Monday 18 March 2013

Put Your Best Face Forward

Put Your Best Face Forward





http://www.flickr.com/photos/origami_potato/7734131276/in/photostream/Think back to the last time you caught a glimpse of yourself in the mirror when you were stressed.  Did you look approachable?  What message did you send to others around you with your distressed facial expressions?  What type of reaction did your family or co-workers have when they engaged with you while you were in such a state?  Ever ponder the misunderstandings that may have arisen because your friend or spouse interpreted your frustration as directed towards them?  Let us reflect on the power of the smile not only in the face of adversity, but also during prosperity.
The concept of spreading good cheer in Islam is, at times, neglected and/or forgotten.  Abu Dhar, may Allah be pleased with him, narrated that Prophet Muhammad ﷺ  (peace be upon him) said, “Don’t underestimate any good deed, even meeting your brother with a cheerful face.” (Muslim).  Prophet Muhammad ﷺ also said, as narrated by Abu Dhar, may Allah be pleased with him, “Smiling in the face of your brother is charity.” (Tirmidhi).  So if smiling is charity, why are some of us so miserly?  Why don’t we see more people meeting others with a welcoming face?  This question has puzzled me for a long time.  I once asked a person who is “smile-challenged” about this phenomenon, and he simply shrugged.  After much contemplation and observation, I may have come to an understanding.
Once, a family member and I went to a restaurant.  After sitting at the table for some time, I was enjoying the simple experience and smiling while my dining partner was just straight-faced.  I asked what he was thinking, and he said he was analyzing how the waiter interacted differently with the people sitting at the next table than how he interacted with my dining partner.  I suggested that perhaps his own reserved facial expression prevented the waiter from engaging in a more amiable manner.  He couldn’t help but agree.  Two important points regarding smiling should be considered:
  1. You reap what you sow.  The level of positive energy you exude through your facial expressions (not to mention your overall body language, tone of voice, etc.) often dictates the level of positive interaction you receive in return.  Anticipating positive interactions with others before they actually happen also helps to breed friendly experiences.
  2. Your facial expressions reflect your inner feelings.  If you catch yourself spending your day with a frown, reflect on your thoughts.   What negative feelings are you harboring?  Consider reflecting on the positive side of each situation you encounter.  Once you modify your way of thinking, you will see a change in your facial expressions and may even find yourself smiling.
To put it quite simply, smiling creates a positive cycle of good feelings.  The act of exercising your facial muscles to smile helps to lighten your own mood, which reflects happiness on your face, which brings about a more positive response from others, which creates a deeper positive experience.  So, what if you are not inclined to smile?  Here are some tips:
  1. Be conscious of the fact that you have a tendency to withhold your smiles and check yourself.
  2. This may sound vain, but make a few mirror checks when you catch yourself frowning, or straight-faced.  Reflect upon the negative message you are sending.
  3. Put on a smile, even if you are not in the greatest mood (especially when you are around your loved ones).
  4. Make a conscious effort to watch others’ expressions and reactions when they see you with this lightened expression on your face.
  5. Don’t think about the possibility of someone not returning a smile.  Someone else may be having a bad day, and may be completely oblivious to his surroundings.  The positive effect you have on one person can never be overestimated.
  6. Reflect upon the fact that smiling is charity.  You are actually donating happiness to others when you flash your pearly whites.  And as is with all business in which we engage with Allah; when we give charity, we actually receive much more in return.  Aside from Allah’s reward, the reward of smiling is often returned with another smile, creating good cheer in a matter of seconds.
Making a conscious effort to smile at others is not only pleasing to Allah, but it helps to create a friendly atmosphere.  When you smile at your family and friends, you are letting them know you are happy with them and you love them.  And when you smile at someone you don’t know, you are offering a piece of happiness.  Spread good cheer, a little bit of effort goes a long way.

Falling Apart?

Falling Apart? 4 Ways to Get Yourself Back Together

By Bobbi Emel, MFT

learning to let goThere are times in life that shake you to your core. Your world is changed so much that you don’t recognize it or yourself anymore and doubts start to creep in that you’re ever going to recover.
That happened to me eight years ago when my partner, Ruth, died of metastatic breast cancer. Even though I knew she was going to die, even though we had talked about it and prepared for it the best we could, even though we had learned invaluable lessons during her illness, my spirit and heart were completely crushed when she took her last breath.

