Chilli Farm are just some of the vendors that are booked. Keen to try cooking with your own chillies at home? Well cooking demonstrations will be held throughout the weekend. Easy Peasy Cookery School will be running cookery workshops throughout the day… places are limited! There will be continuous biscuit decorating pop-in workshops all day. And the ever popular chilli eating competition will return.
Throughout the day a feast for your ears will be treated by a whole host of live music with Los Squideros and The Roving Crows. The celebrations will take place all over Worcestershire for two months and starts on the 23rd of April with the Great English Asparagus Run. On the launch day, family celebrations will be held at the Fleece alongside classic and vintage cars which at lunch. Vale of Evesham Asparagus is now a protected delicacy — this jolly. Joining an elite group of food and drink which include Champagne, Cognac and Roquefort to name but a few.
It does not just have to be green lighting, there are many quirky and unique ideas for example, it can be bunting, selling green food, green bed linen in hotels, decorating shop windows green, wear green clothes, get your local school to have a dress down day and go green, paint your face green and even dye your hair green.
We are encouraging everyone to go green for the gras. Satisfaction guaranteed I will assure you of a quick response, and a reasonably priced service Then call in for a chat. We supply equipment from starter kits to advanced batteries UK manufactured E-Liquids in a range of great flavours - 0mg up to 18mg only.
It really is going to be another quack-tastic day. Traditional butchers using traditional methods, all meats are properly matured on our premises. Free consultation in your own home Fitting service available Extensive range of fabrics and accessories On-line shop.
Specialists in the catering trade serving over establishments. Pig and Beef roasts available. Try tapas inspired by recipes from the Mediterranean and beyond.
This place celebrates good food, family and friends. This Anglo-French cuisine restaurant offers quality food and good value for money. A must visit! Voted as one of the best restaurants in Worcester by TripAdvisor, this restaurant has a rich history and even better food.
Call for more information Tel: Why Choose Shakespeare Stone? Kevin Atkinson, owner and founder of Geeves dry cleaners believes that all dry cleaners should follow suit excuse the pun and says it is time everyone made a real effort in helping to do whatever they can to try and reverse all negative effects some chemicals are having on our planet. Shoe Repairs Laundry Cleaning Duvet Cleaning Moths can damage your winter coat, so make sure you bring it to us before storing it this summer.
B61 0DF. Set in 18 acres of farmland near Ombersley in Worcestershire, Little Owl Farm Park is a perfect way to enjoy a great fun day out for all the family. Outside there are lots of exciting and unusual animals waiting to meet you and show you their homes and personalities, from foxes to pheasants as well as our mischievous Meerkats.
There is also a half mile ramble course where you will find even more of our farm animals in the paddocks, including Reindeer and Rhea. You may even see a. Do not to fear! This show has an incredible mix of material, from atmospheric anthems to chart toppers that will get the crowd dancing in the aisles.
Contemporary or traditional. Hinged or sliding. Custom made furniture. Sloping ceilings and awkward shaped rooms. Huge choice of styles and colours to suit any taste or budget.
Quality furniture fitted to the highest standard for over 25 years. Wychavon District Council has given its support to a countywide project to help people with dementia. Suitcase Stories is a project being run by Museums Worcestershire that has enabled adults living with dementia and their carers to relive memories from the s, s and s using the art of storytelling and reminiscence. Through special workshops, participants in Suitcase Stories have been holding, touching, smelling and feeling objects such as carbolic soap and old pictures from the Royal Family, which all came from the Museums Worcestershire collections.
Their reactions to the objects, which all fell into the themes of holidays, nature, hair and beauty, food, hobbies and family, have helped to inspire stories for storyteller Gavin Young to create a live performance of storytelling and music. Three performances have been arranged and they will take place at three dementia cafes across Worcestershire. Redditch, Wednesday 3 May, from For more information and to book a place at any of the free live performances, please contact Jenny Davis, the Suitcase Stories Project Manager, on or email jenny artsuplift.
You can also go to www. Tel: Mobile: www. Surroo is born into a poor, but loving family in rural India. A trip into the city with his brother to find work ends up with Surroo being trapped alone. Surroo is soon joined in his new home by Mantosh, a disturbed Indian adoptee and the film then jumps twenty years to Melbourne where Surroo starts University.
The once carefree child and sociable student begins to withdraw from all around him as Surroo becomes increasingly preoccupied by his identity and the quest to figure out the location of his birthplace. The unique show that presents the music that divided the greatest decade in pop history into two rival youth cultures. Mods vs Rockers is a spectacular music event where two great bands battle it out to see which musical style will come out the winner. Sparks are sure to fly as both bands will take to the stage together to trade tunes and see whose music.
Are you a Mod or are you a Rocker? Are you a Rocker? Does your world rock to the sound of the rockabilly beat? To be on the Rocker side, sit in seats Or are you more of a Mod?
If you like your suits sharp and your music even sharper, slip on your shades and get on your scoot to support the The Quik Beats, playing the A to Z of beat music from the Animals to the Zombies. To be on the Mod side, sit in seats Available to all ages and all fitness levels. To help hold on to the remnants and truly make the summer last, you can use these tips to bring the outside in. These tips can be implemented into all rooms around the house. Create a chilled outdoor atmosphere in your room.
Naturally made and naturally styled furniture is a must have for anyone trying to create a calming atmosphere. WHC Hire Services has been serving its customers with tool, plant and equipment hire since Our two depots are based in Worcester and Tewkesbury and serve all the many surrounding areas. Pollinators are insects that transfer pollen from one plant to another and therefore are vital for food production, gardens and ensuring a healthy and diverse ecosystem; as we depend on food and a healthy and diverse ecosystem, so do our pollinators.
Bees rely on a diverse food supply in order to survive and there are a number of factors which threaten that for bees. These problems, which threaten all pollinators, are things like an increase of destruction of their natural habitats, an increase in use of pesticides and the threat of diseases. So what can gardeners do to. One important thing we can do to help our pollinators is to not use insecticide on plants which are in flower.
