Which patient is at risk for metabolic acidosis? ?->(Show Answer!)

1. Which patient is at risk for metabolic acidosis?

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MCQ-> Read the following passage carefully and answer the questions given at the end.Passage 4Public sector banks (PSBs) are pulling back on credit disbursement to lower rated companies, as they keep a closer watch on using their own scarce capital and the banking regulator heightens its scrutiny on loans being sanctioned. Bankers say the Reserve Bank of India has started strictly monitoring how banks are utilizing their capital. Any big-ticket loan to lower rated companies is being questioned. Almost all large public sector banks that reported their first quarter results so far have showed a contraction in credit disbursal on a year-to-date basis, as most banks have shifted to a strategy of lending largely to government-owned "Navratna" companies and highly rated private sector companies. On a sequential basis too, banks have grown their loan book at an anaemic rate.To be sure, in the first quarter, loan demand is not quite robust. However, in the first quarter last year, banks had healthier loan growth on a sequential basis than this year. The country's largest lender State Bank of India grew its loan book at only 1.21% quarter-on-quarter. Meanwhile, Bank of Baroda and Punjab National Bank shrank their loan book by 1.97% and 0.66% respectively in the first quarter on a sequential basis.Last year, State Bank of India had seen sequential loan growth of 3.37%, while Bank of Baroda had seen a smaller contraction of 0.22%. Punjab National Bank had seen a growth of 0.46% in loan book between the January-March and April-June quarters last year. On a year-to-date basis, SBI's credit growth fell more than 2%, Bank of Baroda's credit growth contracted 4.71% and Bank of India's credit growth shrank about 3%. SBI chief Arundhati Bhattacharya said the bank's year-to-date credit growth fell as the bank focused on ‘A’ rated customers. About 90% of the loans in the quarter were given to high-rated companies. "Part of this was a conscious decision and part of it is because we actually did not get good fresh proposals in the quarter," Bhattacharya said.According to bankers, while part of the credit contraction is due to the economic slowdown, capital constraints and reluctance to take on excessive risk has also played a role. "Most of the PSU banks are facing pressure on capital adequacy. It is challenging to maintain 9% core capital adequacy. The pressure on monitoring capital adequacy and maintaining capital buffer is so strict that you cannot grow aggressively," said Rupa Rege Nitsure, chief economist at Bank of Baroda.Nitsure said capital conservation pressures will substantially cut down "irrational expansion of loans" in some smaller banks, which used to grow at a rate much higher than the industry average. The companies coming to banks, in turn, will have to make themselves more creditworthy for banks to lend. "The conservation of capital is going to inculcate a lot of discipline in both banks and borrowers," she said.For every loan that a bank disburses, some amount of money is required to be set aside as provision. Lower the credit rating of the company, riskier the loan is perceived to be. Thus, the bank is required to set aside more capital for a lower rated company than what it otherwise would do for a higher rated client. New international accounting norms, known as Basel III norms, require banks to maintain higher capital and higher liquidity. They also require a bank to set aside "buffer" capital to meet contingencies. As per the norms, a bank's total capital adequacy ratio should be 12% at any time, in which tier-I, or the core capital, should be at 9%. Capital adequacy is calculated by dividing total capital by risk-weighted assets. If the loans have been given to lower rated companies, risk weight goes up and capital adequacy falls.According to bankers, all loan decisions are now being assessed on the basis of the capital that needs to be set aside as provision against the loan and as a result, loans to lower rated companies are being avoided. According to a senior banker with a public sector bank, the capital adequacy situation is so precarious in some banks that if the risk weight increases a few basis points, the proposal gets cancelled. The banker did not wish to be named. One basis point is one hundredth of a percentage point. Bankers add that the Reserve Bank of India has also started strictly monitoring how banks are utilising their capital. Any big-ticket loan to lower rated companies is being questioned.In this scenario, banks are looking for safe bets, even if it means that profitability is being compromised. "About 25% of our loans this quarter was given to Navratna companies, who pay at base rate. This resulted in contraction of our net interest margin (NIM)," said Bank of India chairperson V.R. Iyer, while discussing the bank's first quarter results with the media. Bank of India's NIM, or the difference between yields on advances and cost of deposits, a key gauge of profitability, fell in the first quarter to 2.45% from 3.07% a year ago, as the bank focused on lending to highly rated customers.Analysts, however, say the strategy being followed by banks is short-sighted. "A high rated client will take loans at base rate and will not give any fee income to a bank. A bank will never be profitable that way. Besides, there are only so many PSU companies to chase. All banks cannot be chasing them all at a time. Fact is, the banks are badly hit by NPA and are afraid to lend now to big projects. They need capital, true, but they have become risk-averse," said a senior analyst with a local brokerage who did not wish to be named.Various estimates suggest that Indian banks would require more than Rs. 2 trillion of additional capital to have this kind of capital adequacy ratio by 2019. The central government, which owns the majority share of these banks, has been cutting down on its commitment to recapitalize the banks. In 2013-14, the government infused Rs. 14,000 crore in its banks. However, in 2014-15, the government will infuse just Rs. 11,200 crore.Which of the following statements is correct according to the passage?