Shaken worldview

We all have ways that we view our worlds that are ensconced in our minds and based on our experiences. We view the world as safe or unsafe, fair or unfair, hopeful or hopeless, and so on. My world was always safe, predictable, orderly, and full of richness.
Until Ruth died.
I had never lost anyone before so the experience was completely new to me. Suddenly, my long-held worldview was shaken up.
If people you loved died, it meant the world wasn’t as safe as I thought it would be. Without Ruth, the richness was gone and certainly life wasn’t predictable if death could interrupt it.

Forgotten lessons

Ruth and I were blessed to learn so many life-changing lessons as we walked the path together with her cancer. We learned the art of non-resistance, the magic of being in the moment, and the truth that the things we used to stress about really were small stuff.
Early on in my journey with grief, I tried to access these lessons but it was as if I had emotional amnesia. I couldn’t remember them and, on the rare occasions that I did, it was as if I couldn’t access them or take comfort in them.
I was numb and those important lessons were out there, they just couldn’t get in.

Not knowing yourself

Without Ruth, without my usual world, and without the impactful lessons I had learned about life, I felt disconnected from myself.
Who was I now?
I thought I’d had a firm self-identity but suddenly it was scrambled. I felt like the snow in one of those snow globes after someone has turned it upside down and shaken it. My sense of self was scattered everywhere.

The good news

Aren’t you glad we’re finally getting to the good news?
I have a favorite clinical term that I use for grief: It sucks. And although it took me a few years, I eventually came out of the worst throes of it.
Here’s what helped:
1. Have patience and faith
One time, near the end of Ruth’s life, we’d just received some bad news about her prognosis. After thinking about it for awhile, I approached Ruth and asked her what she thought we were meant to learn from this newest information.
Ruth was quiet for a minute. Then she said. “Patience.” Pause. “And faith.”
And that’s what got me through my tumultuous grief. The patience of time passing in its usual way helped immensely.
As did my dim, but persistent, faith that I would come out through the other side of my grief. I kept telling myself that other people had, so I would, too, even if I couldn’t see how that could happen.
When your world shatters, allow the passage of time to heal you and be your guide. Even if it’s a tiny amount, let your faith in the process of recovery inspire you.
2. Allow others to remind you of the gifts and lessons.
Because your world is upside down and you may not remember the lessons and gifts that once guided you, let those closest to you remind you.
I treasured every card I received, every phone call from a friend who told me how much Ruth had meant to them and how our journey with cancer had taught them to lead a richer life.
Slowly, the loving reminders from people of the wonderful lessons I had learned with Ruth thawed my numbness and I was able to remember and embody them once more.
Use your friends. Tell them how lost you feel and allow them to be your anchor in your inner storm.
3. Welcome your new self.
You really can’t go back to who you were before your tragedy happened. You are different now because of the trauma.
I was not the same person without Ruth and with my new knowledge of a world where you can lose someone you love dearly.
I was different and you will be, too, as you heal from your trauma. And different isn’t always bad.
Like the snowflakes in the snow globe, my sense of self eventually settled, but the pattern that was formed was new and beautiful in its own way.
My sense of empathy was greatly increased, my path of helping people bounce back from loss and adversity was more clear, and the lessons I learned from Ruth’s life, death, and the ensuing grief are treasures that I continue to take forward with me into a different and meaningful new world.
4. Release the pressure valve.
One of the keys to bouncing back from grief or other trauma is to not pressure yourself. I had a hard time with this because I kept thinking I had lost all of the lessons Ruth and I had learned. I thought this was disrespectful to her memory.
Now I know that my reactions and feelings were just normal aspects of grief. It’s very easy to feel isolated in your experience and this can add to your own internal pressure to just “get over it.”
Don’t pressure yourself. Release the pressure by talking to others who have been through the same experience. Or read books by people who have.
There are no rules, no perfect timing about when you are supposed to be healed from your trauma. It happens when it happens and it’s usually an ongoing process.
Have mercy on yourself.

