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Signals for parturition originate from: (1) Placenta only (2) Both placenta as well as fully developed foetus (3) Fully developed foetus only (4) Oxytocin released from maternal pituitary Ans: (2) [2012] Q1725 blood pressure medication that does not cause weight gain trusted warfarin 2 mg. Which one of the following statements is false in respect of viability of mammalian sperm It: (1) secretes oxytocin during parturition (2) secretes estrogen (3) facilitates supply of oxygen and nutrients to blood pressure medication vertigo purchase warfarin 5 mg free shipping embyo (4) facilitates removal of carbon dioxide and waste material from embryo blood pressure lying down purchase warfarin 1mg overnight delivery. Which one of the following is the most widely accepted method of contraception in India prehypertension to treat or not to treat order generic warfarin line, as at present Artificial insemination mean: (1) Introduction of sperms of a healthy donor directly into the ovary (2) Transfer of sperms of husband to a test tube containing ova (3) Transfer of sperms of a healthy donor to a test tube containing ova (4) Artificial introduction of sperms of a healthy donor into the vagina Ans: (4) Q1742. One of the legal methods of birth control is: (1) by a premature ejaculation during coitus (2) by abstaining from coitus from day 10 to 17 of the menstrual cycle (3) abortion by taking an appropriate medicine (4) by having coitus at the time of day break Ans: (3) [2012] Q1743. Which of the following cannot be detected in a developing foetus by amniocentesis Triticale has been evolved by intergeneric hybridization between (1) rice and maize (2) wheat and rye (3) wheat and Aegilops (4) wheat and rice Ans: (2) [1988] Q1752. Diploid chromosome number in humans is (1) 48 (2) 46 (3) 42 (4) 44 Ans: (2) Q1754. Mutations used in agriculture are commonly (1) lethal (2) induced (3) recessive and lethal (4) spontaneous Ans: (2) Q1755. The chance of its being a son is (1) 50% (2) zero (3) 100% (4) 25% Ans: (1) [1989, 2001] Q1756. In a genetic cross having recessive epistasis, F2 phenotypic ratio would be (1) 9: 3: 4 (2) 9: 6: 1 (3) 12: 3: 1 (4) 15: 1 Ans: (1) [1990] Q1758. The progeny is albino because (1) plastids are inherited from female parent (2) trait for albinism is dominant (3) green plastids of male must have mutated (4) the albinos have biochemical to destroy plastids derived form green male Ans: (1) [1990] Q1761. Haemophilia is more common in males because it is a (1) Dominant trait carried by X-chromosome (2) Recessive character carried by Y-chromosome (3) Recessive trait carried by X-chromosome (4) Dominant character carried by Y-chromosome Ans: (3) [1990] Q1763. The probability of their daughter becoming colour blind is (1) 50% (2) 0% (3) 75% (4) 25% Ans: (2) [1990] Q1765. A dihybrid condition is (1) tt rr (2) tt Rr (3) Tt Rr (4) Tt rr Ans: (3) [1990] Q1767. The children shall be (1) all blue eyed (2) both blue eyed and brown eyed 1:1 (3) blue eyed and brown eyed 3: 1 (4) all brown eyed Ans: (2) [1991] Q1768. The allele which is unable to express its effect in the presence of another is called (1) complementary (2) codominant (3) recessive (4) supplementary Ans: (3) [1991] Q1769. This is an example of (1) hybrid (2) dominant recessive (3) supplementary genes (4) incomplete dominance Ans: (4) [1991] Q1770. Multiple alleles control inheritance of (1) sickle cell anaemia (2) phenylketonuria (3) blood groups (4) colour blindness Ans: (3) [1991] Q1773. The contrasting pairs of factors in Mendelian crosses are called (1) alloloci (2) multiple alleles (3) paramorphs (4) allelomorphs Ans: (4) [1991] Q1774. First geneticist/ father of genetics was (1) Darwin (2) de Vries (3) Morgan (4) Mendel Ans: (4) Q1775. Mendelís last law is (1) independent assortment (2) segregation (3) polygenic inheritance (4) dominance Ans: (1) Q1776. The phenomenon is (1) mutation (2) epistasis (3) none of the above (4) dominance Ans: (2) [1991] Q1777. An organism with two identical alleles is (1) heterozygous (2) dominant (3) homozygous (4) hybrid Ans: (3) [1992] Q1780. A colour blind girl is rare because she will be born only when (1) her mother is colour blind and father has normal vision (2) her mother and maternal grand father were colour blind (3) parents have normal vision but grand parents were colour blind. A colour blind mother and normal father would have (1) all colour blind (2) colour blind sons and normal/carrier daughters (3) all normal (4) colour blind sons and daughters Ans: (2) [1992] Q1782. An allele is dominant if it is expressed in (1) heterozygous combination (2) both homozygous and heterozygous states (3) homozygous combination (4) second generation Ans: (2) [1992, 94] Q1786. Nucleosome core is made of (1) H1, H2A, H2B, H3 and H4 (2) H1, H2A, H2B and H3 (3) H2A, H2B, H3 and H4 (4) H1, H2A, H2B, H4 Ans: (3) [1992] Q1787. A polygenic inheritance in human beings is (1) Colour blindness (2) Skin colour (3) Sickle cell anaemia (4) Phenylketonuria Ans: (2) Q1788. Mendel studied inheritance of seven pairs of traits in Pea which can have 21 possible combinations. If you are told that in one of these combinations, independent assortment is not observed in later studies, your reaction will be (1) It is impossible (2) Independent assortment principle may be wrong (3) Later studies may be wrong (4) Mendel might not have studied all the combinations Ans: (4) [1993] Q1789. When a certain character is inherited only through female parent, it probably represents (1) incomplete dominance (2) multiple plastid inheritance (3) mendelian nuclear inheritance (4) cytoplasmic inheritance Ans: (4) Q1790. Out of 8 ascospores formed in Neurospora the arrangement is 2a: 4a: 2a showing (1) Second generation division (2) No crossing over (3) First generation division (4) Some meiosis Ans: (1) [1993] Q1791. Of a normal couple, half the sons are haemophilic while half the daughters are carriers. The gene is located on (1) one X-chromosome of mother (2) X-chromosome of father (3) both the X-chromosomes of mother (4) Y-chromosome of father Ans: (1) [1993] Q1792. The linkage is (1) complete (2) cis type (3) absent/ Incomplete (4) trans type Ans: (3) [1993] Q1793. Haploids are preferred over diploids for mutation studies because in haploids (1) mutations are readily induced (2) recessive mutations express immediately (3) tissue culture is easy (4) d o m i n a n t m u t a t i o n s e x p r e s s immediately Ans: (2) [1993] Q1794. Sex is determined in human beings (1) 40 days after fertilization (2) by ovum (3) seventh to eight week when genitals differentiate in foetus (4) at time of fertilization Ans: (4) [1993] Q1796. The proportion of her progeny is (1) all albinic (2) 2 normal: 1 albinic (3) 1 normal: 1 albinic (4) all normal Ans: (3) [1993] Q1798. Of both normal parents, the chance of a male child becoming colour blind are (1) possible only when fatherís mother was colour blind (2) no (3) possible only when motherís father was colour blind (4) possible only when all the four grand parents had normal vision Ans: (3) [1993] Q1799. What shall be proportion of Bd in sperms (1) 1/4 (2) Zero (3) 1/8 (4) 1/2 Ans: (1) [1994] Q1800. Genes located on Y-chromosome are (1) autosomal genes (2) mutant genes (3) holandric genes (4) sex-linked genes Ans: (3) [1994] Q1802. A fruitfly exhibiting both male and female traits is (1) hemizygous (2) heterozygous (3) gynander (4) gynandromorph Ans: (4) [1994] Q1803. A cross between pure tall Pea plant with green pods and dwarf Pea plant with yellow pods will produce short F2 plants out of 16 (1) 4 (2) 9 (3) 1 (4) 3 Ans: (1) [1994] Q1805. The process of mating between closely related individuals is (1) hybridisation (2) self breeding (3) heterosis (4) inbreeding Ans: (4) [1994] Q1806. The change of the light-coloured variety of peppered moth (Biston betularia) to its darker variety (Biston carbonaria) is due to (1) genetic isolation (2) mutation (3) temporal isolation (4) regeneration Ans: (2) [1995] Q1807. The polytene chromosomes were discovered for the first time in (1) Musca nebulo (2) Drosophila (3) Musca domestica (4) Chironomus Ans: (4) [1995] Q1809. Barr body in mammals represents (1) all heterochromatin in male and female cells (2) all the heterochromatin in female cells (3) one of the two X-chromosomes in somatic cells of females (4) Y-chromosomes in somatic cells of male Ans: (3) [1995] Q1810. When two genetic loci produce identical phenotypes in cis and trans position, they are considered to be (1) multiple alleles (2) pseudoalleles (3) parts of same gene (4) different genes Ans: (2) [1995] Q1811. Barr body in human female is formed by (1) inactivation of both X-chromosomes (2) inactivation of paternal X-chromosome (3) inactivation of either the paternal or maternal X-chromosome (4) inactivation of maternal X-chromosome Ans: (3) [1996] Q1814. An individual exhibiting both male and female sexual characteristics in the body is known as (1) gynandromorph (2) hermaphrodite (3) bisexual (4) intersex Ans: (1) [1996] Q1815. Alleles that produce independent effects in their heterozygous condition are called (1) complementary alleles (2) codominant alleles (3) supplementary alleles (4) epistatic alleles Ans: (2) Q1816. Genetic identity of a human male is determined by (1) sex chromosomes (2) autosomes (3) cell organelles (4) nucleolus Ans: (1) [1997] Q1818. This phenomenon is found to be maternally inherited and is due to some genes which are present in (1) mitochondrion (2) nucleus (3) cytoplasm (4) chloroplast Ans: (3) [1997] Q1819. When mated with a normal female fruit fly, the male-specific chromosome will enter egg cells in the proportion of (1) 3: 1 (2) 1: 1 (3) 7: 1 (4) 1: 2 Ans: (2) [1997] Q1820. Muller was awarded Nobel Prize for his (1) work on gene mapping in Drosophila (2) discovery that chemicals can induce gene mutations (3) efforts to prevent the use of nuclear weapons. How