and reflects linear growth
achieved pre- and postnatal; with its deficits it is generally assumed to indicate long-term, cumulative effects
of inadequate nutrition and poor health status. Height for age (HFA) is considered a measure of past
nutrition, because a child who is short today, maybe did not have adequate nutritional intake at so me point

in the past

Answer should be vertebral body.

In children it's intervertebral disc but in adults it usually begins in cancellous bone of vertebral body near
the disc(paradiscal) as disc is avascular.

Ref.
1.Campbell's Operative Orthopaedics - 10th & 11th Ed

*Volume 2 - Part XII - C H A P T E R 40 - Infections of Spine- Specific Infections

Tuberculosis
In the spine the infection spares the intervertebral discs and spreads beneath the anterior and posterior
longitudinal ligaments.

*Volume 2 - Part V - C H A P T E R 18 - Tuberculosis and Other Unusual Infections

"A peridiscal presentation occurs in approximately 80% of patients, with the anterior vertebral body
affected and contiguous progression through subligamentous burrowing (anterior longitudinal ligament) and
eventual extension to the adjacent vertebrae. Less frequently, lesions occur centrally in the vertebral body. "
2. eMedicine Specialties > Infectious Diseases > Bone and Joint Infections
http://emedicine.medscape.com/article/226141-overview
The anterior aspect of the vertebral body adjacent to the subchondral plate is area usually affected. Tuberculosis
may spread from that area to adjacent intervertebral disks. In adults, disk disease is secondary to the spread
of infection from the vertebral body. In children, because the disk is vascularized, it can be a primary
site.3

3. Harrisons principles of internal medicine 17th Ed

Part-7 - Chapter 158 Pg No 1012 Topic Tuberculosis Skeletal Tuberculosis
SKELETAL TUBERCULOSIS
In the United States, tuberculosis of the bones and joints is responsible for ~10% of extrapulmonary cases. In
bone and joint disease, pathogenesis is related to reactivation of hematogenous foci or to spread from adjacent
paravertebral lymph nodes. Weight-bearing joints (the spine in 40% of cases, the hips in 13%, and the knees
in 10%) are most commonly affected. Spinal tuberculosis (Pott's disease or tuberculous spondylitis;
Fig. 158-7) often involves two or more adjacent vertebral bodies. While the upper thoracic spine is the
most common site of spinal tuberculosis in children, the lower thoracic and upper lumbar vertebrae are usually
affected in adults. From the anterior superior or inferior angle of the vertebral body, the lesion slowly
reaches the adjacent body, later affecting the intervertebral disk. With advanced disease, collapse of
vertebral bodies results in kyphosis (gibbus). A paravertebral "cold" abscess may also form. In the upper spine,
this abscess may track to and penetrate the chest wall, presenting as a soft tissue mass; in the lower spine, it
may reach the inguinal ligaments or present as a psoas abscess. CT or MRI reveals the characteristic lesion
and suggests its etiology. The differential diagnosis includes tumors and other infections. Pyogenic bacterial
osteomyelitis, in particular, involves the disk very early and produces rapid sclerosis. Aspiration of the abscess
or bone biopsy confirms the tuberculous etiology, as cultures are usually positive and histologic findings highly
typical. A catastrophic complication of Pott's disease is paraplegia, which is usually due to an abscess or a
lesion compressing the spinal cord. Paraparesis due to a large abscess is a medical emergency and requires
rapid drainage. Tuberculosis of the hip joints, usually involving the head of the femur, causes pain;
tuberculosis of the knee produces pain and swelling. If the disease goes unrecognized, the joints may be
destroyed. Diagnosis requires examination of the synovial fluid, which is thick in appearance, with a high
protein concentration and a variable cell count. Although synovial fluid culture is positive in a high percentage
of cases, synovial biopsy and tissue culture may be necessary to establish the diagnosis. Skeletal tuberculosis
responds to chemotherapy, but severe cases may require surgery.

Answer should be Mebendazole.