Tuesday 5 March 2013

The Power of Remembrance (By: Reehab Ramadan)



There is a feeling that comes to the heart, a feeling of unrest. No matter what is done that feeling of unrest doesn’t leave. Sometimes we try and numb it with entertainment or by distracting ourselves, but again it returns. And it is after this constant return of this feeling of unrest that we may finally remember the ayah (verse), “Verily in the remembrance of Allah do hearts find rest!” (Qur’an 13:28)
There are many verses and traditions of the Prophet ﷺ (peace be upon him) that show us the extreme importance of dhikr (remembrance of Allah) in our lives. One interesting hadith (narration) is that of a man who came to the Prophet ﷺ who felt that the rules had become too much for him. He felt a burden on his shoulders, unsure if he was to be able to fulfill his roles and obligations to his Lord. He came with a concern to the Prophet ﷺ and asked: “O Messenger of Allah, the laws of Islam have become many for us, so give us a means of access which is comprehensive to which we can cling.” Notice, he wants something to cling to, something to hold on to so that he doesn’t slip away. What then did the Prophet ﷺ respond? “Let not your tongue cease to be moist with the remembrance of Allah, The Glorious, The Magnificent.”
Another powerful hadith is that which describes people who will go to Paradise. They will have already made it to the land where all their wishes and dreams are merely a thought away. Where they get to do whatever they please whenever they please and are not plagued by the ups and downs of this worldly life. Will these people, who have made it so far, have any regrets? Will they wish that they could change something in their previous lives, anything? The Prophet ﷺ tells us about the regrets of the people of Paradise. He says “The People of Paradise will not regret except one thing alone: the hour that passed them by and in which they made no remembrance of Allah.”
Lastly, think back to a story mentioned in many traditions and in our Holy Qur’an. The story of Prophet Yunus (Jonah), who had been swallowed by a whale. He lay there in the stomach of this whale, alone and in darkness—a feeling that some of us can relate to without ever having to find our way into the belly of any animal. His reaction was not to curl up and fall into despair; rather he spoke to the only one who could take him out of this darkness and take him out of his lonely state. He said, “La ilaha illa anta subhanaka inni kuntu minathalimin [none has the right to be worshipped but You (O Allah), Glorified are You (above all that (evil) they associate with You). Truly, I have been of the wrong-doers].” He made dhikr. When in unimaginable hardship, he made dhikr. Then what happened? Allah subhanahu wa ta`ala (exalted is He) removed him from the darkness. He saved him and took care of him. Allah then tells us in the Qur’an a very important point which brings this all home. He says, “Had he not been one of My glorifiers (musabbihin), he would have remained inside the whale’s stomach until Judgment Day,” (Qur’an 37:143-144). The dhikr he made saved him from the loneliness and the darkness that he was enveloped in, along with the pain and suffering he was undergoing in the inside of the whale; imagine then what it can do for us.
An issue that often times arises when we try to implement adding dhikr into our lives is that we start off excited and really feeling it. We start off feeling like a fish that has just been placed in water after struggling to breathe on land. But then, the feeling starts to fade and we stop feeling our words. We start feeling that we are speaking empty words and then shaytaan (Satan) comes in telling us that since we don’t feel it, there is no point in doing it.
A wise man from our history, ibn Ata’illah, speaks of this eloquently and holistically. He says: “Do not stop mentioning God just because your heart is not present. Forgetting Him completely is worse than being inattentive while you are mentioning him; perhaps He will elevate you from being inattentive to being attentive, and from being attentive to being fully present with Him, and from being fully present with Him to being fully absent from anything but Him; ‘and this is not difficult for God’ (Qur’an 35:17).”
Take a moment right now to make a commitment to yourself to add more dhikr to your daily routine. It doesn’t have to be something big, take it easy and take baby steps, but make a commitment that you won’t leave. Remember, Allah (swt) loves those deeds which are consistent even if they are small. Not only that, but when you take one step towards Allah He takes ten steps towards you.



Allahuma a’inna ala dhikrika wa shukrika wa husn ibadatak (Oh Allah, assist us in remembering You, thanking You and worshipping You in the best of manners). 



Bioinformatics as a Career

Bioinformatics:

Bioinformatics brings together the fields of life science, computer science and statistics. When biological information is captured on computer, it can be used to produce new computer systems (databases, software, networks, and even hardware) and solve problems in a wide variety of areas ranging from biology to medicine.

Bioinformaticians strive to understand medical and biological systems by the creative use of statistics and computer analysis. They may write computer programs to analyse data in a new way, they may apply existing analytical tools to new data sets, they may introduce novel statistical methods into the analysis of data and they may extend existing analytical capabilities to genome sized data sets.

The most recognised application of bioinformatics has been the mapping of the human genome sequence.

By studying bioinformatics at Sydney, you tap into a vast breadth of expertise in bioinformatics covering the disciplines of statistics, computer science, genetics, biochemistry, veterinary science, medicine and agriculture.

What will you study?

