During the first few days of starvation, glucose utilization by the brain and erythrocytes necessitates depletion of liver and muscle glycogen and increased glucose production by the liver, using gluconeogenic amino acids derived from the catabolism of muscle.

The entire wound-healing process is a complex series of events, that are classified as:
I. Inflammatory Phase:
1) Immediate to 2-5 days
2) Homeostasis: Vasoconstriction, Platelet aggregation, Thromboplastin makes clot.
3) Inflammation: Vasodilatation, Phagocytosis

II. Proliferative Phase:
1) 2 days to 3 weeks.
2) Granulation.
3) Contraction.
4) Epithelialization.

III. Remodelling Phase
1) 3 weeks to 2 years.
2) New collagen forms which increases tensile strength in wounds.
3) Scar tissue is only 80 percent as strong as the original tissue.

The facial artery exits the skull through the stylomastoid foramen, posterior to the mastoid process. It then courses superficially to the external carotid artery and mandibular vein.

 Sister chromatid separation occurs in the Anaphase stage.

Incorrect Options-

•  Metaphase- The chromosomes line up in the center of the cell, and their centromeres become attached to the spindle fibers.
•  Telophase- The nuclear membrane begins to reform at both ends of the cell and spindle fibers disappear.
•  S phase- Each chromosome is duplicated to form identical sister chromatids.

Adult polycystic kidney disease (polycystic kidney disease type I) has an autosomal dominant mode of inheritance. The most common potentially lethal disorder of the kidney is caused by mutations in a single gene. The vast majority of cases are due to cases (85%) resulting from mutations in the PKD1 gene. End-stage renal failure with hypertension and uremia develops in half the patients and eventually, renal dialysis or renal transplantation becomes necessary.

HMG-CoA reductase inhibitors are widely used to lower cholesterol levels and reduce the risk of heart disease. However, a rare but serious side effect of statins is rhabdomyolysis, a condition where muscle tissue breaks down.This can cause symptoms like muscle pain, weakness, or tenderness. In severe cases, it can lead to kidney damage due to the release of muscle proteins into the bloodstream.

The kidneys get more blood flow to filter out the extra waste products generated by working muscles and to maintain fluid balance. This helps keep your body running smoothly during physical activity.

Incorrect Options-

• Liver- plays a vital role in metabolism, its blood flow doesnt increasse disproportionately during exercise.
• Heart-  Blood flow increases but is proportional to workload.
• Skin- Blood flow increases to release heat, but not disproportionately.

A shifted mouth angle and loss of sensation in the anterior third of the tongue is suggestive of damage to facial nerve.

• The terminal branches [temporal, zygomatic, buccal, marginal mandibular, and cervical] control the muscles of facial expression. The marginal mandibular branch of the facial nerve controls the muscles that move the lower lip and mouth angle. Damage to this branch can result in a shifted mouth angle.
• The chorda tympani branch of the facial nerve is responsible for providing taste sensation to the anterior two-thirds of the tongue.

Notes for all these organisms :
 The most appropriate treatment is fluid and electrolyte replacement.
 The use of antibiotics to treat these organisms is controversial “usually self-limiting ”.

 More than 50% of patients taking anticholinergic have side effects: dry mouth, blurry vision, constipation, and urinary retention. A lot of side effects can result from anticholinergic drugs but the commonest is constipation.

The most common source of bacterial infection in IV cannulas is the skin insertion site.

Incorrect Options-

• Contamination of fluid during manufacturing process- Less common due to strict manufacturing standards.
• Contamination of fluid during cannula insertion- possible but not common
• Contamination during injection of medication- less likely as medication are sterile.

The botulinum toxin is the main virulence factor and is produced by Clostridium botulinum. It is an extremely potent neurotoxin that prevents acetylcholine release from nerve endings resulting in flaccid paralysis. Interestingly its small dose is used for medical purposes  like treating muscle spasms and reducing wrinkles.

Klebsiella species are gram-negative rod-shaped bacteria that can grow on charcoal-free fungal agar. 

[Other species that can grow on charcoal-free fungal agar include- legionella species, Francisella tularensis, and Nocardia species].
Other Important and common agar & medium;

•  Thayer-Martin agar (TM)--> Neisseria gonorrhoeae.
•  Hektoen enteric agar (HEA)--> Salmonella and Shigella.
•  The Lowenstein-Jensen medium--> Mycobacterium tuberculosis

General side effects have included hyperpyrexia, chest pain, excessive thirst, weakness, syncope, tongue chewing, dehydration, dry mucus membrane (78% of patients), and feeling hot, another general side effects include "atropine toxicity" which often presents as fever, agitation, and dry skin/mucous membranes.

The esophagus is a tube that carries food from the mouth to the stomach, it is located posterior to the trachea in the neck.

 Standard treatment for giardiasis consists of antibiotic therapy.
 Metronidazole is the most commonly prescribed antibiotic for this condition.

• Appropriate fluid and electrolyte management is critical, particularly in patients with large-volume diarrheal losses.