Insecticide used on a flowering plant can be a danger to pollinating insects because the chemicals can be transferred whilst they are collecting pollen. Another way to encourage bees and pollinators is by planting. Bees can see purple flowers particularly well.
We can rebuild destroyed habitats for solitary pollinators. Water, the nectar of life, can be provided in the way of having a shallow dish filled with stones and water. Pollinators will sometimes need to drink and this will provide a safe drinking ground for them with somewhere to rest if the stones are above the water. I hope that we can all respect this enough to take active steps to ensure pollinators have the resources to complete their important role within our ecosystem.
Daisey McQuaid. We can clear all of your unwanted garden waste. We also cut hedges, mow lawns and undertake garden maintenance projects please contact us at: panddgreenwaste gmail. Free local delivery around Worcestershire Delivered in large bulk bags Please call or e-mail for a free, no obligation quote.
So, I went and entered a 22 mile obstacle race going up and over Snowdonia Mountain. Instead of having full verses and choruses, he picked out vocal phrases and played them like an instrument, using sampling technology. Often, individual syllables were reversed or pitch-shifted.
This type of vocal treatment is still a key characteristic of the UK garage style. The UK's counterpart to Todd Edwards was MJ Cole, a classically trained oboe and piano player, who had a string of chart and underground hits in the late s and early s, most notably with "Sincere" and "Crazy Love". Jess Jackson was responsible for many garage records but one which stood out was "Hobsons Choice". The B Side of this record changed the UK garage scene from funky and soulful to dark and bassy.
Which transformation is an oxidation? In electrochemical cells the cathode is always the electrode where a oxidation occurs b reduction occurs c positive ions are formed d negative ions are formed If the concentrations of the ions are 1. All of the following affect the number of moles of metal deposited during electrolysis except the a current used b electrolysis time c charge on the ion d molar mass The emission spectrum of hydrogen in the visible region consists of a a continuous band of light b a series of equally spaced lines c a series of lines that are closer at low energies d a series of lines that are closer at high energies Which atom in its ground state has the most unpaired electrons?
Which atom has the largest atomic radius? How does the reducing ability of the elements vary across the period from Na to Ar? It a decreases steadily b increases steadily c decreases then increases d increases then decreases Which species contains only covalent bonds?
How many valence electrons are in the pyrophosphate ion, P 2 0 7 4 "? Which species has the largest F-A-F bond angle where A is the central atom? Is it safe to leave the aluminium lining of an old swimming pool in the ground? Aluminium rapidly forms a coating of oxide when exposed to air. This is fairly unreactive but if it is exposed to moderate acid or basic conditions then it could dissolve and be mobilised in water. This aluminium could get into the local water table although it's unlikely that much if any of the aluminium would be dissolved.
However, if the aluminium is in thick sheets, it is valuable - hundreds of pounds sterling per tonne possibly, so it might actually pay to get it removed. The boiling points of the halogens, F2, Cl2, Br2 and I2, increase in that order. This is best attributed to differences in a covalent bond strengths b dipole forces c London dispersion forces d colligative forces How many structural isomers have the formula C3H6CI2?
A reaction in which a carboxylic acid reacts with an alcohol to form an organic compound and-water is called a esterification b hydrolysis c neutralization d saponification What substance is formed when CF 2 CF 2 is polymerized? If you add just one electron to a chlorine atom, it doubles in size. Why the dramatic increase? The chloride ion, CI" is larger than the chlorine atom, CI since it has one more electron but no greater nuclear charge.
This is the case with all the elements in group VII of the periodic table. The radius to which the electrons extend depends on the balance of the attractive force from the nucleus and the repulsive force from all the other electrons.
Probably the easiest way of thinking of this is that in a chlorine atom you have 17 protons which are equally matched by 17 electrons. When an extra electrons is added to form a chloride ion this extra electron is not counter balanced by an extra proton and so does not feel a very strong attachment to the nucleus. This makes it circulate at a much larger distance. So in the cases of the halogens, the greater radius of the anion is due to the greater electron-electron repulsion created when a further electron is added to the atom.
What are the commercial uses of diatomaceous earths? Diatomaceous earths are whitish, powdery silicon deposits consisting essentially of fresh water and marine plankton. They are resistant to heat and chemical reactions and are used in fireproof cements, insulating materials, as an absorbent in the manufacture of explosives and as a filter.
An electron, a proton and an alpha particle have kinetic energies of 16, 4 E and E respectively. EMF of the cell after electrolysis will be a increased b decreased c no change d time is also required. The wavelengths of two photons are A and A respectively. What is the ratio of their energies? Benzoic ,-idd solution is titrated with NaOH conductometricaly, graphical representation of the titration is : -' If the probability of finding an.
Suppose a particle has four quantum numbers such that permitted value are : n : 1, 2, 3 I :! When the value of azimuthal quantum number is 3, the maximum and the minimum values of spin multiplicities are a 4, 3 b 8, 1 c 1, 3 d 8, 2 The radii of two of the first four Bohr orbits of the hydrogen atom are in the ratio 1: 4. The energy difference between them may be : a either Equilibrium is established by introducing an equal number of moles of N 2 and H 2 into a 1-L flask. If D is the theoretical value of vapour density, variation of with Did is by the graph.
For the equilibrium LiC1. How many moles of NH3 should be added to the flask at the temperature to drive the backward reaction for completion.
What is the maximum pressure of water vapour moisture in the atmosphere, below which the pentahydrate is efflorescent? In an experiment to determine the enthalpy of neutralization of sodium hydroxide with sulphuric acid, 50 cm 3 of 0.
Which of the following plots gives the correct representation? Consider the following graph pertaining to distillation. Due to B osmosis there is : a blue colour formation in side X b blue colour formation in side Y c blue colour formation in both of the side X and Y d no blue colour formation Aqueous solution required 1 mol of HCl.
