163 - Swine flu - All you need to know

Important Frequently asked questions about Swine flu : ( FAQs on swine flu )

1. How do symptoms of swine flu differ from other types of flu?

Answer: None, really, although this flu might include gastrointestinal symptoms (diarrhea and vomiting), as well as the usual respiratory symptoms. The basic symptoms for swine flu are similar to the seasonal flu we are vaccinated for each year, which may include, fever, sore throat, cough, stuffy nose, chills, headache and body aches, fatigue.

2. Is there medication for this?

Answer: Yes, Tamiflu or Relenza have shown to be effective against these recently reported strains of swine flu. Altogether, there are four anti-viral drugs that we commonly use to treat various strains of flu.

3. Is there a vaccine?

Answer: Not yet, but the CDC has this current strain of virus and will consider whether to add it to next year's flu vaccine as time goes on.

4. Can I catch it from pigs?

Answer: No. This strain is one that is communicable through human-to-human contact. It is a mutated form of a swine virus.

5. Can I catch it from eating pork?

Answer: Absolutely not! Swine flu is not transmitted by food. It is not a so-called foodborne illness. Bacon, ham and other pork products are safe to eat, assuming they are prepared properly. An internal temperature of 160 degrees for cooked meat will kill any bacteria or virus.

Swine flu is transmitted by airborne droplets from an infected person's sneeze or cough; or from germs on hands, or germ-laden surfaces. Eating pork will not give you swine flu any more than eating chicken will give you bird flu.

6. How does it cross from a pig to a human?

Answer: The swine virus mutates so that it can infect humans and be spread by humans.

7. Can it kill me?

Answer: Deaths have been reported from the Mexico City outbreak. So far the cases in the US have been mild and there have been no deaths as yet. But, like seasonal flu, there is the potential for serious outcomes.

8. How is it different from avian (bird) flu?

Answer: Avian flu so far has had difficulty infecting humans unless they are exposed intensely to birds, because the virus has not mutated in a way that makes it transmissible by humans to other humans. This virus has origins genetically from both pigs and birds, and the big difference from the avian flu is that this swine virus can be transmitted readily from human to human.

9. What if I'm on a plane? Should I wear a mask?

Answer: Not necessary. The air on a plane is filtered. Transmission might occur if someone sitting close to you coughs or sneezes on you. The newer designs of aircraft airflow keep the air in a top-down flow, not forced air from front to back. However, if you do have a respiratory illness, it might be best not to travel.

10. Other than hand washing and covering my mouth if I sneeze or cough, what can I do to take care of myself and others?

Answer: If you are ill, stay home. Control your sneezes and coughs. If you cough into your hand, remember the virus could be live on your hand at least for a few minutes, so wash your hands before touching anyone else. If you get symptoms suggesting the flu, call your doctor, who can call in a prescription for medication to treat the flu. Resist going to the doctor's office or a hospital ER for influenza symptoms unless you are seriously ill. You do not want to spread the disease to others.

P.S : In wake of the current pandemic of swine flu , i thought i'd post some important information about this disease and prevent more people from getting the disease . And who ever are suffering from this disease , there is absolutely no need to panic . And who knows a question ( mcq ) may be asked regarding this disease in any of the forthcoming medical entrance examinations . so watch out .

162 - Testicular cancer Mcqs with answers - part 4

16q: what is the dose of radiation therapy used in the treatment of stage I and stage II seminoma ?


a. 1000 – 1500 cGy
b. 1500 – 2000 cGy
c. 2000 – 2500 cGy
d. 2500 – 3000 cGy

answer d . 2500 – 3000 cGy

17q: what is the major long term effect of standard ( modified bilateral ) RPLND operation ?


a. retrograde ejaculation and infertility
b. urinary incontinence
c. fecal incontinence
d. lymphedema of leg

answer a . retrograde ejaculation and infertility

18q: what are the doses of etoposide and cisplatin in the treatment of high volume metastasis of stage II nonseminoma ?


a. 100 mg/sq.m daily on days 1-5 and 20 mg/sq.m daily on days 1-5 respectively
b. 50 mg/sq.m daily on days 1-5 and 10 mg/sq.m daily on days 1-5 respectively
c. 200 mg/sq.m daily on days 1-5 and 50 mg/sq.m daily on days 1-5 respectively
d. 10 mg/sq.m daily on days 1-5 and 80 mg/sq.m daily on days 1-5 respectively

answer a . 100 mg/sq.m of etoposide and 20 mg/sq.m of cisplatin on days 1-5

19q: which of the following is second line chemotherapy used in 20 – 30 % patients with advanced GCT, who fail to achieve a durable complete response to first line chemotherapy ?