will the progeny be (1) 50% haemophilic daughters and 50% colour-blind daughters (2) h a e m o p h i l i c a n d c o l o u r b l i n d daughters (3) All sons and daughters haemophilic and colour-blind (4) 50% haemophilic, colour-blind sons and 50% haemophilic sons Ans: (4) Q1823. The formation of multivalents at meiosis in a diploid organism is due to (1) monosomy (2) inversion (3) reciprocal translocation (4) deletion Ans: (3) [1998] Q1824. Mental retardation in man associated with sex chromosomal abnormality is usually due to (1) large increase in Y complement (2) increase in X complement (3) reduction in X complement (4) moderate increase in Y complement Ans: (2) [1998] Q1825. If Mendel had studied the 7 traits using a plant with 12 chromosomes instead of 14, in what way would his interpretation have been different

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The Guidelines were also uploaded to arteria carotis communis buy warfarin 2mg lowest price the homepage of the Japanese Society of Nephrology blood pressure form order warfarin line. A certain degree of turnover in the membership of the revision committee will be required in order to blood pressure reduction cheap warfarin 1 mg visa ensure the impartiality of the Guidelines blood pressure medication met order warfarin paypal. In case that both parents are unaffected, disease in the offspring results from new mutation. It can be difficult to detect cysts meeting diagnostic criteria in younger patients, requiring reexamination. In most cases, cysts manifest bilaterally and diagnosis is uncomplicated; in the remaining cases, diagnosis should be carefully performed in accordance with the diagnostic criteria noted herein. Autosomal recessive polycystic kidney disease 3) Comparison of diagnostic criteria between Japan and other countries Following Bearís diagnostic criteria in 1984, numerous other versions have been reported, each with its own emphasis on, for example, age classification or cyst assessment through imaging. Ravineís criteria, which were utilized for some time, were the first guidelines reflecting age as a factor. Diagnostic imaging is also clinically important in terms of disease complications such as cerebral aneurysms. As adverse reactions can occur, careful consideration must be given to the riskĖbenefit balance before utilizing contrast media. Additional diseases to be ruled out include renal tubular acidosis, multicystic kidney (multicystic dysplastic kidney), multilocular cyst of the kidney, medullary cystic kidney disease, and oralĖfacialĖdigital syndrome. As rare diseases are difficult to identify and distinguish during normal medical examinations, despite reports on characteristic indicators other than renal cysts, extra care should be given during differential diagnosis. Physicians must consider whether samples for genetic testing should be sent to foreign laboratories. Subjective symptoms include abdominal or lower back pain, macroscopic hematuria (including its posttraumatic form caused by sports activities), or abdominal bloating. Acute pain is usually attributable to hemorrhagic cysts, infection, or urinary tract stones. Hypertension, diagnosed objectively by physical examination and other methods, is a significant initial symptom (or findings). Anorexia, gastrointestinal obstruction, and malnutrition are manifestations of compression of the gastrointestinal tract by the advanced enlargement of the kidney (and/or the liver). Macroscopic hematuria is observed at least once during the entire clinical course in almost 50% of the patients. The first functional abnormality of the kidney is disturbed concentrating capacity, although it rarely becomes clinically evident unless the patient complains of polydipsia and polyuria. In addition, it is often detected when renal function is normal and cysts are still small. Another way to suppress vasopressin secretion is to increase fluid intake to mediate osmoregulation. A larger human study is needed to clarify the effect of high water intake; patients would be advised to avoid stimulating vasopressin secretion by chronic water depletion. However, the safety of tolvaptan therapy for adult patients with creatinine clearance <60 mL/min or total kidney volume less than 750 mL or children is not established. The procedure would be considered in the management of disease related chronic pain or abdominal distention, as well as for diagnostic purposes and the treatment of infected cysts. The duration of pain relief is shorter in cyst aspiration than surgical cyst decortication. Cyst aspiration followed by instillation of a sclerosing agent (most commonly ethanol) is indicated when the symptoms are caused by one or few dominant or strategically located cysts. Cyst aspiration for diagnostic purposes and the treatment of infected cysts has been the standard procedure. Aneurysm size correlates with the presence of symptoms and the risk of bleeding, and aneurysms may rupture more often and at a