If B required equal volumes of 0. Molar ratio of A and B in the mixture is -' The number of molecules present in a drop of water weighing 0. Helium atom is two times heavier than a hydrogen molecule at K, the average kinetic energy of helium is a two times that of a hydrogen molecule b same as that of a hydrogen molecule c four times that of a hydrogen molecule d half that of a hydrogen molecule.
Polarisation is the distortion of the shape of an anion by an adjacently placed cation. Which of the following statements is correct? The sum of mole fractions A, and C in a solution containing 0.
A solution contains non-volatile solute of molecular mass M2. Which of the following can be used to calculate the molecular mass of solute in terms of osmotic pressure? To which electronic transition between Bohr orbits in hydrogen, the second line in the Balmer series belongs? In which of the following compounds does the ratio of the anion size to the cation size have the lowest value? The frequency of a radiation having a wave number of 2 x cm"1 will be a 6. A molecule may be represented by three structures having energies ,, , and 3 , respectively.
Calculate the heat of neutralisation per mole of aqueous acetic acid? Under the same conditions how many ml of 1 M KOH and 0.
Which one of the following will favour the reverse reaction in a chemical equilibrium? Which of the following oxides of nitrogen will be the most stable one? Which of the following plots represents correctly variation of equivalent conductance A with dilution for a strong electrolyte?
The equivalent conductance at infinite dilution of the salt MX is Which of the following will occur if a 0. A certain sample of beer has a pH of The decomposition of KCIO, to KC1 and 0 2 on c the first reaction has lower activation energy than heating is an example of the second a intermolecular redox reaction d the first reaction has higher activation energy than b intramolecular redox reaction the second.
While studying the decomposition of gaseous N 2 0 5 , d none of these. I it is observed that a plot of logarithm of its partial pressure The number of electrons involved in the reduction I versus time is linear. The kinetic parameter obtained of nitrate ion to hydrazine is from this observation is a 8 b 7 a specific reaction rate b reaction rate c 5 d 3.
Two platinum wires were dipped in CuS0 4 solution taken in a beaker and then connected to a battery. The A first order reaction is half-completed in 45 minutes. The be completed? Which of these values corresponds to that of hydrogen? Atomic weight of thorium is and its atomic number A radioactive sample has initial activity of 28 dpm. Half hour later its activity is 14 dpm. How many atoms of nuclide were present initially? In electrolvsis of NaCI when Pt electrode is taken c d Gelatin is mostly used in making ice cream in order it forms sodium amalgam.
Generally the ionization enthalpy in a period increases but there are some exceptions. Which of the following alkaline earth metal oxides shows a coordination number four? A certain metal is used to prepare an antacid, this metal accidentlv catches fire which cannot be put out by using C0 2 based extinguishers.
Which of the following reactions is employed to produce ozone in the laboratory? When an aqueous solution of sodium chloride is electrolysed using platinum electrodes, the ions discharged at the electrodes are a sodium and hydrogen b sodium and chloride Identify the correct order of acidic strength of CO;. Pick up the incorrect statement? Thermite is a mixture of 3 parts of powdered A1 and 1 part of Fe 2 0 3 1 part of powdered A1 and 3 parts of Fe 2 0 3 1 part of powdered A1 and 1 part of Fe 2 0 3 2 parts of powdered AI and 1 part of Fe 2 0 3.
To which one of the following groups of the periodic table does Y belong? Both boron and aluminium show difference in properties from the remaining members of group This is due to the fact that a both B and AI have smaller size as compared to other members of the family b both B and AI have high values of ionization enthalpy c both B and AI have 2 and 8 electrons in their penultimate shell respectively but the remaining elements of this group have 18 electrons d none of these.
Among the elements of group 15 which of the following properties shows an increase as we move down from nitrogen to bismuth?
A certain compound when burnt gives three oxides. The first turned lime water milky. The second turned anhydrous CuS0 4 blue and the third formed an aqueous solution of low pH. The lowest boiling point of helium is due to its inertness b gaseous nature high polarisability weak van der Waals forces between them.
Which of the following is not an electronic configuration of noble gas? K 2 Cr 2 0 7 is preferred to Na 2 Cr 2 0 7 for use in volumetric analysis as a primary standard because a Na 2 Cr 2 0 7 is hygroscopic while K 2 Cr 2 0 7 is not b K2Cr is hygroscopic while Na 2 Cr 2 0 7 is not c K 2 Cr 2 0 7 is pure while Na 2 Cr 2 0 7 is impure d none of these. A gasJfis passed through water to form a saturated solution.
The aqueous solution on treatment with the AgN0 3 gives a white precipitate. The saturated aqueous solution also dissolves magnesium ribbon with evolution of a colourless gas Y.
Identify X and Y. Which of the following is a biodegradable pollutant? Which of the following forms potassium carbonate on boiling with alcoholic KOH solution?
An organic compound Xon treatment with acidified K 2 Cr 2 0 7 gives a compound Y which reacts with I2 and sodium carbonate to form tri-iodomethane. The two isomers are a A is 3-chloro-1 -pentene and B is 1 -chloropentene b A is 2-chloromethylbutene and B is 1-chloro3 -methyl-1 -butene c A is 3-chloropentene and B is 2-chloropentene d A is 4-chloropentene and B. When the hybridisation state of carbon atom changes from sp3 to sp2 and finally to sp, the angle between the hybridised orbitals a decreases gradually b decreases considerably c is not affected d increases progressively.
When an alkyl iodide RI is treated with Na in dry ether, a symmetrical alkane R2 is obtained. The reaction is called a Grignard reaction b Fischer-Tropsch reaction c Berguis reaction d Wurtz reaction. An alkene with molecular formula C4H8 upon ozonolysis gives one mole of propanone and one mole of methanol.
The alkene is a 1-butene b 2-methylpropene c 2-butene d 2-methylbutene. Oxidation of benzyl chloride with an aqueous solution of lead nitrate in a current of CO, gives a benzaldehyde b benzyl alcohol c p-nitrobenzyl chloride d benzyl nitrate. A compound with molecular formula C 4 H, 0 O 4 on acylation with acetic anhydride gives a compound with molecular formula C,2H18Og.