a. cisplatin , ifosfamide and vinblastine ( VeIP)
b. cisplatin , bleomycin and vincristine
c. etoposide , cisplatin and chlorambucil
d. ifosfamide , bleomycin and etoposide

answer a . VeIP – vinblastine , ifosfamide and cisplatin

20q: what is the treatment of choice in advanced GCT patients who have progressed even after taking ifosfamide containing salvage chemotherapy ( VeIP ) ?


a. dose intensive , high dose cisplatin ( 1500 mg/m2 ) plus etoposide ( 1200 mg/m2 ) with or without cyclophosphamide or ifosfamide with peripheral blood stem cell support
b. dose intensive , high dose carboplatin( 1500 mg/m2 ) plus etoposide ( 1200 mg/m2 ) with or without cyclophosphamide or ifosfamide with peripheral blood stem cell support
c. dose intensive , high dose vinblastine ( 1500 mg/m2 ) plus etoposide ( 1200 mg/m2 ) with or without cyclophosphamide or ifosfamide with peripheral blood stem cell support
d. dose intensive , high dose carboplatin( 1500 mg/m2 ) plus bleomycin ( 1200 mg/m2 ) with or without cyclophosphamide or ifosfamide with peripheral blood stem cell support

answer b . carboplatin and etoposide high dose combination

161 - Testicular cancer Mcqs with answers - part 3

11q: find the wrong statement ?


a. involvement of supradiaphragmatic nodal sites in GCTs is stage III
b. klinefelter syndrome is associated with mediastinal GCT
c. In GCTs management ,Orchiopexy should be performed before puberty, if possible
d. Early orchiopexy reduces the risk of GCT and improves the ability to save testis
e. Testicular feminization syndromes do not increase the risk of testicular cancer

answer e is a wrong statement because testicular feminization syndromes are associated with increased risk of testicular cancer

12q: what are the nodes that are involved first by a right testicular tumor ?


a. para-aortic lymph nodes below the left renal vessels
b. interaortocaval lymph nodes just below the renal vessels
c. retrocrural lymph nodes
d. mediastinal lymph nodes

answer b . interaortocaval lymph nodes just below the renal vessels

13q: what are the nodes that are involved first by a left testicular tumor ?


a. para-aortic lymph nodes below the left renal vessels
b. interaortocaval lymph nodes just below the renal vessels
c. retrocrural lymph nodes
d. mediastinal lymph nodes

answer a . para-aortic lymph nodes below the left renal vessels

14q: how will you treat a stage II nonseminoma with resected low volume metastasis (nodes less than 2cm in largest diameter and less than 6 nodes) involved ?


a. orchiectomy followed by surveillance
b. orchiectomy followed by RPLND ( retroperitoneal lymph node dissection )
c. orchiectomy followed by chemotherapy
d. only chemotherapy by BEP regimen

answer a . orchiectomy followed by surveillance, because it is low volume metastases and the probability of relapse is one-third or less .

15q: all of the following are true regarding the complications of four cycles of BEP
( bleomycin/etoposide/cisplatin ) regimen used in the treatment of testicular cancer except ?


a. nausea, vomiting and hair loss are common
b. myelosuppression is a rare complication
c. symptomatic bleomycin pulmonary toxicity occurs in approx 5% patients
d. weekly bleomycin bolus injection may lead to raynaud’s phenomenon
e. nephrotoxicity and ototoxicity are long term complications

answer b , is wrong because myelosuppression is a frequent complication. Mortatlity due to neutropenia with septicemia also occurs . reduced glomerular filtration and persistent magnesium wasting occur due to nephrotoxicity . peripheral neuropathy is also one of the long term complications of the BEP therapy.

160 - Testicular cancer Mcqs with answers - part 2

6q: all of the following are true about GCTs of testis except ?


a. GCTs are divided into seminomas and non-seminomatous subtypes
b. Non-seminomatous subtypes are most common in the third decade of life
c. Seminomatous subtypes are most common in the fourth decade of life
d. Seminomas represent about 90% of all GCTs
e. Nonseminomas have an aggressive course whereas seminomas have an indolent course

answer d . seminomas represent about 50 % of all GCTs, not 90 %

7q: all of the following are true about non-seminomatous type of GCTs except ?


a. non-seminomas include four histologies : embryonal carcinoma, teratoma, choriocarcinoma and endodermal sinus (yolk sac tumor)
b. choriocarcinoma is associated with the secretion of HCG
c. endodermal sinus (yolk sac tumor) is associated with the secretion of AFP
d. pure embryonal carcinoma AFP or HCG or both .
e. nonseminomatous GCTs metastatize lately to sites such as retroperitoneal lymph nodes and lung parenchyma

answer e , is wrong because nonseminomatous GCTs metastatize early to these sites

8q: all of the following are true about seminomatous type of GCTs except ?