In first year, it is recommended that you complete units of study in biology, mathematics and information technology. In second and third year, you divide your time equally between the life sciences and the mathematical, statistical and computational sciences. In third year, you are highly recommended to enrol in BIOL3027/3927 (bioinformatics and genomics) and BCHM3092/3992 (proteomics and functional genomics). Plus you will complete the BINF3101 (bioinformatics project) unit that is designed specifically to give you an opportunity to do real research, supervised by scientists from the biomedical disciplines.

Career Opportunities:

Bioinformatics graduates are in high demand. Career opportunities in bioinformatics will continue to expand on both the computer and biological science fronts. For computer science, there are opportunities in programming, database development, systems analysis and software engineering. In the biological sciences career opportunities exist for bioinformatics experts who assist biologists and medical researchers to interpret biological or medical data, design user interfaces, and run laboratory information management and analysis systems.

Opportunities also exist in research laboratories in universities, hospitals, and the biotechnological and pharmaceutical industries. The Master of Applied Science (Bioinformatics) is an additional avenue for students wishing to pursue a career in bioinformatics.

Universities in Pakistan offering Bioinformatics Programs:

1.COMSATS Institute of Information Technology,Pakistan
2.International Islamic University, Islamabad,Pakistan.
3.Muhammad Ali Jinnah University, Islamabad,Pakistan
4.Government College University,Pakistan

Universities abroad offering Bioinformatics Programs:

Australia
  • Australian National University , Canberra, Australia
  • Central Queensland University , Rockhampton, Australia
Canada
    • Seneca College, Ontario, Canada
    • UNIVERSITY OF MONTREAL, CANADA
China
    • Hong Kong University-Pasteur Research Center - Hong Kong - China.
UK
    • University of Manchester, UK
    • Imperial College, London, UK
 
 
 
Contributed by: Samia Aslam, Kulsum Khawar

Saturday 2 March 2013

Surgery MCQs with answers Part 4:



1.Breast cancer poor prognosis factors are all except
1.Estrogen receptor positive
2. Her 2 status
3. Stage / grade
4. Lymph node status
5. Size
Please contribute to the discussion by posting the answer with references and pointing out any errors in the question!

2.The tumor, which may occur in the residual breast or overlying skin following wide local excision and radiotherapy for mammary carcinoma, is:
A. Leiomyosarcoma
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Angiosarcoma
Correct answer : D. Angiosarcoma
Angiosarcoma can occur as a late complication following breast conservation surgery.

3.In which of the following types of breast carcinoma, would you consider biopsy of opposite breast?
A. Adenocarcinoma-poorly differentiated
B. Medullary carcinoma
C. Lobular carcinoma
D. Comedo carcinoma
Correct answer : C. Lobular carcinoma
Lobular carcinoma has higher incidence of bilaterality compared to other carcinomas

4.The most important prognostic factor in breast carcinoma is:
A. Histological grade of the tumor
B. Stage of the tumor at the time of diagnosis
C. Status of estrogen and progesterone receptors
D. Over expression of p53 tumour suppressor gene
Correct answer : B. Stage of the tumor at the time of diagnosis

5.Which of the following statements is true of primary grade IV-V vesicoureteric reflux in young children?
a) Renal scarring usually begins in the midpolar regions
b) Postnatal scarring may occur even in the absence of urinary tract infections
c) Long term outcome is comparable in patients treated with either antibiotic prophylaxis or surgery
d) Oral amoxicillin is the antibiotic of choice for prophylaxis
Correct answer : b) Postnatal scarring may occur even in the absence of urinary tract infections
Renal scarring usually begins in the polar regions
Long term outcome is better with surgery
Co-trimoxazole is the drug …

6.The defective migration of neural crest cells results in;
a) Congenital megacolon
b) Albinism
c) Adrenogenital hypoplasia
d) Dentinogenesis imperfecta
Correct answer : a) Congenital megacolon and b) Albinism
Conditions caused by defective migration of neural crest cells:
Congenital megacolon
Albinism
Neurocristopathies
Melanoma
Oropharyngeal teratoma

7.A 45-year-old gentleman has undergone truncal vagotomy and pyloroplasty for bleeding duodenal ulcer seven years ago. Now he has intractable recurrent symptoms of peptic ulcer. All of the following suggest the diagnosis of Zollinger Ellison syndrome, except:
a) Basal acid output of 15 meq/hour
b) Serum gastrin value of 500 pg/ml
c) Ulcers in proximal jejunum and lower end of esophagus
d) Serum gastrin value of 200 pg/ml with secretin stimulation
Correct answer : d) Serum gastrin value of 200 pg/ml with secretin stimulation
Diagnosis of ZES requires a rise of 200 pg/ml or more in …

8.Which one of the following statements is incorrect in regard to stones in the gallbladder?
a) Pigment stones are due to increased excretion of conjugated bilirubin
b) Are considered a risk factor for the development of gallbladder carcinoma
c) 10% of gallstones are radio-opaque
d) A mucocele of the gallbladder is caused by a stone impacted in Hartman’s pouch
Correct answer : d) A mucocele of the gallbladder is caused by a stone impacted in Hartman’s pouch
Mucocele of gallbladder is caused by stone impaction in the neck of gall bladder or in the cystic duct.

