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What is Kienboch's disease | Ans. is 'a' i.e osteochondritis of lunate [Ref. : Maheshwari 3/e p269 (2/e, p268)JOsteochondritis :These are a group of miscellaneous affections of the growing epiphysis in children and adolescents.Typically, a bony nucleus of the epiphysis affected by osteochondritis becomes temporarily softened; and while in the softened stage it is liable to deformation by pressure.Common osteochondritis *NameSite affectedPerthes disease*Pannes disease*Kienbocks disease*Osgood shlatter's disease*Sever s disease*Kohler's disease*Freibergs disease*Scheurmann's disease*Calves disease*- Femoral head (most common)*- Capitulum- Lunate bone- Tibial tubercle- Calcaneal tuberosity- Navicular bone- Metatarsal head- Ring epiphysis of vertebrae- Central bony nucleus of vertebral body* Note that this is a very important chart and must be learnt very well. I had a method to remember it. I placed them in an order of sites affected from hand to foot and then made a mnemonic for the names. Site affectedName of diseaseMnemonic(In order from hand to foot) * Lunate boneKienbock's diseaseKhaike* CapitulumPanner's diseasePaan* Ring epiphysis of vertebraeScheuermann's diseaseSupreme* Central bony nucleus of vertebral bodyCalve s diseaseCourt* Femoral headPerthe \s diseasePassed* Tibial tubercleOsgood shlatter 's diseaseOrder to* Calcaneal tuberositySever's diseaseSever* Navicular boneKohler's diseaseKohl's* Metatarsal headFrieberg's diseaseFreedom | 154,100 | medmcqa_train |
Molar concentration of oral rehydration fluid is - | Ans. is 'b' i.e., Potassium 20 meq | 154,101 | medmcqa_train |
Chronic thiazide therapy causes persistent hypercalcemia due to : | Ans. is 'd' Hyperparathyroidism Chronic thiazide therapy causes hypercalcemia because it enhances the parathyroid mediated increase of Ca reabsorption.Note: Thiazide diuretics cause hypercalcemia where as high ceiling diuretics cause hypocalcemia.Other important side effects of Thiazide diureticsHyperuricemia *Hypokalemia* (More than high ceiling diuretics)Dilutional hyponatremia*Hyperglycemia* and Hyperlipidemia*Magnesium depletion* | 154,102 | medmcqa_train |
Cell of origin of hairy cell leukemia is - | Hairy cell leukaemia is an unusual & uncommon form of B cell malignancy characterized by presence of hairy cells in the blood & bone marrow & splenomegaly.Hairy cells are abnormal mononuclear cells with hairy cytoplasmic projections which are seen in blood,bone marrow & spleen.These cells exhibit CD19,CD20 & CD22 antigen.Reference: Harsh mohan textbook of pathology 6 th edition pg no 379 | 154,103 | medmcqa_train |
Precautions advised after outpatient Radioiodine (I-131) therapy are all, EXCEPT: | There is no such contraindication as do not use household chlorine bleaches for cleaning. Children and Pregnant Women: If there are pregnant women, infants, and children under 16 years of age in the home, arrangements should ensure that a distance >6 feet (or 2 meter) can be maintained between the patient and these occupants for the entire restricted time. Carry Treatment Card: Information card or letter at the time of treatment which show the date, type and amount of radioiodine. The card should be carried for at least 3 months following treatment. In an event of traffic accident or any other medical emergency during the ?rst week after your treatment the card should be produced. Contraception: It is advised that full feility may not occur until after 1 year, and attempts to produce pregnancy should best await a time when they are fully recovered from 131 I therapy, a period of at least 3 months. Ref: Radiation Safety in the Treatment of Patients with Thyroid Diseases by Radioiodine 131 I: Practice Recommendations of the American Thyroid Association, James C. Sisson et al. | 154,104 | medmcqa_train |
Patients with Antiphospholipid antibodies may manifest with any of the following, except: | Answer is D (Thrombocytosis): Refer Review Notes on Antiphospholipid Syndrome Antiphospholipid Antibody Syndrome is associated with thrombocytopenia and not thrombocytosis. The presence of thrombocytopenia does not appear to reduce thrombotic risk in patients with APS. Recurrent aerial or venous thrombosis in any tissue or organ is the most common presentation. Coomb's Positive Hemolytic Anemia may be seen in up-to 10 percent of patients with Antiphospholipid Syndrome. | 154,105 | medmcqa_train |
Which of the following enzymes is used in Recombinant DNA research for Homopolymer tailing | Terminaldeoxynucleotidyltransferase catalyzes the addition of deoxynucleotides to the 3' termini of DNA. ... By use of a tailing method, which adds homopolymerdeoxynucleotide tails to denatured DNA, any double-stranded DNA fragment can be joined to a cloning vehicle Ref biochemistry satyanarayana 4e p255 | 154,106 | medmcqa_train |
Hardness number which does not depend on the ductility of metal: | KNOOP HARDNESS TEST (KHN)
A diamond indenting tool is used. Knoop hardness values is independent of the ductility of the material and values for both exceedingly hard and soft materials can be obtained from this test. The Knoop and Vickers tests are classified as microhardness tests. The Brinell and Rockwell tests are classified as macrohardness tests.