How many hydroxyl groups are present in the compound? Which of the following is the weakest acid? Diazonium salts are the reaction products between nitrous acids and a primary aliphatic amine b N-alkyl substituted aromatic amines c primary aromatic amines d secondary amines. An optically active compound with molecular formula C6H, ,N dissolves in dilute aqueous hydrochloric.
The compound is NHCH, a. Since it does form JVCI5, therefore, it must be N since it has no rf-orbitals to expand its covalency from 3 to 5.
Therefore, A" must be N. The abbreviation PDI refers to name of the polymer poly dispersity index Planck's disposal index poly diagonal index. Ascorbic acid A. Beri-beri II. Retinol B. Cracked lips Riboflavin C. Scurvy i heat of dissociation of acetic acid.
Thiamine D. Night blindness. A drug which is structurally related to adrenaline stability. Therefore, number of electrons involved in the reduction 4. SO2 ions to produce H 2 S0 4. IE, of Mg is higher than that of Na because of higher nuclear charge and completely filled 3.?
Both are minerals of zinc. NaCl structure and are ionic. The metal is Mg which burns in C 0 2 atmosphere. All other properties stated here decrease down the group. First oxide C0 2 turns lime water milky, the second oxide H 2 0 turns anhydrous white CuS0 4 blue due to hydration and the third oxide S0 2 dissolves in H 2 0 giving an acid H 2 S0 3 which lowers the pH of the solution.
C, H, S are the elements in a compound. Since Y is obtained by oxidation of X with K. Since it also contains a chiral carbon, therefore, it is optically active. C6H,,N Dear Students, W e know that its too difficult to remember the elements in their correct order in the first three periods of the table. So we are presenting some mneumonics to leam few very difficult things in Chemistry in a very easy way. The order of hardness Mohs' scale of hardness Tall gyroscopes can fly apart, orbiting quickly to complete disintegration or, Those girls can fly and other queer things can do.
Talc, gypsum or rock salt, calcite, fluorite, apatite, orthaclase, quartz, topaz, corundum, diamond. The molecular shape of fructose and glucose There are two simple sugars monosaccharides - fructose and glucose - which combine in a specific way to form sucrose.
Contributed by Neha Chandak, Nagpur Remember the molecular shape of fructose has five carbons letter f starts both words and hexagon is the shape of glucose letter g in both words. The elements in their correct order in the first three periods of the table Hydrogen being omitted and potassium included.
Here lies Benjamin bold cry not old friend needlessly. Nature magnifies all simple people sometimes, clots and kings. If you have such mneumonics in Physics, Chemistry, Botany or Zoology which can he proved as aid to memory then send them to us. P per Kg of the compound.
The yield of chloroform is minimum in which case? COCH, 3. Starch is a polymer of A and cellulose is a polymer of B. A and B are a a-glucose, 3-fructose b p-glucose, a-fructose c a-glucose, a-fructose d a-glucose, P-glucose For coupling reaction of phenol the best medium is a a buffer containing 0. Which of the following is correct? H 2 S0 4 , A is obtained as major product.
More than one response to a question will be disqualified. In case of a tie, the winners will be decided through a lucky draw. The decision of the editor will be final and binding in all cases and will not be a matter for consideration of any court and no correspondence will be entertained.
Name and photograph of the prize winners of this contest will be published in the June issue of MTG is not responsible for any postal delays, transit losses or mutilation of entries. Ustic acid is a natural compound found in lichens. Which statement correctly represents four of the functional groups present in ustic acid? H Carboxylic acid, ketone, aldehyde and alcohol Ether, ketone, alcohol and aldehyde Carboxylic acid, ketone, phenol and alcohol Ester, phenol, carboxylic acid and ketone Which of the following constitutes irreversible colloidal system in water as dispersion medium?
Which one of the following chlorides will not fume in air? The concentration of acid in water layer b 2 a 1 3 d 4 c. Of the five AH values required to calculate a lattice energy using the Born-Haber cycle, the one that is most difficult to measure is the electron affinity of the non-metal the heat of formation of gaseous atoms of the nonmetal the ionisation energy of the metal the heat of sublimation of metal.
Which of the following is a true peroxide? What is the enthalpy change, in kJ, for the reaction? Arsine AsH 3 is a molecular hydride of a group V element. Which one of the following notations shows the product incorrectly? The concentration of a coloured substance is to be determined by measuring the absorbance of an aqueous solution of it and interpolating from a graph of absorbance versus concentration. Which procedural error will result in a concentration that is too high?
Procedural Mistakes I. What will be the partial pressure of H 2 in a flask containing 2 g of H 2 , 14 g of N 2 and 16 g of 0 2? If you have taken any of the exams given below and possess plenty of grey cells, photographic memory then you are the right candidate forthis contest. All you have to do is write down as many questions with all choices you can remember, neatly on a paper with name of the exam, your name, address, age, y o u r photograph and mail them to us. Borax is used in the manufacture of optical glasses.
Borax is used as a flux. Borax is used as a water softener. Borax is not used for glazing paper. The Benefits Plenty! Each complete question with answer will make you richer by Rs. We will make you famous by publishing your name photo if possible.
Also you can derive psychological satisfaction from the fact that your questions will benefitthousandsof readers. Our panel of experts will cross-check your questions. You have to send it within a month of giving the particularexam. Which one of the following compounds is not a protonic acid?
Payment will be made after the MCQs are published. Kindly note that each question should be complete. Payment will be made only for complete questions. Preference will be given to the reader sending the maximum complete and correct questions. Other conditions apply. The decision ofthe Editor, MTG shall be final and binding. A solution is 0. The minimum concentration of SrCl2 in the solution required to start the precipitation of SrF 2 is equal to 5 b 0.