All standard textbooks mention mebendazole / mebendazole/albendazole as DOC, no
standard book mention mebendazole as second choice, while many books mention
albendazole as second choice.
Mebendazole is the drug of choice for patients of all ages over 2 years and is taken
as a single dose, because reinfection is so common a second dose may be given after 23 weeks

Ref
1. Basic & Clinical Pharmacology - Katzung - 11th Edition - Chapter 51
Table 531 Drugs for the Treatment of Helminthic Infections. 1
Infecting Organism

Drug of Choice

Alternative Drugs

Ascaris lumbricoides (roundworm)

Albendazole or pyrantel pamoate

or mebendazole

Ivermectin, piperazine

Trichuris trichiura (whipworm)

Mebendazole or albendazole

Ivermectin

Roundworms (nematodes)

Necator americanus (hookworm); Ancylostoma

duodenale (hookworm)

Albendazole or mebendazole or
pyrantel pamoate

Strongyloides stercoralis (threadworm)

Ivermectin

Albendazole or
thiabendazole

Enterobius vermicularis (pinworm)

Mebendazole or pyrantel
pamoate

Albendazole

2.Lippincott's Illustrated Reviews: Pharmacology, 4th Edition

Unit VII - Chemotherapeutic Drugs > Chapter 37 - Anthelmintic Drugs
* Mebendazole - Mebendazole [me-BEN-da-zole], a synthetic benzimidazole compound, is effective
against a wide spectrum of nematodes. It is a drug of choice in the treatment of infections by
whipworm (Trichuris trichiura), pinworm (Enterobius vermicularis), hookworms (Necator
americanus and Ancylostoma duodenale), and roundworm (Ascariasis lumbricoides).
3. AHFS Drug Information - http://www.medicinescomplete.com/mc/ahfs/current/a382315.htm
"Mebendazole is the drug of choice and albendazole and ivermectin, are alternatives"

Answer should be Africa.

Ref
th

1.Baily & Love short textbook of surgery 25 ed

Pg No 1192
Sigmoid volvulus
This is rare in Europe and the USA but more common in
Eastern Europe and Africa. Indeed, it is the most common cause
of large bowel obstruction in the indigenous black African population.
2. eMedicine Specialties > General Surgery > Colorectal
Volvulus, Sigmoid and Cecal - http://emedicine.medscape.com/article/197322-overview
In the volvulus belt of Africa and the Middle East, nearly 50% of large bowel obstructions are a result of
volvulus, almost exclusively of the sigmoid colon.
3.GPNotebook - http://www.gpnotebook.co.uk/medwebpage.cfm?ID=315621401

This condition accounts for about 2% of intestinal obstructions in the UK. However, it is much more
common in Russia and Central Africa.
4.Radiology secrets - By E. Scott Pretorius, Jeffrey A. Solomon, Douglas S. Katz
http://books.google.com/books?id=J5V9vW3lMhwC&pg=RA3-PA26&lpg=RA3PA26&dq=sigmoid+volvulus+more+common+in+africa&source=bl&ots=7mbTSAJRCc&sig=rwzidNvlXugxmD0_
GyVBPpe7wIk&hl=en&ei=P7RRTZfHF8O8rAec34CrCA&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDI
Q6AEwBT

Answer should be Chronic Renal Disease > Polycystic Kidney or both as in

polycystic kidney, its not contraindicated even if large cysts if well localized.
Ref

1.Oxford textbook of clinical nephrology, 3rd Ed- Volume 1 - By Alex M. Davison, J. Stewart
Cameron, Jean Pierre Gruenfeld

http://books.google.com/books?id=kNDzFS1abRkC&pg=PA173&lpg=PA173&dq=contraindication+of
+renal+biopsy&source=bl&ots=v2kkAzz2K2&sig=kZp_7P0PGdJ2Zu9XK1223xNC6TU&hl=en&ei=h5xRT
eGyGYq3rAf80dypCA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CD8Q6AEwBjgK#v=onepag
e&q=contraindication%20of%20renal%20biopsy&f=false

2. http://www.nephrologychannel.com/biopsy/index.shtml
The most common contraindication to kidney biopsy is disease:

Bleeding disorder (e.g., inability to coagulate, platelet abnormality)

Hypertension
Pyelonephritis (disease of the pelvis of the kidney)
Shrunken kidney (i.e., as a result of disease)
Tumor