a. they are more common in the fourth decade
b. constitute about 50 % of all GCTs and 70 % of patients present with stage I disease
c. seminomas have an indolent course
d. chemotherapy is the treatment of choice in patients with stage I disease and stage II disease where the nodes are less than 5 cm in maximum diameter.
e. When a tumor contains both seminoma and nonseminoma components, patient management is directed by the more aggressive nonseminoma component.

answer d , is wrong because radiation therapy is the treatment of choice in patients with stage I disease and stage II disease where the nodes are less than 5 cms in maximum diameter

9q: find the false statement ?


a. Approximately 70% of patients presenting with disseminated nonseminomatous GCT have increased serum concentrations of AFP and/or hCG
b. AFP concentrations are increased only in nonseminomas where as HCG levels may be increased in both seminomas and nonseminomas
c. Presence of an increased AFP level in a seminoma patient indicates that an occult nonseminomatous component is also present .
d. LDH levels are not as specific as AFP or hCG but are increased in 50–60% patients with metastatic nonseminoma and in up to 80% of patients with advanced seminoma.
e. After orchidectomy the increased AFP and HCG levels decay according to first order kinetics . half life is 24-36 hrs for AFP and 5-7 days for HCG .

answer e , is wrong because the half life of AFP is 5-7 days and half life of HCG is 24-36 hrs

10q: all of the following statements about treatment of Germ cell tumors of testis are true except ?


a. stage IA, IB and stage IIA, IIB, IIC seminomas all are treated with radiation therapy
b. stage III seminoma is treated with chemotherapy
c. Regardless of histology, patients with stage IIC and stage III GCT are treated with chemotherapy.
d. Inguinal orchiectomy followed by retroperitoneal radiation therapy cures approximately 98% of patients with stage I seminoma.
e. Bleomycin, etoposide and cisplatin ( BEP regimen ) are the three drugs which are usually used in the chemotherapy of testicular cancer .

answer a , is false because stage IIC seminoma is treated with chemotherapy and not radiation therapy . when the involved lymph nodes greatest diameter is greater than 5 cms then it is stage IIC GCT .

159 - Testicular cancer Mcqs with answers - part 1

1q: all of the following are true about testicular cancer except ?


a. primary germ cell tumors ( GCTs ) of the testis constitute 95 % of all testicular neoplasms .
b. about 95 % of newly diagnosed patients are cured
c. very rarely the GCTs can even arise from the pineal gland
d. the tumor occurs most frequently in men between the ages of 40 and 60
e. higher incidence has been observed in Scandinavia and newzealand than USA

answer d . the tumor occurs most frequently in men between 20 and 40 years of age and not 40 and 60 years

2q: which of the following statements about testicular cancer is false ?


a. a testicular mass in a male of age greater than or equal to 50 years of age should be regarded as lymphoma unless proved otherwise .
b. GCTs are 4 or 5 times more common in whites than in african-american males
c. The incidence of the testicular GCTs has been decreasing lately
d. Cryporchidism is associated with a several fold higher risk of GCT
e. Inguinal cryptorchid testis are at a higher risk than abdominal cryptorchid testis

answer e , is a wrong statement because abdominal cryptorchid testis are at higher risk of developing into cancer than inguinal cryptorchid testis

3q: an isochromosome of the short arm of which chromosome is pathognomonic of GCT?


a. 11
b. 12
c. 13
d. 14

answer b . 12th chromosome

4q: involvement of nodes in germ cell tumor of testes belongs to which stage ?


a. I A
b. I B
c. II A
d. III

answer c . stage IIA, IIB, IIC involves nodes


click here to view a table explaining the staging of Germ cell tumors of testis ( testicular cancer ) and treatment given according to the stage . 

5q: involvement of the spermatic cord in germ cell tumor of testis belongs to which stage?


a. I A – T1
b. I B – T2
c. I B – T3
d. I B – T4

answer C. I B – T3 . IA – T1 involves testis only without any vascular or lymphatic invasion . I B – T2 involves testis only with lymphatic and vascular involvement or involvement of tunica albuginea . I B – T4 involves testis along with the scrotum .

158 - Drugs causing Pancreatitis

Definite Cause :

1. 5-Aminosalicylate
2. 6-Mercaptopurine
3. Azathioprine
4. Cytosine arabinoside
5. Dideoxyinosine (didanosine)
6. Diuretics
7. Estrogens
8. Furosemide
9. Metronidazole
10. Pentamidine
11. Tetracycline
12. Thiazide
13. Trimethoprim-sulfamethoxazole
14. Valproic acid

Probable Cause :

1. Acetaminophen
2. α-Methyl-DOPA
3. Isoniazid
4. l-Asparaginase
5. Phenformin
6. Procainamide
7. Sulindac

 ( DOPA, dihydroxyphenylalanine )

P.S : This question is very frequently asked in PGI chandigarh PUNJAB entrance examination .

Click here and Check out a mnemonic to easily remember these drugs