9.One of the following is not correct in papillary carcinoma of thyroid:
a) Can be reliably diagnosed using fine needle aspiration cytology
b) Always unifocal
c) Typically spreads to the cervical lymph nodes
d) Requires a a total thyroidectomy for large tumours
Correct answer :
b) Always unifocal
Papillary carcinoma is usually mulitifocal. Lymphatic spread occurs to cervical lymph nodes. (Hematogenous spread occurs in case of follicular carcinoma.)

10.In which of the following conditions acquired (secondary) megacolon is seen?
a) Fissure in-ano
b) Complete absence of parasympathetic ganglion cells
c) Absence of sympathetic ganglion cells
d) Rectal malignancy
Correct answer :
d) Rectal malignancy
Absence of ganglion cells result in congenital megacolon. Fissure in ano causes anal sphincter spasm, but does not result in megacolon. Rectal malignancies cause luminal obstruction leading to development of megacolon.

Surgery MCQs with answers Part 3:



1.Allen’s test is useful in evaluating:
A. Thoracic outlet compression
B. Presence of cervical rib
C. Integrity of palmar arch
D. Digital blood flow
Correct answer : C. Integrity of palmar arch
How to perform allen’s test: (To check for patency of radial and ulnar arteries and to confirm integrity of the palmar arterial arch between them)

2.The patient makes a tight fist
The examiner compresses the radial and ulnar arteries distally
The fist is released and compression of the ulnar artery is released
The speed of return of colour to the palm is looked for
Steps 1 and 2 are …

3.The most common cause of acquired arteriovenous fistula is;
A. Bacterial infection
B. Fungal infection
C. Blunt trauma
D. Penetrating trauma
Correct answer : D. Penetrating trauma

4.Which of the following statements is true regarding testicular tumors?
A. Are embryonal cell carcinomas in 95% of cases
B. Bilateral in up to 10% cases
C. Teratomas are more common than seminomas
D. Usually present after 50 years of age
Correct answer : B. Bilateral in up to 10% cases
15% of familial and 5% of sporadic cases of testicular tumour are bilateral.

5.The treatment of choice for squamous cell anal cancer is:
A. Abdominoperineal resection
B. Laser fulgaration
C. Chemoradiotherapy
D. Platinum—based chemotherapy
Correct answer : C. Chemoradiotherapy
Chemotherapy with radiotherapy (Nigro regimen) is the preferred treatment for anal carcinoma.

5.Which of the following drugs is not a part of the ‘Triple Therapy’ immunosuppression for post-renal transplant patients?
A. Cyclosporine
B. Azathioprine
C. FK 506
D. Prednisolone
Correct answer : C. FK 506
Components of triple therapy immunosuppression for post-renal transplant patients are :
Cyclosporine
Azathioprine
Prednisolone

5.The most common cause of gastric outlet obstruction in India is:
A. Tuberculosis
B. Cancer of stomach
C. Duodenal lymphoma
D. Peptic ulcer disease
Correct answer : B. Cancer of stomach

6.All of the following modalities can be used for in situ ablation of liver secondaries, except?
A. Ultrasonic waves
B. Cryotherapy
C. Alcohol
D. Radiofrequency
Correct answer : A. Ultrasonic waves
Ablation of liver secondaries can be done by:
Cryotherapy
Radiofrequency ablation
Microwave ablation
Injection of chemicals like alcohol and acetic acid

7.Biliary stricture developing after laparascopic cholecystectomy usually occurs at which part of the common bile duct?
A. Upper
B. Middle
C. Lower
D. All sides with equal frequency
Correct answer : A. Upper
During surgery, the common bile duct may be mistakenly identified as the cystic duct. Hence, surgeon may ligate the common bile duct instead of the cystic duct resulting in the development of a stricture in the upper part.