3. http://www.patient.co.uk/doctor/Renal-Biopsy.htm
Patients with chronic renal failure and bilaterally small, shrunken kidneys should not undergo
biopsy. The technique is then very difficult and the biopsy appearances are very unlikely to provide
any benefit for clinical management.
4. Critical care nephrology - By Claudio Ronco, Rinaldo Bellomo, John A. Kellum - Table 53.2

http://books.google.com/books?id=XkKn96HThzEC&pg=PA290&lpg=PA290&dq=contraindication+of
+renal+biopsy&source=bl&ots=J7qkfTVTuh&sig=cF80G3Zejn9vqtwCl2o3a64Okk&hl=en&ei=bp5RTZysI4fkrAedoeCfCA&sa=X&oi=book_result&ct=result&resnum=7&ve
d=0CDkQ6AEwBjgU#v=onepage&q=contraindication%20of%20renal%20biopsy&f=false

Answer should be Blood Glucose as initial investigation was asked.

Ref :
1. Agency for Toxic Substances and Disease Registry - CDC
CME - Case Studies in Environmental Medicine (CSEM)
http://www.atsdr.cdc.gov/csem/egpg/laboratory_evaluation.html
Ethylene Glycol and Propylene Glycol Toxicity - All patients with known or suspected ethylene
glycol ingestion require the following tests

arterial blood gases

blood glucose
serum electrolytes
blood ethanol

Other helpful laboratory tests may include

serum BUN and creatinine

calcium and magnesium levels
acetaminophen and aspirin levels
liver function tests
urinalysis (with special attention to crystalluria)

http://www.atsdr.cdc.gov/csem/egpg/posttest.html
Useful laboratory tests for diagnosing ethylene glycol poisoning include which of the
following?
A. arterial blood gases (ABG)
B. blood glucose
C. blood ethanol
D. all of the above
2. Acute Poisoning Management Guidelines - AIIMS Article
http://medind.nic.in/jac/t00/i2/jact00i2p142.pdf

At present, it is recommended to check the blood sugar using a reliable bedside test and
to administer dextrose only if the blood sugar is below 80 mg/dl. However, if the sticks are
not available, it is still advisable to administer dextrose to all patients with altered sensorium,
including those with focal neurologic deficits3,4
3. eMedicine Specialties > Emergency Medicine > Toxicology
Toxicity, Ethylene Glycol: Treatment & Medication

http://emedicine.medscape.com/article/814701-treatment
When administering ethanol, determine glucose levels by fingerstick collection at regular intervals and
confirm with laboratory analysis to detect the hypoglycemia occasionally associated with ethanol therapy.

Answer should be none.

Ref
1. Illness in the academy: a collection of pathographies by academics
By Kimberly Rena Myers
http://books.google.com/books?id=f1QIpLhWGh0C&pg=PA145&dq=hypothyroidism+
endometriosis&hl=en&ei=6lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEI
Q6AEwAw#v=onepage&q=hypothyroidism%20endometriosis&f=false
Women with endometriosis may also have associated disorders related to autoimmune
dysregulation or pain Compared with published rates in the general USA female population,
women with endometriosis had higher rates of hypothyroidism
2. Endometriosis: the complete reference for taking charge of your health
By Mary Lou Ballweg, Endometriosis Association
http://books.google.com/books?id=9iYA38bG80AC&pg=PA159&dq=hypothyroidism+endometriosis&hl=en&
ei=6lQTYWFMYrlrAfJyITACA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFIQ6AEwBg#v=onepage
&q=hypothyroidism%20endometriosis&f=false
Hypothyroidism was seven times more common. Fibromyalgia was twice as common. The autoimmune
inflammatory diseases, systemic lupus ... 'These findings suggest a strong association between
endometriosis and autoimmune disorders
3.http://www.nih.gov/news/pr/sep2002/nichd-26.htm
Hypothyroidism an underactive thyroid gland was seven times more common in the endometriosis
patients. In many cases, hypothyroidism may also be an autoimmune disorder, resulting from an immune
system attack on the thyroid gland.