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MCQ-> Read the following passage carefully and answer the given questions. Certain words/phrases have been given in bold to help you locate them while answering some of the questions. Virtual currencies are growing in popularity. While the collective value of virtual currencies is still a fraction of the total U.S. Dollars in circulation, the use of virtual currencies as a payment mechanism of transfer of value is gaining momentum. Additionally, the number of entities (issuers, exchangers and intermediaries, to name just a few) that engage in virtual currency transactions is increasing and these entities often need access to traditional banking services.Virtual currencies are digital representations of value that function as a medium of exchange, a unit of account and a store of value (buy now redeem later policy). In many cases, virtual currencies are “convertible” currencies; they are not legal lenders, but they have an equivalent value in real currency. Despite what seems to be a tremendous interest in virtual currencies their overall value is still extremely small relative to other payment mechanisms, such as cash, cheques and credit and debit cards. The virtual currency landscape includes many participants from the merchant that accepts the virtual currency, to the intermediary that exchanges the virtual currency on behalf of the merchant, to the exchange that actually converts the virtual currency to the real currency to the electronic wallet provider that holds the virtual currency on behalf of its owner. Accordingly, opportunities abound for community banks to provide services to entities engaged in virtual currency activities. Eventually, it is also possible that community banks may find themselves holding virtual currency on their own balance sheets.Launched in 2009, Silicon is currently the largest and most popular virtual currency. However, many other virtual currencies have emerged over the past few years, such as Litecoin, Dogecoin, Peercoin and these provide even more anonymity to its users than that provided by Bitcoin.As the virtual currency landscape is fraught with dangers, what important risks should community bankers consider?The most significant is compliance risk- a subset of legal risk. Specifically, virtual currency administrators or legal exchangers may present risks similar to other money transmitters, as well in presenting their own unique risks. Quite simply, many users of virtual currencies do so because of the perceptions that transactions conaucted using virtual currencies are anonymous. The less-than transparent nature of the transactions, :nay make it more difficult for a inancial institution to truly know and understand the activities of its customer and whether the customer’s activities are legal. Therefore, these transactions may present a higher risk for banks and require additional due diligence and monitoring.Another important risk for community banks to consider is credit risk. How should a community bank respond if a borrower wants to specifically post Bitcoin or another virtual currency as collateral for a loan? For many, virtual currencies are simply another form of cash, so it is not hard to analyse that bankers will face such a scenario at some point. In this case, caution is appropriate. Bankers should carefully weigh the pros and cons of extending any loan secured by Bitcoin or other virtual currencies (in whole or in part), or where the source of loan repayment is in some way dependent on the virtual currency. For one, the value of Bitcoin in particular has been volatile. Then, the collateral value could fluctuate widely from day-to-day. Bankers also need to think about control over the account. ‘How does the banker control access to a virtual wallet, and how can it control the borrower’s access to the virtual wallet? In the event of a loan default, the bank would need to take control of the virtual currency. This would require access to the borrower’s virtual wallet and private key. All of this suggests that the loan agreement needs to be carefully crafted and that additional steps need to be taken to ensure the bank has a perfected lift on the virtual currency.Virtual currencies bring with them, both opportunities and challenges, and they are likely here to stay. Although, it is too early to determine just how prevalent they will be in the coming years, we too expect that the virtual participants in the virtual currency ecosystem will increasingly intersect with the banking industry.Which of the following is the meaning of the phrase ‘fraught with dangers’ as mentioned in the passage?