Magnetite, Fe 3 0 4 can be converted into metallic iron by heating with carbon monoxide as represented by this equation. Substance Molar mass Fe 3 0 4 g mol' 1 a 6. Which of the following best describes the equilibrium constant K of this interconversion?
Which of the following ion is coloured? Argol, a brown crust formed during fermentation of grape juice contains a C 0 2 b Fuse oil c Potassium hydrogen tartarate d Lye the. A metal nitrate on reaction with KI gives black precipitate and with excess KI gives orange solution.
Cyclohexanol is dehydrated to cyclohexene on heating with conc. H 2 S0 4 to form olefin B. Ozonolysis of B gave ketone with formula C 8 H g O, which shows positive iodoform test. What is the concentration of nitrate ions if equal volumes of 0. The resulting solution will be a acidic b basic c neutral d amphoteric. The density of H 2 S mol wt. Which of the following transition have minimum wavelength? If the observed and theoretical molecular mass of NaCl is found to be Which of the following is correct for lyophilic sol?
Irreversible sol Formed from inorganic substances Readily coagulated by addition of electrolyte Self stabilized.
A compound formed by elements A and B has a cubic structure in which A atoms are at the corners of the cube and B atoms are at the face centres.
Which of the following forms a toxic substance in blood by combining with haemoglobin? Which of the following rate law has an overall order of 0. The half lives of two radioactive nuclides A and B are 1 and 2 min. Equal weights of A and B are taken separately and allowed to disintegrate for 4 min. What will be the ratio of weights of A and B disintegrated?
Which of the following is not the extensive property? Which isomeric form of benzene hexachloride is used as insecticide? Acetamide is a neutral c acidic a. A solid AS has NaCl structure. Which of the following does not contain P - O - P bond?
The magnetic moment of a transition metal ion is found to be 5. The number of unpaired electrons present in it is a 2 b 3 c 4 d 5. The flocculation value is expressed in terms of a millimole per litre b mol per litre c gram per litre d mol per millilitre. The prefix neo means a carbon atom having four alkyl groups, position of alcohol group should be at CJ. Presence o f - 7 effect in a carbocation decreases delocalisation of the positive charge and hence decreases stability of the carbocation and vice versa.
Thus the carbocation iii having -COCH 3 grouping is the least stable, follwed by ii having -OCH 3 grouping, followed by i having only alkyl group. A pair of molecule which cannot be superimposed on its mirror image i. It gives non-acid hydrolysis products and it decreases acidity in the soil. Further 2 amines are more basic than 1 amine while amides are least basic because electron pair on nitrogen is involved in delocalisation.
NH4OH is weak electrolyte. Lyophilic sols are self stabilised reversible, organic macromolecules and are not coagulated by addition of electrolytes. Here Si0 2 and H 2 0 do not carry any charge. This and the clamping of the cord increase left sided heart pressures, which functionally close the foramen ovale.
Increased oxygen concentration shuts off prostaglandin production in the ductus arteriosus, causing gradual closure. V ratio is often normal. ITiV, may he equal in both conditions; it is he! Asthma: look for wheezing in children. Treat with beta, agonists in the emergency depart meni.
Use steroids if asthma is severe or does not respond to beta agonists. Cromolyn is for prophylaxis, not acute attacks. The new leukotrieue inhibitors zalirlukast, ziletiton are used regularly, not usually for acute jltacks. Phosphodiesterase inhibitors theophylline, amino- phylline are older, second -line agents. Note: Do not put patients with asthma or COPD on beta blockers, which block the beta, recep- tors needed to open the airways.
Wheezing in children under age 1 is often due to respiratory syncytial virus, especially in the winter. Look for coexisting fever. Beware the asthmatic who no longer hyperventilates or whose CO z is normal or rising the patient should hyperventilate, which causes low CO.
Do not think that patients who seem calm or sleepy are okay. They are probably trashing and need an immediate arterial blood gas analysis and possible, intubation. Fatigue alone is enough reason to intubate an asthmatic. If the patient is asymptomatic and talking to you, the lab value should not make you panic. Usually, unless the patient is crashing rapidly a trial of O, by nasal cannula is given first , if litis approach does not work or if the patient becomes too tired use of accessory must les is a good clue to the work ol breathing , intubate.
With a solitary pulmonary nodule, the first step is to check for old films. If the lesion has not changed in more than I year, il is likely to be benign. A baseline chest x-ray is standard preoperative evaluation for patients over 60 and patients with known pulmonary or cardiovascular disease, but when to order pulmonary function tests is not as clear. Overall, the best indicator of possible, postoperative pulmonary complications is preoperative pulmonary function.
Overall, the best way to reduce pulmonary postoperative complications is to stop smoking preoperative! Aggressive pulmonary toileting, incentive spirometry minimal narcotics, and early ambulation help to preven t or minimize postoperative pulmonary complication. Note: The most common cause of a postoperative fever in the first 24 hours is atelectasis.
Adult respiratory distress syndrome ARBS : acute lung injury that results in uoncardiogenic pulmonary edema, respiratory distress, and hypoxemia. Common causes are sepsis, major trauma, panc reatitis, shod, near drowning, and drug overdose. Look for ARDS to develop within 7.
X-ray shows pulmonary edema with norma! Treat with intubation, mechanical ventilation with high percentage of O, and positive end expira- tory pressure PEEP The diagnosis of pneumonia usually is based on clinical findings plus elevated white blood cell count and chest x -ray abnormalities.
On physical exam, look to differentiate between typical Staphylococcus pneumoniae and atypical other bugs pneumonia, although the distinction is not alwa s le. Mycoplasma sp. Certain clinical clues should make yon think of certain bugs: m College student: think Mycoplasma sp.
It should be a consideration especially if the patient has no other signs of immunodeficiency e. Sinusitis: usually S. You cannot transilltmiinaie the sinuses, and an x-ray or CT scan shows opacification of the frontal or maxillary sinuses order a sinus x-ray to confirm the diag- nosis if it has not already been done. Note: The most common cause of epistaxis in children is nose-picking do not assume, low or defective platelets without evidence. Respiratory distress syndrome, due to atelectasis from deficiency of surfactant, almost always occurs in premature infants and infants of diabetic mothers.