Mannapalli 3rd ed page no 17 | 154,107 | medmcqa_train |
Most abundant complement in the body | C3 is the most abundant complement. | 154,108 | medmcqa_train |
Which of the following is not formed sphincter of oddi complex? | Sphincter of oddi complex:- 1. sphincter ampullae 2. sphincter pancreaticus 3. superior choledochal sphincter 4. inferior choledochal sphincter | 154,109 | medmcqa_train |
Disorders associated with vitiligo EXCEPT? | DISORDERS ASSOCIATED WITH VITILIGO Thyroid disease: Hypehyroidism Hypothyroidism Pernicious anemia Addison's disease Diabetes mellitus Hypoparathyroidism Myasthenia gravis Alopecia areata Morphoea and lichen sclerosis | 154,110 | medmcqa_train |
True signs of placental separation are all of the following. except? | Signs of placental separation Lengthening of cord A gush of fresh bleeding Suprapubic bulge, due to firm uterine fundus after placental separation, is the most specific sign A Flabby uterus means that the placenta is still probably stuck to the uterus and hence preventing its proper contraction | 154,111 | medmcqa_train |
A 12 year old girl presents with a 0.4 cm slightly raised strawberry coloured nodule in the skin of the abdomen below the umbilicus. It is present for many years and not changed in color or size. Diagnosis | Answer: c) Hemangioma (ROBBINS 9th ED, P-516)HEMANGIOMAHemangiomas are very common tumors characterized by increased numbers of normal or abnormal vessels filled with bloodMost are present from birth and initially increase in size, but many eventually regress spontaneouslyWhile hemangiomas typically are localized lesions confined to the head and neck, they can occasionally be more extensive (angiomatosis) and can occur internally.Nearly one third of these internal lesions are found in the liverMalignant transformation is rare.Capillary hemangiomasMost common typeOccur in the skin, subcutaneous tissues, and mucous membranes of the oral cavities and lips, as well as in the liver, spleen, and kidneysJuvenile hemangiomas (strawberry type hemangiomas)Juvenile hemangiomas of the newborn are extremely common and can be multiple.These arise in the skin and grow rapidly for a few months, but then fade by 1 to 3 years of age and completely regress by age 7 in the vast majority of cases.Cavernous hemangiomasComposed of large, dilated vascular channelsAs compared to capillary hemangiomas, cavernous hemangiomas are more infiltrative, frequently involve deep structures, and do not spontaneously regress.Intravascular thrombosis and associated dystrophic calcification are common.They can be locally destructive, and as a result some may require surgery.Cavernous hemangiomas are one component of von Hippel-Lindau diseasePyogenic granulomasCapillary hemangiomas that present as rapidly growing red pedunculated lesions on the skin, gingival, or oral mucosa.They bleed easily and are often ulceratedRoughly a quarter of lesions develop after trauma, reaching a size of 1 to 2 cm within a few weeks.Curettage and cautery is usually curative.Pregnancy tumor (granuloma gravidarum) is a pyogenic granuloma that occurs infrequently (1% of patients) in the gingiva of pregnant women.These lesions may spontaneously regress (especially after pregnancy), or undergo fibrosis, but occasionally require surgical excision | 154,112 | medmcqa_train |
The following methods can be used to detect the point mutation in the beta (β)-globin gene that causes sickle cell anemia, except - | To detect point mutation, DNA analysis is required. While northern blot is a test for study of RNA.
Polymerase chain reaction, DNA sequencing and southern blot testing are rapid methods for DNA analysis, and can all be used to detect the point mutation in the globin gene. | 154,113 | medmcqa_train |
Treatment of choice for vocal nodule is | Treatment of vocal nodules Early cases of vocal nodules can be treated conservatively by educating the patient about the proper use of voice. With this treatment, many nodules in children disappear completely. Surgery is required for large nodules or nodules of long standing in adults. They are excised with precision under an operating microscope either with cold instruments or laser avoiding any trauma to the underlying vocal ligament. Speech therapy and re-education in voice production are essential to prevent their recurrence. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 343 | 154,114 | medmcqa_train |
When selecting the colour of cement to use for cementing a porcelain jacket crown, the powder being tested is best mixed with: | Self-cured and dual-cured materials can be opaque or translucent, and those indicated for cementation of ceramic restorations are usually provided in several shades. Light-cured materials are indicated for bonding of laminated ceramic veneers (esthetic cements) or orthodontic brackets. Some esthetic resin cements used for cementation of veneers include glycerin-based, water-soluble “try-in” pastes to help with shade selection.
Reference: Craig’s 14th ed page no 289 | 154,115 | medmcqa_train |
Schneider's 1st rank symptoms seen in | Ku Schneider (1959) described symptoms which, though not specific to schizophrenia, were of great help in making a clinical diagnosis of schizophrenia. These are popularly called as Schneider's first-rank symptoms of schizophrenia (FRS or SFRS). He also described the second rank symptoms of schizophrenia (which were considered by him as less influenced the diagnostic criteria and classification of schizophrenia and other related psychotic disorders. First Rank Symptoms (SFRS) of Schizophrenia 1. Audible thoughts: Voices speaking out thoughts aloud or ' thought echo'. 2. Voices heard arguing: Two or more hallucinatory voices discussing the subject in the third person. 3. Voices commenting on one's action. 4. Thought withdrawal: Thoughts cease and subject experiences them as removed by an external force. 5. Thought inseion: Experience of thoughts imposed by some external force on person's passive mind. 6. Thought diffusion or broadcasting: Experience of thoughts escaping the confines of self and as being experienced by others around. 7. ' Made' feelings or effect. 8. 'Made' impulses. 9. 'Made' volition or acts: In 'made' affect, impulses and volitions, the person experiences feelings, impulses or acts which are imposed by some external force. In 'made' volition, for example, one's own acts are experienced as being under the control of some external force. 10. Somatic passivity: Bodily sensations, especially sensory symptoms, are experienced as imposed on the body by some external force. 11. Delusional perception: Normal perception has a private and illogical meaning. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 54 | 154,116 | medmcqa_train |