younger age than sporadic aneurysms. However, there is no correlation between the risk of rupture and sex, renal function and blood pressure. Recommendation Grade: C1 Treatment of a cerebral aneurysm is determined by a comprehensive examination of factors such as location, shape, and size of the aneurysm, and general conditions, age, and medical history of the patient. Decisions regarding treatment advisability and method should follow consultation with a neurosurgeon. Detection of a cerebral aneurysm during screening should be followed by careful control of smoking, alcohol consumption, and blood pressure. Treatment of a cerebral aneurysm is surgery, involving a craniotomy and endovascular treatment, with specifics determined following comprehensive investigation of the location, shape, and size of the aneurysm, and general conditions, age, and medical history of the patient. As treatment options have their respective strengths and weaknesses, decisions should follow consultation with a neurosurgeon. If conservative observation is chosen, biannualóor at the very least, annualómonitoring of aneurysm size is recommended. Most causative bacteria originate from the intestine, and many are gram-negative rods. Recommendation Grade: C1 Tranexamic acid may be considered when cystic hemorrhage does not improve by conservative treatment. These episodes are normally managed with conservative medical treatment and rarely require surgery or embolization. Thus, tranexamic acid may be considered when cystic hemorrhage does not improve by conservative treatment. We may recommend, however, the standard prophylactic treatment in patients with metabolic disorder. The main component of the stones is uric acid, and the most common metabolic abnormality is hyperoxaluria. Medical preventive treatments are not recommended because of the lack of studies that prove their efficacy. For patients with a heart murmur, it is uncertain whether the disease is mild or severe. Such patients are unable to eat properly, leading to malnutrition and an overall deterioration of health. However, according to the recent European Renal Best Practice Guidelines, initiation of dialysis with peritoneal dialysis should not be considered a contraindication. Which of the two modalities, hemodialysis or peritoneal dialysis, is better for patientsí long survival Although there have been several studies concerning this question that examined different populations and situations of dialysis patients, there is no definite conclusion or consensus on this matter. The dialysis modalities, hemodialysis or peritoneal dialysis, should be decided by patients themselves according to the suitability of the modality for the patients. Recommendation Grade: C1 If native kidney enlargement seems sufficiently massive to jeopardize accommodation of the donor kidney, unilateral or bilateral nephrectomy is recommended. However, patients should be monitored postoperatively for possible complications such as thromboembolism, hyperlipidemia, postoperative diabetes onset, and hypertension. If the patient has a cerebral aneurysm, treatment is preferable prior to renal transplantation. If native kidney enlargement seems sufficiently massive to jeopardize accommodation of the donor kidney, unilateral (or rarely, bilateral) nephrectomy is recommended. However, there is no professional consensus on issues such as nephrectomy timing (simultaneous or heterochronic), scope (unilateral or bilateral), or method (open or laparoscopic). It is characterized by cystic dilation of renal collecting ducts and varying degrees of hepatic abnormalities consisting of biliary dysgenesis, and periportal fibrosis and bile duct proliferation in the liver. Cysts are usually small, and have mainly diffuse dilatations rather than a round shape. Renal ultrasonography demonstrates markedly enlarged echogenic kidneys, not a hubble-bubble low-echogenic appearance, and this recognition is important for diagnosis. Many diseases present with kidney cysts, all of which can be differential diagnoses. Prognosis is difficult to assess, although now it becomes clear that survival of all but the most severely affected neonates who demonstrate pulmonary hypoplasia is possible. It is expected that the prognosis will be improved in the future through improvement in the treatment of end-stage renal failure and disease management in infants early after birth. However, the request for a genetic examination from an overseas laboratory as an option may be subjected to genetic counseling because the enforcement of prenatal genetic diagnosis in Japan is difficult. Generally, hemodialysis is often unsuitable for children, and peritoneal dialysis is recommended when there are no special circumstances. However, its adaptation should be decided carefully according to individual cases. Generally, the best replacement therapy method for the kidney in children is thought to be renal transplantation, and its early enforcement is recommended.