Arterial blood gases show hypox- emia and hypercarbia, whereas x-ray shows diffuse atelectasis. Treat with 0 2 , give surfactant, and intubate if needed often. Diaphragmatic hernia commonly causes respiratory problems because bowel herniated into the chest pushes on developing lung and causes lung hypoplasia on the affected side. Note: Look for meconium aspiration if the infant is covered with meconium when delivered.
Suction the nose first bulb suction ; then suction the oropharynx under direct visualization. Intubate if necessary. Look for a neonate with excessive oral secretions, coughing and cyanosis with attempted feed- ings, abdominal distention, and aspiration pneumonia.
Diagnosis is made by inability to pass a nasogastric tube; contrast x-ray shows the proximal esophagus only Treatment is early surgical correction. Cystic fibrosis: autosomal recessive inheritance; the most common lethal genetic disease in white children.
Diagnosis is made by an abnormal increase in the electrolytes of the patient's sweat sodium and chloride. Look for S. Treat with chest physical therapy, annual influenza vaccine, fat- soluble vitamin supplements, pancreatic enzyme replacement, and aggressive treatment of in- fections with antibiotics.
Pleural effusion: if you do not know the cause, always consider thoracentesis and examine the fluid with Gram stain, culture and sensitivity including tuberculosis culture , cell count with differential, glucose low in infection , and protein high in infection. GERD presents as "heartburn," often related to eating and lying supine. Initial treatment is to elevate the head of the bed and to avoid coffee, alcohol, tobacco, spicy and fatty foods, chocolate, and medications with anticholinergic properties.
If this approach fails, antacids, ID. Surgery is reserved for severe or resistant cases Nissen fundoplication. Hiatal hernia, as the term is commonly used, implies a sliding hiatal hernia; that is, the entire gastroesophageal junction moves above the diaphragm, pulling the stomach with it — a common and benign finding.
A paraesophageal hiatal hernia means that the gastroesophageal junction stays below the diaphragm, but the stomach herniates through the diaphragm into the thorax.
This is an uncommon, serious type of hernia that: may become strangulated and should be repaired surgically. Hiatal iiorniiis. In tin; sliilmn type.
Hit; i. In it pniaesuplinuiini iieiuin. Hit: astinestinitnt e;ii junction is fixocl hclow iho tiia phiatpp. Look for epigastric tender- ness. Patients may have occult blood in stool and nausea or vomiting. Peptic ulcer disease is more common in males. The two types are gastric and duodenal. Endoscopy is becoming the first-line diagnostic study upper GJ barium study is classi- cally done first and is more sensitive but more expensive than x-ray.
Always biopsy any gastric ulcer to exclude malignancy duodenal ulcers do not have to be biopsied initially. The major complication is perforation. Look lor peritoneal signs, history of peptic ulcer disease, or free-air on abdominal x-ray.
Treat with antibiotics and laparotomy with repair of perforation: a If ulcers are severe, atypical, or nonhealing, think about Zollinger-F. Triple therapy ampieilhn or amoxicillin, metronidazole, and bismuth is the gold standard, but many regimens are in use.
Surgical options should be considered after fai lure of medical treatment or in patients with complications perforation, bleeding. Common procedures include antrectomy, vago- tomy, and Billroth I and II. After surgery especially Billroth procedures watch for dump- ing syndrome weakness, dizziness, sweating, nausea or vomiting after eating.
Achlorhydria, the absence of hydrogen chloride, is associated with pernicious anemia anliparietal cell antibodies destroy parietal cells and thus cause achlorhydria and B,? Upper versus lower gastrointestinal bleeding see table, top of next page. Important points; 1. Kndoscopy is usually die first test performed upper or lower, depending on symptoms. Classically, barium x-ray studies were performed first, but endoscopy is more sensitive.
Gastroenterology 31 Upper vs. Surgery is reserved for severe or resistant bleeding and usually invol ves resection, of af- fected bowel usually colon. Diverticulosis is extremely common, and the incidence increases with age. It is thought to be caused partially by a low-fiber, high-fat diet.
Complications are lower GI bleeding common cause and diverticulitis inflammation of a diverticula , book for lower left quadrant pain and tenderness, fever, diarrhea or constipation, and a white count. I, Putty Jl Hiint:ip! Sui'tiieal Htacticn. Diarrhea has multiple etiologies and is best broken down into categories: 1.
Systemic causes: any illness can cause diarrhea as a systemic symptom e. Osmotic diarrhea: nonabsorbable solutes remain in the bowel, where they retain water e.
When the patient stops ingesting the substance e. Secretory diarrhea: bowel secretes fluid. Causes include bacterial toxins cholera, some? Diarrhea continues with NPO status. Malabsorption: causes include celiac sprue look tor dermatitis herpetiformis, and stop gluten in the diet , Crohn's disease, and gastroenteritis. Diarrhea stops with NPO status. Infectious causes: look for fever, white blood cells in stool not with toxigenic bacteria; only with invasive bacteria such as S'hiiiclla, Sdmom-lk Yersinia , and Campylobacter spp.
Hikers and stream drinkers may get Gkircliu s i. Treat with metronidazole. Exudati ve diarrhea: inflammation in bowel mucosa causes seepage of fluid. Due to in- flammatory bowel disease Crohn's disease or ulcerative colitis or cancer. Altered intestinal transit: after bowel resections or medications that interfere with bowel function. With all diarrhea, watch for dehydration and electrolyte disturbances e.
Do a rectal exam, look lor occult blood in stool, and examine stool lor ova or parasites, lat content steatorrhea , and white Wood cells.