8.Which one of the following statements is incorrect regarding stones in the common bile duct?
A. Can present with Charcot‘s triad
B. Are suggested by a bile duct diameter > 6 mm in ultrasound
C. ERCP, sphincterotomy and balloon clearance is now the standard treatment
D. When removed by exploration of the common bile ducts the T-tube can be removed after 3 days
Correct answer : D. When removed by exploration of the common bile ducts the T-tube can be removed after 3 days
T tubes are kept in the bile duct for 7-30 days. …

8.A patient of post cholecystectomy biliary stricture has undergone an ERCP three days ago. Following this she has developed acute cholangitis. The most likely organism is:
A. Escherichia coli
B. Bacillus fragilis
C. Streptococcus viridans
D. Pseudomonas aeruginosa
Correct answer : A. Escherichia coli

9.Apart from Escherichia coli. the other most common organism implicated in acute suppurative bacterial peritonitis is:
A. Bacteroides
B. Klebsiella
C. Peptostreptococcus
D. Pseudomonas
Correct answer : A. Bacteroides

10.Referred pain from all of the following conditions may be felt along the inner side of right thigh, except:
A. Inflamed pelvic appendix
B. Inflamed ovaries
C. Stone in pelvic ureter
D. Pelvic abscess
Correct answer : D. Pelvic abscess

Surgery MCQs with answers Part 2:



1.A new born presented with bloated abdomen shortly after birth with passing of less meconium. A full thickness biopsy of the rectum was carried out. Which one of the following rectal biopsy findings is most likely to be present?
A. Fibrosis of submucosa
B. Hyalinisation of the muscular coat
C. Thickened Muscularis propria
D. Lack of ganglion cells
Correct answer : D. Lack of ganglion cells
The history is suggestive of congenital aganglionic megacolon (Hirschprung disease). The ganglion cells in the intestinal wall are absent. It occurs due to arrest in migration of neural crest cells. …

2.In which one of the following conditions is sialography contraindicated?
A, Ductal calculus
B. Chronic parotitis
C. Acute parotitis
D. Recurrent sialadenitis
Correct answer : C. Acute parotitis
Acute parotitis is a contraindication for saliography.

3.Abbey Estlander flap is used in the reconstruction of:
A. Buccal mucosa
B. Lip
C. Tongue
D. Palate
Correct answer : B. Lip
Abbey Estlander flap (stair step advancement technique) is used in reconstruction of lip.

4.The most common complication seen in hiatus hernia is:
A. Oesophagitis
B. Aspiration pneumonitis
C, Volvulus
D. Esophageal stricture
Correct answer : A. Oesophagitis

5.In which one of the following head and neck cancer, perineural invasion is most commonly seen?
A. Adenocarcinoma
B. Adenoid cystic carcinoma
C. Basal Cell Adenoma
D. Squamous cell carcinoma
Correct answer : B. Adenoid cystic carcinoma
Perineural invasion is characteristically seen in adenoid cystic carcinoma. It is the most common malignant tumour of submandibular salivary glands.

6.Lumbar sympathectomy is of value in the management of:
A. Intermittent claudication
B. Distal ischaemia affecting the skin of the toes
C. Arteriovenous Fistula
D. Back pain
Correct answer : B. Distal ischaemia affecting the skin of the toes
The sympathetic system controls the blood flow to skin (not muscle). Sympathetic tone has a vasoconstrictor effect. Hence lumbar sympathectomy will cause vasodilation and increased blood flow to skin of toes.

7.A blood stained discharge from the nipple indicates one of the following:
A. Breast abscess
B. Fibroadenoma
C. Duct Papilloma
D. Fat Necrosis of Breast
Correct answer : C. Duct Papilloma
Causes of blood stained nipple discharge
Intraductal papilloma
Carcinoma
Duct ectasia
Fibrocystic disease

8.The most preferred approach for pituitary surgery at the present time is:
A. Transcranial
B. Transethmoidal
C. Trans-sphenoidal
D. Transcallosal
Correct answer : C. Trans-sphenoidal

9.Which of the following is not a preferred site for planning vascular access for maintenance hemodialysis?
A. Nondominant extremity
B. Upper limb
C. Radiocephalic AV fistula
D. Saphenofemoral fistula
Correct answer : D. Saphenofemoral fistula
Usual site is forearm of non dominant hand. The femoral vessels are used only if all upper limb vessles have been used.

10.Dacron vascular graft is:
A. Nontextile synthetic
B. Textile synthetic
C. Nontextile biologic
D. Textile biologic
Correct answer : B. Textile synthetic
Dacron is a synthetic graft material. It is a type of medical textile.