Moth eaten alopecia is seen with - | Ans. is 'b' i.e., Syphilis | 154,117 | medmcqa_train |
Community diagnosis means | Community diagnosis refers to identification and quantification of health problems in a community in terms of moality and morbidity rates and ratios, and identification of their correlates for the purpose of defining those individuals or groups at risk or those in need of healthcare.Park 23e pg: 91 | 154,118 | medmcqa_train |
A 2-year-old child with history of fall one year back with parietal bone fracture now presented with painful and growing parietal swelling. | (b) Growing fracture,Ref: Growing skull fractures: classification and management. Naim-Ur-Rahman et al Br J Neurosurg. (1994)Growing Fractures:* Also known as traumatic encephaloceles or leptomeningeal cysts* Skull fractures associated with an underlying dural tear may fail to heal properly.* Enlargement of the defect is caused due to herniation of brain, or a leptomeningeal cyst, or dilated ventricles.* Neurologic symptoms may be found if associated compression of the underlying brain is present.* Occur primarily in children with age < 3 years and with diastasis greater than 3 to 4 mm.* Usually detected within one year of an acute head injury as a localized swelling or palpable skull defect that increases in size. | 154,119 | medmcqa_train |
Non specific esterase is positive in all the categories of AML except - | Ans. is 'd' i.e., M6 o FAB classification divides AML into eight types M 0 to M7. o This scheme takes into account : ? i) The degree of maturation (MO to M3) ii) The lineage of leukemic blast (M4 to M7). Class Blast cells o Myeloperoxidase negative Mo minimally differentiatedAML o Auer rods negative o Express myeloid lineage antigen o 3 % blasts myeloperoxidase positive M AML without differentiation o Auer rods positive o Full range of myeloid maturation MZ AML with maturation o Myeloperoxidase positive o Auer rods positive | 154,120 | medmcqa_train |
NOT a content of superior mediastinum | Mediastinum refers to the space between two lungs in thorax. SUPERIOR MEDIASTINUM Space above 2nd costal cailage CONTENTS: thymus, arch of aoa, superior venacava, pulmonary aeries, esophagus, trachea, T1 - T4 veebra, PICA - 1, 2. INFERIOR MEDIASTINUM Space below superior mediastinum, again divided into anterior, middle and posterior mediastinum. CONTENTS: pulmonary trunk, bronchus, thymus, hea, ascending aoa, PICA 3 - 12 esophagus, descending aoa, T5 - T12 veebra. Angle between manubrium of sternum & body of sternum is called angle of louis, which is 1630. | 154,121 | medmcqa_train |
A10-year-old girl present with polyuria and polydipsia with hypokalemia, hypercalciuria and metabolic alkalosis. What is the probable diagnosis? | Ans: (c) Bartter syndromeRef: Nelson Textbook of Pediatrics, 20th edition, Page 2534BARTTER SYNDROME (AUTOSOMAL RECESSIVE)Clinical Subtypes:Antenatal Bartter syndrome (Hyperprostaglandin E syndrome):Mutations-genes that encode the sodium potassium 2 chloride transporter NKCC2 (the site of action of furosemide) orThe luminal potassium channel ROMK - cause neonatal Bartter syndrome.Present with polyhydramnios, salt wasting and severe dehydration.Classic Bartter syndrome:Defects-genes that produce the basolateral chloride channel CIC-KbPresents milder in childhood with failure to thrive and a history of recurrent episodes of dehydration. PathogenesisDefect in sodium, chloride and potassium transport in the ascending loop of HenleHypokalemic metabolic alkalosis with hypercalciuria (similar to chronic loop diuretic use)The loss of sodium and chloride, with resultant volume contraction, stimulates the renin/angiotensin 11/ aldosterone axis.Aldosterone promotes sodium uptake and potassium secretion, exacerbating the hypokalemia.It also stimulates hydrogen ion secretion distally, worsening the metabolic alkalosis. Hypokalemia stimulates prostaglandins, which further activate the renin/angiotensin ll/aldosterone axis.Clinical Manifestations In Smaller ChildrenConsanguinity with history of polyhydramnios.Triangular facies, protruding ears, large eyes with strabismus and drooping mouth.In Older ChildrenHistory of recurrent episodes of dehydration, failure to thrive, Hypokalemic metabolic alkalosis, Urinary calcium, potassium and sodium levels - elevatedSerum renin, aldosterone and prostaglandin E levels - elevated (antenatal form)Blood pressure is usually normal, except in antenatal form - have severe salt wastingRenal function is typically normal, Ultrasound shows Nephrocalcinosis, due to hypercalciuria.Diagnosis - Based clinical presentation + laboratory findings.(Severe hypokalemia, usually <2.5mmol/L, with metabolic alkalosis. Hypercalciuria is typical)Differential Diagnosis:1. Diuretic abuse.2. Chronic vomiting - Measurement of urinary chloride (elevated - Bartter syndrome and low in patients - chronic vomiting).Treatment and PrognosisPrevent dehydration and maintaining nutritional status.Correcting hypokalemia (at very high doses)Sodium supplementation - Infants and young children.Indomethacin, a prostaglandin inhibitor, may also be effective.Long-term prognosis is generally good.Chronic hypokalemia, nephrocalcinosis and chronic indomethacin therapy can lead to chronic interstitial nephritis and chronic renal failure.GITELMAN SYNDROME (AUTOSOMAL RECESSIVE)Causes hypokalemic metabolic alkalosis, hypocalciuria and hypomagnesemia.PathogenesisDefects - in sodium chloride co-transporter NCCT, present in the distal convoluted tubule (resembles chronic thiazide diuretic use).Clinical ManifestationsPresent late in childhood with history of recurrent muscle cramps and spasms due to hypomagnesemia.No history of recurrent episodes of dehydration.Biochemical abnormalities include hypokalemia, metabolic alkalosis and hypomagnesemia.The urinary calcium level is usually very low and urinary magnesium level is elevated.Prostaglandin E secretion, Renin and aldosterone levels - normal.Diagnosis - Adolescent - with hypokalemic metabolic alkalosis, hypomagnesemia and hypocalciuria. Treatment - Correcting hypokalemia and hypomagnesemia.Liddle Syndrome:In collecting duct - gain of function mutations of the gene coding (epithelial sodium channel)Causes an inherited form of hypertension with hypokalemia and suppressed aldosteroneLoss