Healthy thinking includes all except a)continuity b)constancy c)organisation d)clarity Ans is d i.e.

Clarity Ref: Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry By Patricia R. Casey, Brendan Kelly 3/e p47 Schneider suggested there were three features of healthy thinking: . Constancy: this is characteristic of a completed thought that does not change in content unless and until it is superseded by another consciously-derived thought . Organisation: the contents of thought are related to each other in consciousness and do not blend with each other, but are separated in an organised way. . Continuity: there is a continuity of the sense continuum, so that even the most heterogenous subsidiary thoughts, sudden ideas or observations that emerge are arranged in order in the whole content of consciousness. Correction in Nov 09 Q no. 10; answer remains the same, explanation is changed. 10. Vaginal sphincter is formed by all except: a) Internal urethral sphincter b) External urethral sphincter c) Pubovaginalis d) Bulbospongiosus 10. Ans is a i.e. Internal urethral sphincter [Ref: Moores Anatomy 5/e p402; Anatomy at a glance By Omar Faiz, David Burns Moffa p61; Grays Anatomy 40/e p1094-1096; BDC 4/e vol. 2 p393; Practical guide to female pelvic medicine By Gamal M. Ghoniem, G. Willy Davila] There is no internal urethral sphincter in females. It is present in males at the bladder neck and proximal urethral. Its function is to prevent retrograde ejaculation of semen into the bladder during the time of ejaculation. In males the detrusor muscle fibers of the bladder at the region of bladder neck and proximal urethra are organized into internal urethral sphincter which is under involuntary control. In females the musculature surrounding the internal urethral orifice of the bladder is not organized into an internal sphincter. External urethral sphincter is present in both males and females.

Vaginal sphincter is formed by the fibres of pubococcygeus known as pubovaginalis. There are other muscles also which contribute in compressing the vaginal orifice. The Bulbospongiosus muscle fibres run anteriorly on either side of the vagina to attach to the corpora cavernosa of the clitoris and posteriorly to perineal body. Bulbospongiosus in females acts to constrict the vaginal orifice and express the secretions of greater vestibular glands. The external urethral sphincter is composed of 3 muscles - sphincter urethrae, compressor urethrae, and urethrovaginalis sphincter (or muscle); last 2 muscles found in females only. When external urethral sphincter contracts to compress the urethra, it compresses the vaginal orifice also.

We have made changes in the question and answer of q no 177 of Nov 08. Ans remains the same. This question has also been repeated in Nov 10. A 20year female patient with 6th cranial nerve palsy and proptosis on T2 weighted MRI shows a hyperintense lesion in cavernous sinus which shows homogenous contrast enhancement. Most probable diagnosis is? a) schwannoma b) meningioma c) cavernous sinus hemangioma d) astrocytoma Ans is a i.e. Schwannoma Ref: Osborn Neuroradiology 1/e p501; CT and MRI of the Whole Body 4/e p162, 166; http://www.ajnr.org/cgi/content/full/25/2/280; http://www.ajnr.org/cgi/content/full/24/6/1148 Common tumors within cavernous sinus are: Schwannoma, Meningioma and Metastasis. (Ref: Osborn Neuroradiology) Cavernous sinus hemangioma is a very rare tumor of this region. (http://www.ajnr.org/cgi/content/full/24/6/1148) All the cavernous sinus tumors can cause sixth nerve palsy (and proptosis). So the diagnosis is to be made on the basis of incidence and MR chaaracterstics. MR characteristics: Menigioma Usually hypointense to isointense on T1-weighted and isointense to hyperintense with T2-weighted images. Somebooks write that it is mostly isointense on T2 wt sequences. Enhances homogenously on post contrast scans. Schwannoma Mostly hypointense on T1 and hyperintense on T2. Smaller tumors show homogenous density and strong homogenous enhancement. Larger tumors demonstrate heterogeneity of both density and contrast enhancement because of the presence of intratumoral cystic degeneration & xanthomatous changes. Cavernous hemangioma Mostly hypointense on T1 and hyperintense on T2. Shows good homogenous contrast enhancement. Thus meningioma can be ruled out as it usually isointense on T2. We are left with Schwannoma and Cavernous hemangioma. We would personally like to go with Schwannoma as it is one of the commonest tumors of the cavernous sinus and smaller tumors have homogenous enhancement. Cavernous hemangioma though matches more with the contrast enhancement characteristics, is a very rare tumor of this region.