A right shift decreases oxygen's affinity for hemoglobin.
 In a right shift (hypoxia, fever, etc.) oxygen has a lower affinity for hemoglobin. Blood will release oxygen more readily. This means more O2 will be released to the cells, but it also means less oxygen will be carried from the
lungs in the first place.

A left shift will increase oxygen's affinity for hemoglobin.
 In a left-shift condition (alkalosis, hypothermia, etc.) oxygen will have a higher affinity for hemoglobin. SaO2 will increase at a given PaO2, but more of it will stay on the hemoglobin and ride back through the lungs without being used. This can result in tissue hypoxia even when there is sufficient oxygen in the blood.
 
 In Summary :

•  PH --> increase results in a shift to the left, and a decrease results in a shift to the right.
•  Temperature--> increase results in a shift to the right, decrease results in a shift to the left.
•  PCO2--> increase results in a shift to the right, and a decrease results in a shift to the left.
•  2,3-DPG --> increase results in a shift to the right, and a decrease results in a shift to the left.

Tyramine acts as a catecholamine-releasing agent, tyramine is physiologically metabolized by MAOA. In humans, if monoamine metabolism is compromised by the use of monoamine oxidase inhibitors (MAOIs) and foods high in tyramine are ingested, a hypertensive crisis can result.

[Foods high in tyramine- Aged cheese, fermented meat, pickled or preserved foods, alcoholic beverages, yeast extracts, soy products].

Methergine is a semi-synthetic ergot alkaloid used for the prevention and control of postpartum hemorrhage.

Contraindicated in -Hypertension, toxemia, pregnancy, and hypersensitivity.

 Ferritin is a high molecular weight protein that consists of approximately 20% iron. It is found in all cells, but especially in hepatocytes and reticuloendothelial cells, where it serves as an iron reserve. While low serum ferritin is widely viewed as the best single laboratory indicator of iron depletion. As ferritin is an acute phase reactant and is increased when an acute or chronic inflammatory process is present.

• A single dose of azithromycin is the most commonly used treatment for chlamydia.
• While doxycycline is also an effective treatment, it is usually prescribed for a week. At a 100mg dose twice daily.

[All sex partners should be evaluated, tested, and treated].

The most likely cause of food poisoning in this case is  Staphylococcus aureus.

Incorrect Options-

• Giardia- Diarrhoea+cramps, but no vomiting or dehydration
• Salmonella- Onset in 12-72 hours, not within 6 hours.
• C. perfringens- symptoms appear 8-24 hours after eating contaminated food.

Streptococcus pneumoniae is a common cause of bacterial arthritis, especially in young adults. It can spread to the joints through the bloodstream, leading to joint pain, swelling, and tenderness.

Erythromycin has the least activity against S. aureus, due to its susceptibility to bacterial resistance.

Other Options-

• Clindamycin-effective for S. aureus especially in skin infections.
• Vancomycin- used for resistant infection.
• Dicloxacillin- specifically effective.

Furosemide causes high blood Na+, urea, glucose, and cholesterol and low blood K+, and Ca+.

Decreased body temperature is not a characteristic sign or symptom of extracellular fluid volume deficit, other options provided are all common signs of dehydration.

Elderly patients are more susceptible to blood pressure drops. Hypotension is the most significant risk associated with antihypertensive drugs in elderly patients

 Heparin and its low molecular weight derivatives are effective at preventing deep vein thromboses and pulmonary emboli in patients at risk but there is no evidence that anyone is more effective than the other in preventing mortality. Heparin binds to the enzyme inhibitor Antithrombin III causing a conformational change that results in its activation through an increase in the flexibility of its reactive site loop.

The trachea is almost cylindrical in shape but is flattened at the back. It is approximately 11 cm long, with a width ranging from 2 to 2.5 cm, typically larger in males than in females. In children, the trachea is smaller, positioned deeper within the body, and is more flexible compared to that of adults.

 Sulphonylurea is best to be avoided in elderly people and those with renal failure.

 Heparin potentiates antithrombotic effects in antithrombin three. Warfarin inhibits vitamin K-dependent gamma-carboxylation of factors 2, 7, 9, 10.

Boiling is the most reliable way to destroy Entamoeba histolytica cysts.

Incorrect Options-

• other methods like iodine and chlorine may not kill all cysts, and freezing is ineffective against cysts

Sucralfate is an anti-ulcer medication. It works mainly in the stomach lining by adhering to ulcer sites and protecting them from acids, enzymes, and bile salts.

Steroids cause proximal myopathy.

Incorrect Options-

• Cause osteoporosis by inhibiting Vitamin D, not osteomalacia.
• There has been no association with breast Ca.
• It causes hyperglycemia & steroid-induced diabetes, not hypoglycemia.

Lidocaine (not xylocaine) is the local anesthetic that is also an anti-arrhythmic.