of function mutations - pseudo hypoaldosteronism (severe sodium wasting and hyperkalemia).X (RECESSIVE)-linked nephrolithiasis (Dent disease)Mutations in the gene - voltage-gated chloride channel CLN5 (present throughout the nephron)Characterized by recurrent stone formation and progression to Fanconi syndrome.In loop of Henle - activating (severe hypoparathyroidism) and inactivating mutations (hyperparathyroidism) in the calcium receptor gene (which mediates parathyroid hormone-induced calcium uptake).ALPORT SYNDROME (AS) - (HEREDITARY NEPHRITIS)X-linked disease (85%) - Mutations in the genes coding for type IV collagen (gene - major component of basement membranes).Autosomal recessive - mutations in the COL4A3 and COL4A4 genes on chromosome 2Autosomal dominant form also occurs.Clinical Manifestations Renal manifestations:Asymptomatic intermittent microscopic hematuria.Recurrent episodes of gross hematuria occurring 1-2 days after an upper respiratory infectionProteinuria - frequently seen in males but may be absent in females.Progressive proteinuria can be severe enough to cause nephrotic syndrome.Extra renal manifestations:Bilateral sensorineural hearing loss (never congenital)Ocular abnormalities - anterior lenticonus (pathognomonic), macular flecks and corneal erosions.Rarely - Leiomyomatosis of the esophagus, tracheobronchial tree, and female genitals and platelet abnormalities.DiagnosisA careful family history+a screening urinalysis of first-degree relatives+an audiogram+ophthalmologic examination.Likely in the patient with hematuria and at least two of the followingMacular flecks, recurrent corneal erosions, GBM thickening and thinning, and sensorineural deafness.Absence of epidermal basement membrane staining for the a5 chain of type IV collagen in male hemizygotes and discontinuous epidermal basement membrane staining in female heterozygotes is pathognomonic for X-linked AS.Treatment:Progressive renal dysfunction leading to end-stage renal disease.Risk factors for progression - gross hematuria during childhood, nephrotic syndrome and prominent GBM thickening.Table for Different Electrolyte Imbalance:Combination of metabolic alkalosis, hypokalemia (high urinary losses of potassium and chloride, despite a state of relative volume depletion with secondary hyperaldosteronism), a high urine chloride level, and normal blood pressure is characteristic of Bartter syndrome, Gitelman syndrome and current diuretic use.Bartter syndrome is usually associated with hypercalciuria, and often with nephrocalcinosis.Children with Gitelman syndrome have low urinary calcium losses but hypomagnesemia as a consequence of urinary magnesium losses. | 154,122 | medmcqa_train |
Best antagonist of morphine is – | Naloxone is the preferred specific antidote for morphine poisoning. | 154,123 | medmcqa_train |
Filigree burns occur in ? | Ans. is 'a' i.e., Lightening Lightening burns Lightening refers to discharge of current between a negatively charged cloud and positively charged aicle on eah. During lightening, injuries result due to following mechanisms :- Direct effect of high voltage current. Heat, i.e. super heated air causing burns. Expanded and displaced air, which acts as a blast wave. Sledge hammer blow by compressed air pushed before the current (sledge hammer effect and blow death). The characteristic finding in lightening burns is filigree burns/ arborescent burns/arborescent marking/ litchenberg flower. In this burns are seen as coloured branching patterns, especially on shoulder and flanks. This branching distribution like inveed tree, does not correspond to blood vessels. | 154,124 | medmcqa_train |
The most common cause for chronic cor pulmonale is | Answer is B (COPD): The most common cause of chronic cor puhnonale is chronic. obstructive pulmonary disease - Rubin's pathology | 154,125 | medmcqa_train |
A 75-year-old thin cachectic woman undergoes a tracheostomy for failure to wean from the ventilator. One week later, she develops significant bleeding from the tracheostomy. Which of the following would be an appropriate initial step in the management of this problem? | The patient had a sentinel bleed from a tracheoinnominate aery fistula, which carries a greater than 50% moality rate. If the bleeding has ceased, then immediate fiberoptic exploration in the operating room is indicated. If the bleeding is ongoing, several stopgap measures can be attempted while preparing for median sternotomy in the operating room, including inflation of the tracheostomy balloon to attempt compression of the innominate aery, reintubation of the patient with an endotracheal tube, and removal of the tracheostomy and placement of the finger through the site with anterior compression of the innominate aery | 154,126 | medmcqa_train |
A Sentinel pile indicates | Ans. c (Fissure in ano) (Ref. Bailey and Love Surgery 26th/1250; Ref. Q. 216 of MH-2007).SENTINEL PILE- This misnomer is given to a skin tag marking--and often containing within it--the distal end of an anal fissure, found usually in the posterior midline. | 154,127 | medmcqa_train |
Which of the following is not characteristic of visceral pain - | • Visceral pain is poorly localized, often the pain is referred or radiating
• Pain of hollow viscus is often felt as a colic (it comes and goes to reappear again).
• Highly localized types of damage to the viscera seldom cause severe pain
• Often accompanied by vomiting and hypotension | 154,128 | medmcqa_train |
Hanup disease, limiting amino acid | It&;s an autosomal recessive disease. Absorption of aromatic amino acids from intestine as well as reabsorption from renal tubules are defective Patient improve when put on high protein diet with supplementation of niacin Hence the limiting amino acid is tryptophanRef: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 242 | 154,129 | medmcqa_train |
All of the following statements about Lymphoepethelioma of the parotid gland are true, except: | Lymphoepithelioma occur chiefly in the nasopharynx of young or middle aged persons. It also seen in the oropharynx, tongue, tonsil, parotid, nasal chamber and paranasal sinus. Ref: Shafer'S Textbook of Oral Pathology By Rajendran, 6th Edition, Pages 119-120; Epstein-Barr Virus By Erle S. Robeson, Page 60 | 154,130 | medmcqa_train |
Which of the following structure is not present in the transpyloric plane? | Transpyloric plane- An imaginary plane that passes at the lower border of L1 vertebra posteriorly and the tip of 9th costal cartilage anteriorly.