X If the patient has a history of antibiotic use, think of Clostridium diiiiciJc arid test the stool lor C. If the test is positive, treat with metronidazole if it fails or is not a choice, use vancomycin. It Do not forget about diabetic diarrhea, factitious diarrhea surreptitious laxative abuse, usu- ally by medical personnel , hyperthyroidism, and colorectal cancer as causes of diarrhea. Irritable bowel syndrome IBS is a common cause of Gl complaints.
Look for psychosocial stressors in the history and normal physical findings and diagnostic tests. This diagnosis of exclusion re- quires basic lab tests, rectal and stool examination, and.
IBS is three times more common in females than males.. After bacterial diarrhea especially E. Treat supportively. Both are treated with S ASA with or without a sulfa drug e. It may be precipitated by the use of antidiarrhea medications.
Symptoms include high fever, leukocytosis, abdominal pain, rebound tenderness, and a very dilated seg- ment of colon on abdominal x-ray. Toxic megacolon is an emergency. Start treatment by dis- continuing all antidiarrhea medications; then place the patient on NPO status, insert a nasogastric tube, and administer IV fluids, antibiotics to cover bowel flora e.
Go to surgery if perforation occurs free air on abdominal x-ray. Alcoholic hepatitis: elevated liver function tests; aspartate aminotransferase levels are more than twice as high as alanine aminotransferase levels in a patient who was just drinking. Hepatitis A: look for outbreaks from food-borne source; no long-term sequelae. Serology: positive IgM antibody to hepatitis A virus during jaundice or shortly thereafter.
Hepatitis B: prevention is best treatment vaccination ; acquired, through needles, sex, or perinatally. Transfused blood is now screened for hepatitis B, but a history of transfusion years ago is still a risk factor. Use hepatitis B immunoglobulin for exposed neonates and health care workers. Serology: HBsAg-positive with unresolved infection acute or chronic. Positive HBsAb means thal: the P atient is immune either to recovery from infection or vaccination and never appears if the patient develops chronic hepatitis.
Sequelae are cirrhosis and he- patocellular cancer only with chronic infection. Hepatitis C: t he new king of chron i c hepatitis; most likely cause of hepati tis after a blood transfusion used to be hepatitis B before blood was screened. More likely than hepatitis B to progress to chronic hepatitis, cirrhosis, and cancer.
Serology : antibody to hepatitis C virus shows immunity. Hepatitis D: seen only in patients with hepatitis B; may become chronic with hepatitis B coinfection. Acquired in same ways as hepatitis B. IgM antibodies to hepatitis D antigen show recent resolution of infection; presence of hepatitis D antigen means chronicity' 6.
Hepatitis E: similar to hepatitis A food- and water-borne, no chronic state. Often fatal in pregnant: women. Drug-induced: look for acetaminophen, isoniazid other tuberculosis drugs , halothane, carbon tetrachloride, tetracycline. Stop the drug! Reyes syndrome: develops in a child given aspirin for fever.
Acute fatty liver of pregnancy: develops in third trimester. Treat wittj immediate delivery; Idiopathic autoimmune hepatitis: year-old women with anti -smooth muscle or antinudear antibodies and no risk factors or lab markers of other causes for hepatitis.
Treat with steroids. Biliary tract disease: see below; look for markedly elevated alkaline phosphatase. Liver disease, chronic: often due to alcohol, hepatitis, and metabolic diseases hemochro- matosis, Wil son's disease, alpha, antitrypsin deficiency. Stigmata of chronic liver disease in- clude gynecomastia, testicular atrophy palmar erythema, spider angiomas on skin, and ascites. Alcoholism: positive history, Mallory bodies on histology not specific.
Hepatitis B or C: positive history and serology. Hemochromatosis: primary form is autosomal recessive disease look for family history caused by excessive iron that is deposited in liver cirrhosis, hepatocellular carcinoma , pancreas diabetes , heart dilated cardiomyopathy , skin pigmentation, classically called "bronze diabetes" , and joints arthritis.
Men are symptomatic earlier and more often; women lose iron with menstruation. Treat with phlebotomy. Secondary iron over- load also may cause a hemochromatosis-like picture, including anemia from ineffective erythropoiesis e. Wilson's disease: autosomal recessive disease caused by excessive copper. Serum cerulo- plasmin is low. Serum copper may be normal, but liver biopsy shows excessive copper. Treat with penicillamine copper chelator. Metabolic derangements that acc ompany liver failure: 1.
Coagulopathy: prolonged prothrombin, time; in severe cases, partial thromboplastin time may be prolonged.
Because the damaged liver cannot use vitamin K, patients must be treated with fresh frozen plasma. Hypoalbuminemia: liver synthesizes albumin. Ascites can be detected on physical exam by shifting dullness or a positive fluid wave. Possible complication is spontaneous bacterial peritonitis -infected ascitic fluid that leads to sepsis.
Do a paracentesis, and examine the ascitic fluid for white blood cells especially neutrophils , Gram stain, culture and sensitivity, glucose low with infection , and protein high with infection. Usually caused by E. Treat with broad-spectrum antibiotics. Hyperammonemia: liver clears ammonia. Last choice is neomycin stops bowel flora from making Nil,. Hepatic encephalopathy: mostly due to hyperammonemia; often precipitated by protein, GI bleed, or infection. Hepatorenal syndrome: liver failure causes kidney failure idiopathic.
Hypoglycemia: liver stores glycogen. Disseminated intravascular coagulation: activated clotting factors usually cleared by liver.
Biliary tract disease: jaundice may be caused by bile duct obstruction. Look for markedly ele- vated alkaline phosphatase, conjugated bilirubin that is more elevated than unconjugated bilirubin, pruritus, clay colored stools, and dark urine that is strongly bilirubin positive. Unconjugated bilirubin is not excreted in the urme because it is tightly bound to albumin. Common bile duct obstruction with gallstone: look for history of gallstones or the four Fs female, forty, fertile, fat.