Hermansky-Pudlak syndrome 2 answers are correct - B,C

In Hermansky-Pudlak syndrome - Platlet counts are normal but platlet function is abnormal, so option B is
also wrong.
Ref

1.emedicine Dermatology & emedicine ophthalmology

http://emedicine.medscape.com/article/1069291-diagnosis
http://emedicine.medscape.com/article/1200277-diagnosis
Standard blood tests (eg, prothrombin time [PT], activated partial thromboplastin time [aPTT], platelet count,
bleeding time) do not identify the platelet defect in Hermansky-Pudlak syndrome.
Platelet studies: Patients with the syndrome have normal platelets counts. However, platelets in patients with
the syndrome show abnormal aggregation with collagen, thrombin, epinephrine, and ADP.

2.
http://www.albinism.org/publications/HPS.html
Bleeding Problems
The bleeding problems of HPS result from a malfunction of platelets, the tiny blood cells that clump together
to plug up damaged blood vessels in cuts, scrapes, and bruises. The platelets lack dense bodies, which are tiny
storehouses of the chemicals which platelets need to stay clumped together.
The usual tests which physicians use to diagnose coagulation (clotting) problems usually will show normal
results in HPS. These tests which may be normal include the prothrombin time (PT), partial
thromboplastin time (PTT), and platelet count.
3.Pulmonary Manifestations of Pediatric Diseases-By Nelson L. Turcios, Robert J. Fink

http://books.google.com/books?id=wl_c5KJAB88C&pg=PA267&dq=HermanskyPudlak+syndrome+normal+platelet+count&hl=en&ei=ZhNRTbuDCZCGvgO21eGMCQ&sa
=X&oi=book_result&ct=result&resnum=5&ved=0CEkQ6AEwBA#v=onepage&q=Hermans
ky-Pudlak%20syndrome%20normal%20platelet%20count&f=false
Clinical features and laboratory abnormalities including a prolonged bleeding time with
normal platelet count

DISASTER CYCLE PROGRESS FROM answer should be

mitigationreconstruction as rehabilitationreconstruction are both part of recovery
phase and mentioned together in asia disaster management strategy.
Ref :
1. Park 19th Ed- Pg No - 651 Fig 1
Disaster cycle includes
1. Risk reduction cycle (mitigation & preparedness)
2. Recovery phase (impact-response-rehabilitation-reconstruction), so answer should be mitigation->reconstruction

2.FOOD AND AGRICULTURE ORGANIZATION (FAO.ORG)

3.Asian Disaster Reduction Center

http://www.adrc.asia/publications/TDRM2005/TDRM_Good_Practices/PDF/PDF2005e/Chapter2_2.2.pdf
Total Disaster Risk Management - Good Practices -. Chapter 2.

In case of Diabetes, diagnosis can be type 3 hyperlipidemia too and we can consider
syndrome X.
Ref

1. eMedicine Specialties > Endocrinology > Metabolic Disorders

Dysbetalipoproteinemia
http://emedicine.medscape.com/article/118466-overview
Examination may reveal palmar xanthomas on hands.

Orange-yellow discoloration of the palmar creases is present, and these creases

may be raised in more severe cases.

2. emedicine Differential Diagnoses of Carotenemia

http://emedicine.medscape.com/article/1104368-diagnosis
Other Problems to Be Considered
Jaundice
Riboflavinemia
Yellow skin discoloration associated with use of the oral multitargeted tyrosine kinase inhibitor sorafenib for
treatment of metastatic renal cell carcinoma9
Lycopenemia appears as orange-yellow skin discoloration due to the ingestion of large amounts of tomatoes. It
usually results from excessive ingestion of lycopene in foods. Type III hyperlipoproteinemia, a rare form of
dyslipidemia, was described with lycopenemia, including orange discoloration of xanthomas, following
elevated serum lycopene unassociated with excessive dietary intake. 10

Answer should be middle cardiac vein.