Structures at the Transpyloric plane
- Pylorus of stomach
- Hilum of kidney
- Beginning of duodenum
- Neck of pancreas
- Fundus of gallbladder
- Origin of the superior mesenteric vessel. | 154,131 | medmcqa_train |
Most common benign tumour of the stomach is ? | Ans. is 'a' i.e., Adenoma E ihtelial nolvus are the most common benign tumor of the stomach. They are of 5 types: a) Hyperplastic (regenerative) most common type (75%), with low malignant potential b) Adenomatous second most common, with high malignant potential (should be removed when diagnosed) c) Hamaomatous d) Inflammatory with negligible malignant potential e) Hetrotopic Polyps that are symptomatic, > 2 cm, or adenomatous should be removed, usually by endoscopic snare polypectomy. | 154,132 | medmcqa_train |
All are true regarding myositis ossificans progressive except | B i.e. Progressive form of normal myosites Fibrodysplasia (Myositis) Ossificans Progressiva Patho Histology - It is a rare autosomal dominant (AD) disorder of connective tissue differentiation. - Main pathogenic mechanism is defective regulation of the induction of endochondral ossification - Intense perivascular lymphocytic infiltration into normal skeletal muscles is the earliest featureQ - The proliferating loose myxoid fibrous tissue infiltrates and replaces normally formed fibrous connective tissue and striated muscle - Numerous small blood vessels, cells immunoreactive for S -100 protein and cailagenous foci are scattered among proliferating lesion. - Endochondral ossification is a feature of maturing lesion. Only the absence of normal anatomical orientation differentiates this hetrotropic bone from normal. Otherwise it demonstrates all features of normal bone modeling (i.e., coical & trabecular organization, medullary canal, metaphyseal funneling) and remodeling (i.e., respond to weight bearing stress, resistance to fatigue fracture) - Bone morphogenetic protein - 4 (BMP - 4) is over expressed and Basic fibroblast growth factor which is an extremely potent stimulator of angiogenesis (in vivo) is elevated in urine during acute flare up stage. Clinical features - In myositis ossificans progressiva, the life expectancy is decreased and the commonest causes of death is lung diseaseQ. This autosomal dominant disease is characterized by hetrotropic ossification most commonly involving spine and congenital defomities of hand &feetQ. The disease usually stas before 6 year of ageQ - Moality in fibrodysplasia ossificans progressive (myositis ossificans progressiva) is usually related to restrictive lung disease caused by an inability of chest to expandQ. - Begins in childhood usually before age of 6 yearsQ and becomes evident with in first 10 years of life. - Primary congenital skeletal abnormality is deformity of great toeQ. The toes may be sho, in valgus, monophalangic or have abnormal shaped proximal phalanx. - Begins as painful erythematous subfascial nodule mostly located on posterior aspect of neck & back which gradually calcify & eventually ossify (hetrotropic ossification) - The hetrotropic ossification progress in a axial to appendcular, cranial to caudal and proximal to distal direction. So the most commonly involved site is neck followed by spine & shoulder girdleQ. And same is the order for limitation of motion . - Trauma in form of tripping & falling, immunization, injection or biopsy stimulates new bouts of ossificationQ, and can be catastrophic. - The ossification is irreversible, unlike other forms of hetrotropic ossification. This condition is quite different from myositis ossificans traumaticaQ. - Diaphragm, extra ocular muscles & smooth muscles are characteristically sparedQ - Limitations of jaw mobility , extremely limited chest expnsionQ, reduced lung volumes 44% of normal) but relatively preserved flow rates and scoliosis / hypokyphosis are other feature Life expectancy is decreased and premature death usually result from respiratory failure Alt restrictive lung disease and their complicationsQ or from inanition caused by jaw ankylosis. | 154,133 | medmcqa_train |
Meningococcal polyvalent vaccine is routinely recommended to: | Ans. b. All healthy children between 5-7 years of age (Ref: Park 23/e p166, 22/e p157)'Quadrivalent (polyvalent) vaccines are administered as a single dose to individuals aged >_ 2 years.'- Park 22/e p157Meningococcal VaccinesPolysaccharide VaccinesConjugate Vaccines* Available against Meningococci of serogroup A, C, W135, and Y.* Types:- Bivalent (A, C)- Trivalent (A, C, W135)- Quadrivalent (A, C, W135, Y)* Polysaccharide vaccines are administered as a single dose to persons > 2 years old* Most of these vaccines are given subcutaneously* MC reaction is 1-2 days of pain and redness at the site of injection in 4-56% of recipients* More immunogenic, induce immunogenic memory* Types:- Monovalent (A or C)- Quadrivalent (A, C, W135, Y)* Given as IM injection, preferably in deltoid muscle (or in the anterolateral aspect of thigh in children <12 months)* Monovalent Men A conjugate vaccine should be given as a single dose to individuals 1-29 years of age* For Monovalent Men C conjugate vaccine, one single IM dose is recommended for children aged > 12 months, teenagers and adults. Children 2-11 months of age require 2 doses administration at an interval of at least 2 months and a booster about 1 year thereafter.* Quadrivalent vaccines are administered as a single dose to individuals aged > 2 years. | 154,134 | medmcqa_train |
Drug not causing exatithematous skin eruption – | Drugs causing exanthematic reactions
Most common : - Ampicillin and penicillin, Phenylbutazone and other pyrazolones, Sulphonamides, Phenytoin,
Carbamazepine, Gold, Gentamicin, Meprobamate, Atropine
Less common : - Cephalosporins, Barbiturates, Thiazides, Naproxen, Isoniazid, Phenothiazines, Quinidine. | 154,135 | medmcqa_train |