Ultrasound can often image the stone; if not, use endo - scopic retrograd e c I k dan gi opancre atography. Common bile duct obstruction irom cancer: usually pancreatic cancer, sometimes cholangiocarcinoma or bowel cancers. Cholestasis: often from medications oral contraceptives, phenolhiazines, androgens or pregnancy. Primary biliary cirrhosis: middle aged woman with no risk factors for liver or biliary disease, marked pruritus, jaundice, and positive antimitochondrial antibodies; rest of work-up is negative.
Cholestyramine helps with symptoms, but no treatment other than liver transplantation is available. Primary sclerosing cholangitis: young adults with inflammatory bowel disease usually ulcerative colitis ; presents like cholangitis.
Treat with antibiotics, and remove stones surgically or endoscopically. Esophageal disorders: dysphagia is usually an esophageal complaint. Patients may present with atypical chest pain. Achalasia; hypertensive lower esophageal sphincter US , incomplete relaxation of US, and loss or derangement of peristalsis. Achalasia is usually idiopathic but may be sec- ondary to Chagas' disease South America. Patients have intermittent dysphagia for solids and liquids with no heartburn.
Barium swallow reveals dilated esophagus with distal "bird- beak" narrowing. Diagnosis can be made with esophageal manometry. Treat with calcium channel blockers, pneumatic balloon dilatation, and, as a last resort, surgery myotomy. Diagnose with esophageal manometry. Treat with calcium channel blockers and, if needed, surgery myotomy.
See figure, top of next page. Scleroderma: may cause aperistalsis duo to fibrosis and atrophy of smooth muscle. Barrett's esophagus: columnar metaplasia due lo acid rellux; must be followed wjtb peri odic endoscopy and biopsies to rule out progression to adenocarcinoma.
Other causes include hypertriglyceridemia, viral infections mumps, coxsackie virus , trauma, and medications 36 Gastroenterology UilluM! II' torn. Perforated peptic ulcer disease also may have elevated amylase and presents similarly, but patients have free air on abdominal x-ray and history of peptic ulcer disease.
Mallory- Weiss tears are superficial esophageal erosions that may cause a GI bleed. They usu- ally are seen with vomiting and retching alcoholics and bulimics. Diagnosis and treatment are done endoscopically sclerose any bleeding vessels.
Boerbave's tears are fit 11 thickness esophageal ruptures; if not iatrogenic: from endoscopy , they are usually due to vomiting or retching alcoholics and bulimics. Diagnose with endoscopy or barium enema, and treat with immediate surgical repair and drainage. Note: Willi suspected GI perforation, never use barium which may cause chemical peritonitis. Use water-soluble contrast instead e. Be able to recognize a sketch of this most, common variant. Treat each of the following conditions with surgical repair.
Vittl Nl'O, ovugai-tvU ttibv. IV fluids, a. The main point to know is that bowel herniates into the thorax, compressing and impeding lung development pul- monary hypoplasia develops. Omphalocele vs. Sac contains multiple abdomi - nal organs, the umbilical ring is absent, and other anomalies are common. Gastroschisis is to the right of" the midline. Only small bowel is exposed no true hernia sac , the umbilical ring is present, and other anomalies are rare.
They also may develop inflammatory bowel disease or irritable bowel syndrome and often have if complaints with anxicly or psychiatric problems separation anxiety, reluc- tance to go to school, depression, child abuse.
Neonatal jaundice: may be physiologic or pathologic. Hie lirsi step Is to measure total, direct, and indirect bilk tibm.
The main concern is kcrnk -ferns, which is due to high levels of 'unconjugated 38 Gastroenterology bilirubin and subsequent deposit into the basal ganglia. Bilirubin is mostly unconjugated. Pathologic jaundice; levels rise higher than normal and continue to rise or fail to decrease appropriately.
Any jaundice present at birth is pathologic. Treat with temporary cessation of breast feeding switch to bottle until jaundice resolves. The youngest, sickest infants are at greatest risk lor hyperbilirubinemia and kernicterus. Hemolysis: from Kb incompatibility or congenital red cell diseases that cause hemolysis in the neonatal period. Look for anemia, peripheral smear abnormalities, family history and higher level of unconjugated bilirubi n.
Metabolic; Crigler-Najjar syndrome causes severe unconjugated hyperbilirubinemia, Gilbert's disease c auses mild unconjugated fit, per biliritbinernia, and. Rotor and Dubin- Johnson syndromes cause conjugated hyperbilirubinemia. Biliary atresia: full-term infants with clay or gray colored stools and high levels of conju- gated bilirubin. Treat with surgery. Medications: avoid sulfa drugs in neonates displaces bilirubin from albumin and may precipitate kernicterus.
Note: Any infant born to a mother with active hepatitis H should, get the first immunization shot and hepatitis B immunoglobulin at birth. In primary endocrine disturbances, the gland itself is malfunction- ing e. The appropriate response is or the pituitary to secrete less TSH because of feedback inhibition. In a secondary endocrine disturbance, the gland is perfect! Hypothyroidism may be associated hypercholesterolemia, which resolves with treatment.
Usually TSH is high, andT 4 primary is low. Treat with thyroid hormone synthetic T 4. Causes of hypothyroidism: 1. Hashimoto's thyroiditis: most common cause; associated with other autoimmune dis eases e. I l istology shows lymphocyte infiltration of the gland. Subacute thyroiditis: acute viral inflammation with fever and enlarged, tender thyroid gland. History of upper respiratory inf ect ion or mumps is common. Patients often recover without treatment. After treatment for hyperthyroidism, be aware that it frequently occurs second most common cause in U.
Sick -euthyroid. The condition is self limiting, and no treatment is necessary except for the underlying disorder. Iodine deficiency: rare in U. May cause cretinism in children stunted growth and.DBX hail from London. Three guys with an eclectic musical history, from dance to rock and back again, creating a powerful sound of organic intensity and elevating electronica. Pete is an Ivor Novel. London. 2 Tracks. Followers. Stream Tracks and Playlists from D-B-X on your desktop or mobile device.