Ref
Grays anatomy 39th Ed Section 6 Chapter 60 Topic Heart
CARDIAC VEINS
The heart is drained by the coronary sinus and its tributaries, the anterior cardiac veins and the small
cardiac veins. The coronary sinus and its tributaries return blood to the right atrium from the entire
heart (including its septa) except for the anterior region of the right ventricle and small, variable parts
of both atria and left ventricle. The anterior cardiac veins drain an anterior region of the right ventricle
and a region around the right cardiac border when the right marginal vein joins this group, ending
principally in the right atrium. The small cardiac veins (Thebesius' veins) open into the right atrium and
ventricle and, to a lesser extent, the left atrium and sometimes left ventricle.
Variation in cardiac veins
Attempts to categorize variations in cardiac venous circulation into 'types' have not produced any
accepted pattern. There are major variations concerning the general directions of drainage. The
coronary sinus may receive all the cardiac veins (except the small veins), including the anterior
cardiac veins (33%), which may be reduced by diversion of some into the small cardiac vein and then
to the coronary sinus (28%). The remainder (39%) represent the 'normal' pattern, as described above.
CORONARY SINUS
The large majority of cardiac veins drain into the wide coronary sinus, c.2 or 3 cm long, lying in the
posterior atrioventricular groove between the left atrium and ventricle (Figs 60.2, 60.25). The sinus
opens into the right atrium between the opening of the inferior vena cava and the right atrioventricular
orifice; the opening is guarded by an endocardial fold (semilunar valve of the coronary sinus; Fig.
60.7). Its tributaries are the great, small and middle cardiac veins, the posterior vein of the left
ventricle and the oblique vein of the left atrium; all except the last have valves at their orifices.
Great cardiac vein
The great cardiac vein begins at the cardiac apex, ascends in the anterior interventricular groove to
the atrioventricular groove and follows this, passing to the left and posteriorly to enter the coronary
sinus at its origin (Fig. 60.25). It receives tributaries from the left atrium and both ventricles, including
the large left marginal vein that ascends the left aspect ('obtuse border') of the heart.
Small cardiac vein
The small cardiac vein lies in the posterior atrioventricular groove between the right atrium and
ventricle and opens into the coronary sinus near its atrial end (Fig. 60.25). It receives blood from the
posterior part of the right atrium and ventricle. The right marginal vein passes right, along the inferior
cardiac margin ('acute border'). It may join the small cardiac vein in the atrioventricular groove, but
more often opens directly into the right atrium.
Middle cardiac vein
The middle cardiac vein (Fig. 60.25) begins at the cardiac apex, and runs back in the posterior
interventricular groove to end in the coronary sinus near its atrial end.
Posterior vein of the left ventricle
The posterior vein of the left ventricle (Fig. 60.25) is found on the diaphragmatic surface of the left
ventricle a little to the left of the middle cardiac vein. It usually opens into the centre of the coronary
sinus, but sometimes opens into the great cardiac vein.
Oblique vein of the left atrium
The small vessel that is the oblique vein of the left atrium (Fig. 60.25) descends obliquely on the back
of the left atrium to join the coronary sinus near its end. It is continuous above with the ligament of the
left vena cava. The two structures are remnants of the left common cardinal vein.

ANTERIOR CARDIAC VEINS

The anterior cardiac veins drain the anterior part of the right ventricle. Usually two or three,
sometimes even five, they ascend in subepicardial tissue to cross the right part of the atrioventricular
groove, passing deep or superficial to the right coronary artery. They end in the right atrium, near the
groove, separately or in variable combinations. A subendocardial collecting channel, into which all
may open, has been described. The right marginal vein courses along the inferior ('acute') cardiac
margin, draining adjacent parts of the right ventricle, and usually opens separately into the right
atrium. It may join the anterior cardiac veins or, less often, the coronary sinus. Because it is
commonly independent, it is often grouped with the small cardiac veins, but it is larger in calibre,
being comparable to the anterior cardiac veins or even wider.
SMALL CARDIAC VEINS
The existence of small cardiac veins, opening into all cardiac cavities, has been confirmed, but they
are more difficult to demonstrate than larger cardiac vessels. Their numbers and size are highly
variable: up to 2 mm in diameter opening into the right atrium and c.0.5 mm into the right ventricle.
Numerous small cardiac veins have been identified in the right atrium and ventricle, but they are rare
in the left atrium and left ventricle.

Massive hemoptysis - ans?

90. Retinitis pigmentosa - ans?
96. VVF - ans?
Ref : International Journal of Gynecology and Obstetrics (2005) 90, 146147
Vesicovaginal fistulas are frequently associated with amenorrhea. The amenorrhea is
attributed to chemical endometritis, anemia, endocrine upset,and chronic malnutrition [4].
http://www.fistulacare.org/pages/pdf/Partners/Virtual-Resource-Center/JournalNews/ClinicalInfo/ezegwui.pdf