A 34-year-old woman is seen in the emergency depament. About 5 hours previously, she began to have nausea, vomiting, abdominal cramps, and diarrhea. She then developed double vision, which prompted her to ask her husband to bring her to the emergency depament. When she is asked to go into the examining room, she stumbles. When she tries to answer questions, her voice sounds odd and she seems to mumble. Physical examination demonstrates a dry mouth, drooping eyelids, markedly diminished pupillary light reflex, a flaccid facial expression, and difficulty in opening her mouth. Within an hour, her condition has markedly deteriorated. She can no longer stand and is intubated because of difficulty breathing. Which of the following microbial species is MOST likely to have caused her condition? | This is a typical presentation of botulism, which is caused by the preformed toxin of Clostridium botulinum. Patients develop a progressive flaccid paralysis that can lead to death if their respiratory system is not adequately suppoed. Mentation is intact in these patients, and they do not exhibit sensory changes except for those, such as the double vision, related to failure of extra- and intraocular muscles. Note: You are probably aware that botulism can follow ingestion of home canned vegetables, fish, fruits, and condiments. You may not be aware that other vehicles that have been the source of outbreaks include commercially prepared canned foods, poultry, and dairy products; and even restaurant-prepared non-canned foods including seafood, foil-wrapped baked potatoes, chopped garlic in oil, and patty melt sandwiches. For this reason, the absence of a classic history of ingestion of home canned food should not be used to exclude the diagnosis of botulism. Treatment is suppoive. Most patients recover from foodborne botulism without sequelae. You should also be aware that C. botulinum can cause true infection coupled with toxin production in wounds and in infants. Clostridium perfringens is one of the causes of gas gangrene. Clostridium ramosum has been associated with intra-abdominal infections after bowel perforation. Clostridium septicum has complicated colorectal malignancy. | 154,136 | medmcqa_train |
The rectum measures | The adult rectum is approximately 12-18 cm in length and is conveniently divided into three equal pas: the upper third, which is mobile and has a peritoneal coat; the middle third where the peritoneum covers only the anterior and pa of the lateral surfaces; and the lowest third, which lies deep in the pelvis surrounded by fatty mesorectum and has impoant relations to fascial layers. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1219 | 154,137 | medmcqa_train |
Tardy ulnar neuritis may be due to | B i.e. Cubitus valgus deformity | 154,138 | medmcqa_train |
Hemorrhagic cystitis is caused by : | Cyclophosphamide is a prodrug and is activated by hepatic biotransformation to aldophosphamide. One of its degradation products is acrolein that is responsible for hemorrhagic cystitis (its characteristic adverse effect). This adverse effect can be decreased by vigorous hydration and by the use of mercapto ethane sulfonic acid (mesna). | 154,139 | medmcqa_train |
In myasthenia gravis , all of the following are true except | Overall, women are affected more frequently than men, in a ratio of ~3:2. The cardinal features are weakness and fatigability of muscles. The weakness increases during repeated use (fatigue) or late in the day and may improve following rest or sleep. Unrelated infections or systemic disorders can lead to increased myasthenic weakness and may precipitate "crisis" The distribution of muscle weakness often has a characteristic pattern. The cranial muscles, paicularly the lids and extraocular muscles (EOMs), are typically involved early in the course of MG; diplopia and ptosis are common initial complaints. Facial weakness produces a "snarling" expression when the patient attempts to smile. Weakness in chewing is most noticeable after prolonged effo, as in chewing meat. Speech may have a nasal timbre caused by weakness of the palate or a dysahric "mushy" quality due to tongue weakness. Difficulty in swallowing may occur as a result of weakness of the palate, tongue, or pharynx, giving rise to nasal regurgitation or aspiration of liquids or food. Bulbar weakness is especially prominent in MuSK antibody- positive MG. In ~85% of patients, the weakness becomes generalized, affecting the limb muscles as well. Ref harrison 20th edition page 3232, 3233 | 154,140 | medmcqa_train |
Factor IX deficiency results in increased - | Ans. is 'b' i.e., PTT (Partial thromboplastin time) o Partial thromboplastin time (PTT): It tests the intrinsic and common coagulation pathways. So, a prolonged PTT can results from deficiency of factor V, VIII (factor VIIIc, Von willebrand factor), IX, X, XI, XII, prothrombin or fibrinogen.o Prothrombin time (PT): It tests the extrinsic and common coagulation pathways. So, a prolonged PT can results from deficiency offactor V, VII, X, prothrombin or fibrinogen.# Thus in common coagulation pathway defect both PT and PTT are elevatedo Activated clotting time (clotting time): It also tests the intrinsic and common coagulation system. So it is prolonged in deficiency of same factors as for prolonged PTT.o Thrombin time : It tests the conversion of fibrinogen to fibrin and is elevated in fibrinogen deficiency.o Bleeding time : this altered in platelet dysfunction. | 154,141 | medmcqa_train |
All of the following can be done with Individual as a unit except | Health education can be done individually BUT limitation is that the numbers we reach is really small, and health education is given to only those who come in contact with health system. | 154,142 | medmcqa_train |
Precursor of norepinephrine - | Ans. is 'b' i.e.. Tyrosine | 154,143 | medmcqa_train |
Persistent foetal lobulation of adult kidney is due to | In humans, embryologically, the kidneys originate as distinct lobules that fuse as they develop and grow. The lobulation of the fetal kidney is usually lost as the lobules become bonded together by the growth of new coex and the renal capsule. Persistent fetal lobulation is a normal variant seen occasionally in adult kidneys . It occurs when there is incomplete fusion of the developing renal lobules.It is often seen on ultrasound, CT or MRI as smooth indentations of the renal outline in between renal pyramids. They should be distinguished from renal coical scarring , which generally overlie the pyramids. Reference : radiopaedia.org/aicles/persistent-fetal-lobulation-of-the-kidneys | 154,144 | medmcqa_train |
CMV retinitis in HIV occurs when teh CD4 counts falls below - | CD4 count<100 cells/mm3 REF:<\p> MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.473 case-3 | 154,145 | medmcqa_train |
Drop metastases is seen in | Drop metastases - Dissemination through CSF giving rise to nodular masses at some distance from primary tumour. It is seen in Medulloblastoma | 154,146 | medmcqa_train |
Intra epidermal Bulla is seen in : | Ans. is 'b' Pemphigus "Pemphigus causes intraepidermal blistering because of loosening of desm somal links b/w epidermal cells caused by immunological attack- Roxburg, 16/e | 154,147 | medmcqa_train |
A young patient has a midline, tender swelling in neck occurring after an attack of sore throat. The diagnosis is - | Diagnosis in this case is subacute thyroiditis. Symptoms are more severe in acute thyroiditis with complications and acute thyroiditis is more common in children.