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M/E Cavernous haemangiomas are composed of thin-walled cavernous vascular spaces blood pressure in pregnancy order warfarin australia, flled partly or completely with blood arteria radial cheap warfarin 2mg with visa. True to blood pressure 7545 order cheap warfarin on-line its name blood pressure medication hydralazine buy discount warfarin on-line, it appears as exophytic, red granulation tissue just like a nodule, commonly on the skin and mucosa of gingiva or oral cavity. Pregnancy tumour or granuloma gravidarum is a variant occurring on the gingiva during pregnancy and regresses after delivery. M/E It shows proliferating capillaries similar to capillary haemangioma but the capillaries are separated by abundant oedema and infammatory infltrate, thus resembling infammatory granulation tissue. M/E Capillary lymphangioma is composed of a network of endothelium lined, capillary-sized spaces containing lymph and often separated by lymphoid aggregates. A large cystic variety called cystic hygroma occurs in the neck producing gross deformity in the neck. M/E Cavernous lymphangioma consists of large dilated lymphatic spaces lined by fattened endothelial cells and containing lymph. These tumours are found most often in the dermis of the fngers or toes under a nail. M/E the tumours are composed of small blood vessels lined by endothelium and surrounded by aggregates, nests and masses of glomus cells. In fact, it is an opportunistic infection with gram-negative bacilli of Bartonella genus. M/E Lobules of proliferating blood vessels are seen lined by epithelioid endothelial cells having mild atypia. Mixed infammatory cell infltrate with nuclear debris of neutrophils is present in these areas. It is found most often in the skin and subcutaneous tissue in relation to medium-sized and large veins. M/E There is an active proliferation of endothelial cells forming several layers around the blood vessels so that vascular lumina are diffcult to identify. Reticulin stain delineates the pattern of cell proliferation inner to the basement membrane. Pericytes are cells present external to the endothelial cells of capillaries and venules. This is a rare tumour that can occur at any site but is more common in lower extremities and the retroperitoneum. M/E the tumour is composed of capillaries surrounded by spindle-shaped pericytes outside the vascular basement membrane forming whorled arrangement. Hepatic angiosarcomas are of special interest in view of their association with carcinogens like polyvinyl chloride, arsenical pesticides and radioactive contrast medium, thorotrast, used in the past. G/A the tumours are usually bulky, pale grey-white, frm masses with poorly-defned margins. M/E the tumours may be well-differentiated masses of proliferating endothelial cells around well-formed vascular channels, to poorly-differen tiated lesions composed of plump, anaplastic and pleomorphic cells in solid clusters with poorly identifable vascular channels. Classic (European) Kaposiís sarcoma this is the form which was frst described by Kaposi. Kaposiís sarcoma in renal transplant cases this form is associated with recipients of renal transplants who have been administered immunosuppressive therapy for a long time. G/A the lesions in the skin, gut and other organs form prominent, irregular, purple, dome-shaped plaques or nodules. M/E the changes are nonspecifc in early stage and more characteristic in late nodular stage. The classic form of Kaposiís sarcoma is largely confned to skin and the course is generally slow and insidious with long survival. Hypertension with systolic pressure of 160 mmHg has greater risk of causing atherosclerosis as under: A. The most important mitogen for smooth muscle proliferation in atherosclerosis is: A. Biopsy of affected artery in the following condition is not only of diagnostic valve but also cures the main symptom of the patient: A. In Kaposiís sarcoma, the lesions are more extensively distributed at different body sites and visceral organs in: A. Heart is divided into four chambers: a right and a left atrium both lying superiorly, and a right and a left ventricle both lying inferiorly and are larger. The atria are separated by a thin interatrial partition called interatrial septum, while the ventricles are separated by thick muscular partition called interventricular septum. The blood in the heart chambers moves in a carefully prescribed pathway: venous blood from systemic circulation > right atrium > right ventricle > pulmonary arteries > lungs > pulmonary veins > left atrium > left