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MCQ-> Analyse the following passage and provide appropriate answers for questions that follow. Certain variants of key behavioural genes, “risk allele” make people more vulnerable to certain mood, psychiatric, or personality disorders. An allele is any of the variants of a gene that takes more than one form. A risk allele, then, is simply a gene variant that increases your likelihood of developing a problem. Researchers have identified a dozen - odd gene variants that can increase a person’s susceptibility to depression, anxiety and antisocial, sociopathic, or violent behaviours, and other problems - if, and only if, the person carrying the variant suffers a traumatic or stressful childhood or faces particularly trying experiences later in life. This hypothesis, often called the “stress diathesis” or “genetic vulnerability” model, has come to saturate psychiatry and behavioural science. Recently, however, an alternate hypothesis has emerged from this one and is turning it inside out. This new model suggests that it’s a mistake to understand these “risk” genes only as liabilities. According to this new thinking, these “bad genes” can create dysfunctions in unfavourable contexts - but they can also enhance function in favourable contexts. The genetic sensitivities to negative experience that the vulnerability hypothesis has identified, it follows, are just the downside of a bigger phenomenon: a heightened genetic sensitivity to all experience. This hypothesis has been anticipated by Swedish folk wisdom which has long spoken of “dandelion” children. These dandelion children - equivalent to our “normal” or “healthy” children, with “resilient” genes - do pretty well almost anywhere, whether raised in the equivalent of a sidewalk crack or well - tended garden. There are also “orchid” children, who will wilt if ignored or maltreated but bloom spectacularly with greenhouse care. According to this orchid hypothesis, risk becomes possibility; vulnerability becomes plasticity and responsiveness. Gene variants generally considered misfortunes can instead now be understood as highly leveraged evolutionary bets, with both high risks and high potential rewards. In this view, having both dandelion and orchid kids greatly raises a family’s (and a species’) chance of succeeding, over time and in any given environment. The behavioural diversity provided by these two different types of temperament also supplies precisely what a smart, strong species needs if it is to spread across and dominate a changing world. The many dandelions in a population provide an underlying stability. The less - numerous orchids, meanwhile, may falter in some environments but can excel in those that suit them. And even when they lead troubled early lives, some of the resulting heightened responses to adversity that can be problematic in everyday life - increased novelty - seeking, restlessness of attention, elevated risk - taking, or aggression - can prove advantageous in certain challenging situations: wars, social strife of many kinds, and migrations to new environments. Together, the steady dandelions and the mercurial orchids offer an adaptive flexibility that neither can provide alone. Together, they open a path to otherwise unreachable individual and collective achievements.The passage suggests ‘orchids’:
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MCQ-> Throughout human history the leading causes of death have been infection and trauma, Modem medicine has scored significant victories against both, and the major causes of ill health and death are now the chronic degenerative diseases, such as coronary artery disease, arthritis, osteoporosis, Alzheimer’s, macular degeneration, cataract and cancer. These have a long latency period before symptoms appear and a diagnosis is made. It follows that the majority of apparently healthy people are pre-ill.But are these conditions inevitably degenerative? A truly preventive medicine that focused on the pre-ill, analyzing the metabolic errors which lead to clinical illness, might be able to correct them before the first symptom. Genetic risk factors are known for all the chronic degenerative diseases, and are important to the individuals who possess them. At the population level, however, migration studies confirm that these illnesses are linked for the most part to lifestyle factors — exercise, smoking and nutrition. Nutrition is the easiest of these to change, and the most versatile tool for affecting the metabolic changes needed to tilt the balance away from disease.Many national surveys reveal that malnutrition is common in developed countries. This is not the calorie and/or micronutrient deficiency associated with developing nations (type A malnutrition); but multiple micronutrient depletion, usually combined with calorific balance or excess (Type B malnutrition). The incidence and severity of Type B malnutrition will be shown to be worse if newer micronutrient groups such as the essential fatty acids, xanthophylls and falconoid are included in the surveys. Commonly ingested levels of these micronutrients seem to be far too low in many developed countries.There is now considerable evidence that Type B malnutrition is a major cause of chronic degenerative diseases. If this is the case, then t is logical to treat such diseases not with drugs but with multiple micronutrient repletion, or pharmaco-nutrition’. This can take the form of pills and capsules — ‘nutraceuticals’, or food formats known as ‘functional foods’, This approach has been neglected hitherto because it is relatively unprofitable for drug companies — the products are hard to patent — and it is a strategy which does not sit easily with modem medical interventionism. Over the last 100 years, the drug industry has invested huge sums in developing a range of subtle and powerful drugs to treat the many diseases we are subject to. Medical training is couched in pharmaceutical terms and this approach has provided us with an exceptional range of therapeutic tools in the treatment of disease and in acute medical emergencies. However, the pharmaceutical model has also created an unhealthy dependency culture, in which relatively few of us accept responsibility for maintaining our own health. Instead, we have handed over this responsibility to health professionals who know very little about health maintenance, or disease prevention.One problem for supporters of this argument is lack of the right kind of hard evidence. We have a wealth of epidemiological data linking dietary factors to health profiles/ disease risks, and a great deal of information on mechanism: how food factors interact with our biochemistry. But almost all intervention studies with micronutrients, with the notable exception of the omega 3 fatty acids, have so far produced conflicting or negative results. In other words, our science appears to have no predictive value. Does this invalidate the science? Or are we simply asking the wrong questions?Based on pharmaceutical thinking, most intervention studies have attempted to measure the impact of a single micronutrient on the incidence of disease. The classical approach says that if you give a compound formula to test subjects and obtain positive results, you cannot know which ingredient is exerting the benefit, so you must test each ingredient individually. But in the field of nutrition, this does not work. Each intervention on its own will hardly make enough difference to be measured. The best therapeutic response must therefore combine micronutrients to normalise our internal physiology. So do we need to analyse each individual’s nutritional status and then tailor a formula specifically for him or her? While we do not have the resources to analyze millions of individual cases, there is no need to do so. The vast majority of people are consuming suboptimal amounts of most micronutrients, and most of the micronutrients concerned are very safe. Accordingly, a comprehensive and universal program of micronutrient support is probably the most cost-effective and safest way of improving the general health of the nation.The author recommends micronutrient-repletion for large-scale treatment of chronic degenerative diseases because
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