Just take a look of acute thyroiditis.
• Acute thyroiditis is rare and due to suppurative infection of the thyroid.
• More common in children and often is preceded by an upper respiratory tract infection or otitis media.
Etiology
The thyroid gland is inherently resistant to infection due to its extensive blood and lymphatic supply, high iodide content, and fibrous capsule.
Infectious Agents can Seed Thyroid
1. Via hematogenous or lymphatic route
2. Via direct spread from persistent pyriform sinus fistulae or thyroglossal duct cysts
3. As a result of penetrating trauma
4. Due to immunosuppression
• Streptococcus and anaerobes account for about 70% of cases.
• In children and young adults, MC cause is presence of a pyriform sinus (remnant of the fourth branchial pouch that connects the oropharynx with thyroid), such sinuses are predominantly left-sided.
• Long-standing goiter and degeneration in thyroid malignancy are risk factors in elderly.
Clinical Features
• Thyroid pain, often referred to the throat or ears, and a small, tender goiter.
• Fever, dysphagia and erythema over the thyroid.
• Systemic symptoms of a febrile illness and lymphadenopathy.
• Complications such as systemic sepsis, tracheal or esophageal rupture, jugular vein thrombosis, laryngeal chondritis, and perichondritis or sympathetic trunk paralysis may also occur.
Diagnosis
• ESR and WBC count are usually increased, but thyroid function is normal.
• FNA biopsy shows infiltration by polymorphonuclear leukocytes.
• Culture of the sample can identify the organism.
• Persistent pyriform sinus fistula should be suspected in children with recurrent acute thyroiditis. A barium swallow demonstrates the anomalous tract with 80% sensitivity.
Treatment
• Parenteral antibiotics and drainage of abscesses.
• Patients with pyriform sinus fistulae require complete resection of the sinus tract, including the area of the thyroid where the tract terminates, to prevent recurrence. | 154,148 | medmcqa_train |
Delorme's operation is for | Ans. B. Rectal prolapse. (Ref. LB 25th pg. 1225)RECTALPROPLASE# It may be mucosal or full thickness (whole wall included).# Commences as rectal intussusception.# In children, the prolapse is usually mucosal an should be Rxed conservatively.# In the adults, the prolapse is often full thickness and is frequently asociated with incontinence.# Surgery is necessary for full-thickness reactla prolpase.# The operation is performed either via perineum (Thiersch operation, Delorme's operation, &/or Altemeier operation) or via the abdomen (Well's operation, Ripstein's operation, or laparosocpic approach).Rx of RECTAL PROPLASE:# An abdominal rectopexy has a lower rate of recurrence but, when the patient is elderly and very frail, a perineal operation is indicated. As an abdominal procedure risks damage to the pelvic autonomic nerves, resulting in possible sexual dysfunction, a perineal approach is also usually preferred in young men.A. Perineal approach -These procedures have been used most commonly.# Thiersch operation- This procedure, which aimed to place a steel wire or, more commonly, a silastic or nylon suture around the anal canal, has become obsolete as the suture would often break or cause chronic perineal sepsis, or both, or the anal stenosis so created would produce severe functional problems. Delorme's operation is now the preferred perineal operation.# Delorme's operation- In this procedure, the rectal mucosa is removed circumferentially from the prolapsed rectum over its length. The underlying muscle is then plicated with a series of sutures, such that, when these are tied, the rectal muscle is concertinaed towards the anal canal. The anal canal mucosa is then sutured circumferentially to the rectal mucosa remaining at the tip of the prolapse. The prolapse is reduced, and a ring of muscle is created above the anal canal, which prevents recurrence.# Altemeier's procedure- This consists of excision of the prolapsed rectum and associated sigmoid colon from below, and construction of a coloanal anastomosis.B. Abdominal approach# The principle of all abdominal operations for rectal prolapse is to replace and hold the rectum in its proper position. They are recommended in patients with complete prolapse who are otherwise in good health.# Many variations have been described: in Wells' operation, the rectum is fixed firmly to the sacrum by inserting a sheet of polypropylene mesh between them; Ripstein's operation involves hitching up the rectosigmoid junction by a Teflon sling to the front of the sacrum; many surgeons simply suture the mobilised rectum to the sacrum using four to six interrupted non-absorbable sutures - so called sutured rectopexy. Recently, the technique has been performed laparoscopically. | 154,149 | medmcqa_train |
All of the following are true about Hepcidin except | Hepcidin, a 25-amino acid peptide secreted by hepatic Kupffer's cells downregulates duodenal iron absorption by regulating DMT1 activity as well as other proteins in the iron-responsive pathways (e.g., FP1). Hepcidin is a negative regulator of iron absorption because mice that fail to express hepcidin have elevated body iron stores, whereas mice with enhanced hepcidin expression have profound iron deficiency. . | 154,150 | medmcqa_train |
Which of the following is not responsible for the generation of Reactive Oxygen Species during Ischemia-Reperfusion Injury? | New damage may be initiated during reoxygenation by increased generation of ROS. Some of the ROS may be generated by injured cells with damaged mitochondria that cannot carry out the complete reduction of oxygen.