ventricle > aorta > systemic arterial supply. The transport of blood is regulated by cardiac valves: two loose fap-like atrioventricular valves, tricuspid on the right and mitral (bicuspid) on the left; and two semilunar valves with three leafets each, the pulmonary and aortic valves, guarding the outfow tracts. The normal circumference of the valvular openings measures about 12 cm in tricuspid, 8. Wall of the heart consists mainly of the myocardium which is covered externally by thin membrane, the epicardium or visceral pericardium, and lined internally by another thin layer, the endocardium. Blood is transported to myocardial cells by the coronary arteries which originate immediately above the aortic semilunar valve. There are three major coronary trunks, each supp lying blood to specifc segments of the heart: 1. There are 3 anatomic patterns of distribution of the coronary blood supply, depending upon which coronary artery crosses the crux. Crux is the region on the posterior surface of the heart where all the four cardiac chambers and the interatrial and interventricular septa meet. These patterns are as under: 250 Right coronary artery preponderance Balanced cardiac circulation Left coronary preponderance Coronary veins run parallel to the major coronary arteries to collect blood after the cellular needs of the heart are met. Acute heart failure Sudden and rapid development of heart failure occurs in the following conditions: i) Larger myocardial infarction ii) Valve rupture iii) Cardiac tamponade 251 iv) Massive pulmonary embolism v) Acute viral myocarditis vi) Acute bacterial toxaemia. Chronic heart failure More often, heart failure develops slowly as observed in the following states: i) Myocardial ischaemia from atherosclerotic coronary artery disease ii) Multivalvular heart disease iii) Systemic arterial hypertension iv) Chronic lung diseases resulting in hypoxia and pulmonary arterial hypertension v) Progression of acute into chronic failure. Left-sided heart failure: i) Systemic hypertension ii) Mitral or aortic valve disease (stenosis) iii) Ischaemic heart disease iv) Myocardial diseases. The clinical manifestations of left-sided heart failure result from decreased left ventricular output and hence there is accumulation of fuid upstream in the lungs. Accordingly, the major pathologic changes are as under: i) Pulmonary congestion and oedema causes dyspnoea and orthopnoea. Whatever be the underlying cause, the clinical manifestations of right sided heart failure are upstream of the right heart such as systemic (due to caval blood) and portal venous congestion, and reduced cardiac output. Accordingly, the pathologic changes are as under: i) Systemic venous congestion in different tissues and organs. Forward heart failure According to this hypothesis, clinical manifestations result directly from failure of the heart to pump blood causing diminished fow of blood to the tissues, especially diminished renal perfusion and activation of renin-angiotensin-aldosterone system. Right ventricular hypertrophy: i) Pulmonary stenosis and insuffciency ii) Tricuspid insuffciency iii) Mitral stenosis and/or insuffciency iv) Chronic lung diseases. Stress leading to accumulation of excessive volume of blood in a chamber of the heart causes increase in length of myocardial fbres and hence cardiac dilatation as a compensatory mechanism. G/A Thickness of the left ventricular wall (excluding trabeculae carneae and papillary muscles) above 15 mm is indicative of signifcant hypertrophy. In concentric hypertrophy, the lumen of the chamber is smaller than usual, while in eccentric hypertrophy the lumen is dilated. There may be 253 multiple minute foci of degenerative changes and necrosis in the hyper trophied myocardium. It is the most common and important form of heart disease in the early years of life and is present in about 0. However, complex anomalies involving combinations of shunts and obstructions are also often present. In 90% of cases, the defect involves membranous septum and is very close to the bundle of His. The defect lies low in the interatrial septum adjacent to atrioventricular valves. The defect is located high in the interatrial septum near the entry of the superior vena cava. There are two forms of tetralogy: a) Cyanotic tetralogy the effects on the heart are as follows: i) Pressure hypertrophy of the right atrium and right ventricle. In this, the aorta which is normally situated to the right and posterior with respect to the pulmonary trunk, is instead displaced anteriorly and to right.

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