Extracardiac symptoms:

•  Central nervous system: Drowsiness, lethargy, fatigue, neuralgia, headache, dizziness, and confusion may occur.
•  Ophthalmic: Visual aberration is often an early indication of digitalis toxicity. Yellow-green distortion is most common, but red, brown, blue, and white also occur. Drug intoxication also may cause snowy vision, photophobia, photopsia, and decreased visual acuity.
•  GI: In acute and chronic toxicity, anorexia, nausea, vomiting, abdominal pain, and diarrhea may occur. Mesenteric ischemia is a rare complication of rapid intravenous infusion.
•  Many extracardiac toxic manifestations of cardiac glycosides are mediated neurally by chemoreceptors in the medulla

 Cardiac symptoms: Palpitations, shortness of breath, syncope, swelling of lower extremities, bradycardia, hypotension.

Neomycin is the only aminoglycoside among the given options that is administered orally. However, it is not used for systemic infection due to its poor oral absorption and potential toxicity. It mainly acts on bowel flora in preparation for bowel surgery.

Anti-psychotic medications increase appetite, cause changes in metabolism, and a tendency to develop metabolic syndrome. All these factors contribute to weight gain.

• Commonly, patients are asymptomatic for the first 24 hours or have non-specific abdominal symptoms(such as nausea and vomiting).
• Hepatic necrosis begins to develop after 24 hours (elevated transaminases, RUQ pain, and jaundice) and can progress to acute liver failure. Patients may also develop Encephalopathy, Oliguria, Hypoglycemia, Renal failure (usually occurs around day 3), or lactic acidosis.

Hemochromatosis is suggested by persistently elevated transferrin saturation in the absence of other causes of iron overload. It is the initial test of choice.

• [ Ferritin concentration can be high in other conditions, such as infections, inflammations, and liver disease. Ferritin levels are less sensitive than transferrin saturation in screening tests for hemochromatosis].

Local anesthetic should be infiltrated and then the area should be prepared carefully and draped. The spinal needle is then positioned between the 2 vertebral spines at the L4-L5 level and introduced into the skin with the bevel of the needle facing up.

Sympathomimetic toxicity causes the above-mentioned features due to increased sympathetic activity.

Incorrect Options-

• Anticholinergic- dry mouth, blurred vision, mental changes.
• Tricyclic antidepressants- arrhythmias, seizures, mental changes
• Organophosphates-excessive parasympathetic symptoms 

 Phenytoin toxic effects include- Gingival hyperplasia, diplopia, nystagmus, megaloblastic anemia secondary to interference with folate metabolism, hirsutism, diminished deep tendon reflexes in the extremities, CNS depression, endocrine disturbances (diabetes insipidus, hyperglycemia, glycosuria, osteomalacia).

• Hepatitis A is a highly contagious liver disease that has fecal-oral transmission.
• Hepatitis B, C, and D are primarily transmitted by blood and bodily fluids, not through the fecal-oral route.

Treatment of ventricular tachycardia depends on patient stability; Unstable patients: electrical cardioversion; Stable patients: amiodarone, lidocaine, procainamide.

 Four causes of hypoxemia[ abnormally low oxygen in the blood] is caused by one or more of the
following:

•  Hypoventilation
•  Diffusion impairment
•  Right to left shunt (usually in the lungs, but can be in the heart)
•  Abnormal ventilation/perfusion ratios

PTU inhibits thyroid peroxidase enzyme-

• Prevents oxidation of iodide into iodine
• Blocks organification of iodine with tyrosine.
• Inhibits coupling of iodotyrosines to form T3 and T4.

 Clozapine may cause a severe reduction in white blood cell count, a condition known as agranulocytosis, dementia-related psychosis in the elderly, seizure, dizziness, headache, tremor, low blood pressure, and fever.

Nitrate should not be used in conjugation with drugs used to treat erectile dysfunction, such as Sildenafil (Viagra). The combination can cause extreme hypotension.

 Injury to the Median nerve at the wrist results in the following:

•  The muscles of the thenar eminence are paralyzed and wasted.
•  The thumb is laterally rotated and adducted.
•  The hand looks flattened and apelike.
•  Opposition movement of the thumb is impossible.
•  The first two lumbricals are paralyzed.
•  Loss of the sensation over the lateral fingers.

Immature cortical T lymphocytes are developing T-cells found in the cortex of the thymus. They play a crucial role in T cell development.

• Markers- CD4 and CD8 [double positive stage] before differentiating into either helper T-cells CD4+ or cytotoxic T-cells CD8+.

Streptomycin and other aminoglycosides can elicit toxic reactions involving both the vestibular and auditory branches of the eighth cranial nerve. Patients receiving an aminoglycoside should be monitored frequently for any hearing impairment owing to the irreversible deafness that may result from its prolonged use.

[None of the other agents listed in the question adversely affect the function of the eighth cranial nerve].

Streptomycin and other aminoglycosides can elicit toxic reactions involving both the vestibular and auditory branches of the eighth cranial nerve. Patients receiving an aminoglycoside should be monitored frequently for any hearing impairment owing to the irreversible deafness that may result from its prolonged use.

[None of the other agents listed in the question adversely affect the function of the eighth cranial nerve].

The heart increases its blood supply by dilating the coronary arteries.

Other options like Pulmonary resistance reduce lung blood flow, constriction of the aortic artery decreases blood flow to the body, and dilate IVC increases venous return but doesn't directly improve heart muscle oxygenation.