Cellular anti-oxidant defense mechanisms may be compromised by ischemia, exacerbating the situation.
ROS generated by infiltrating leukocytes also may contribute to the damage of vulnerable injured cells.
Activation of the complement system also may contribute to ischemia-reperfusion injury. Complement proteins may bind to the injured tissues, or to antibodies that are deposited in the tissues, and subsequent complement activation generates byproducts that exacerbate the cell injury and inflammation.
Robin’s Textbook of pathology 10th edit Page 43-44 | 154,151 | medmcqa_train |
Cyanotic hea disease with left axis detion is:- | --> Remember, tricuspid atresia is the only cyanotic hea disease with left axis detion. Tricuspid atresia: Congenital absence of Tricuspid valve. Right ventricle is hypoplastic Features: - Left ventricular type of apical impulse - Large 'a' waves in jugular venous pulse - Enlarged liver with presystolic pulsations - ECG : --> Left axis detion & left ventricular hyperophy --> Mean QRS axis is -450 Patients with tricuspid atresia follow a course similar to TOF OTHER OPTIONS: TGA --> Right axis detion Ebstein anomaly --> Himalayan P waves | 154,152 | medmcqa_train |
Not true about Chondroblastoma | Treatment is surgical, extended currettage with bone grafting. | 154,153 | medmcqa_train |
ABE (Acute Bacterial Endocarditis) is most commonly caused by: | Staph. aureus | 154,154 | medmcqa_train |
Which of the following nucleus of Hypothalamus is most closely related to sexual activity in males | A i.e.Preoptic nucleus - Sexual behavior is integrated in anterior-ventral hypothalamusQ; plus piriform coex (in males only) - Ganong - Sexual drive can be stimulated from several areas of hypothalamus, especially the most anterior and most posterior poions of hypothalamusQ (Guyton) - Medial preoptic area (MPOA) or the most anterior poion of hypothalamus is most impoant integrative nucleus involved in sexual behavior regulation of males in all veebratesQ. It integrates the male sexual behavior by receiving all indirect inputs from every sensory organ and sends efferents to structures that are critical for initiation and patterning of copulation. Therefore, stimulation of MPOA enhances sexual activity in males, whereas its damage consistently impairs male sexual behavior. Integrating Areas of Hypothalamus Function Anterior hypothalamus (response to heat), Temprature regulation (anteriorly Posterior hypothalamus (response to cold) hot, posteriorly cold) Suprachiasmatic nuclei Control of circadian body rhythm Punishment centers (esp periventricular zone of hypothalamus adjacent to 3rd ventricle, lateral Defensive reactions (fear, anger, rage, punishment, fighting)= hypothalamus & central grey area of mesencephalon) are stimulatory and ventromedial nuclei of hypothalamus, hippocampi, anterior limbic coex (esp anterior cingulate gyri and subcallosal gyri) are inhibitory to fear (punishment) Unpleasant sensation (Aversion) Reward centers locatd along the course of medial Calmness (Placidity, tameness & forebrain bundleQ especially in lateral and ventromedial tranquility) = Pleasant sensation nuclei of hypothalamus are self stimulatory (Reward or satisfaction) Appetitive Behavior Lateral (superior) hypothalamusQ Thirst Lateral hypothalamus activity level Hunger (eating) & increased Venteromedial nucleusQ, arcuate & paraventricular nuclei Satiety (Decreased eating) & tranquility Anterior ventral hypothalamus; most anterior (medial preoptic area=MPOA) & most posterior poions of hypothalamusQ; piriform coex (in males only) Sexual drive Neuroendocrinal control of Preoptic area FSH & LH Gn RH Supraoptic & paraventricular nuclei Vasopressin, Oxytocin Paraventricular nuclei TSH (thyrotropin) TRH ACTH & [3- lipotropin 03-LPH) CRH Paraventricular nucleus and arcuate nucleus GH somatostatin & GRH Arcuate nucleus; (hypothalamus inhibits secretion) Prolactin PIH & PRH Dorsal & posterior hypothalamus Catecholamines | 154,155 | medmcqa_train |
Growth phase of hair is | A i.e. Anagen | 154,156 | medmcqa_train |
True about follicular lymphoma: | Answer- A. Lymphadenopathy is the most common presentationIt is the tumor of germinal centre (follicular centre), B cells, and is strongly associated with chromosomal translocation involving Bcl 2.Growth pattern is nodular (follicular) or nodular (follicular) and diffuse.The neoplastic cells closely resemble normal germinal centre B cells, expressing CD19, CD 20, CD 10, surface Ig, and Bcl 6.In most follicular lymphomas, centrocytes predominate.It usually presents in middle age and affects males and females equal.The most common presentation for follicular lymphoma is with new painless lymphadenopathy. | 154,157 | medmcqa_train |
The type of estrogen found in highest concentration in adult female is- | Ans (c) Estradiol(Ref: Ganong, 25th ed/p.406)Naturally occurring estrogens are,Estradiol (E2 ) - predominant estrogen during reproductive yearsEstrone (E1) - predominant estrogen in menopausal womenEstriol (E3) - predominant estrogen in pregnant women | 154,158 | medmcqa_train |
True about translation of protein is | A i.e. It has 3 steps initiation, elongation & termination | 154,159 | medmcqa_train |
Which of the following is not seen in testicular carcinoma? | Testicular tumors MC presentation is a nodule or painless swelling of one gonad. 10% patients present with acute pain or manifestation due to secondaries like neck or abdominal masses, GI disturbances, respiratory or CNS symptoms, bone pain or lumbar backache due to nerve roots involvement by bulky retroperitoneal disease Secondary hydrocele is also seen in 5-10% cases 5% GCT may present with gynecomastia as a systemic endocrine manifestation Gynecomastia is more common seen with sex cord or gonadal stromal tumors (Leydig cell tumor, seoli cell tumor, Granulosa cell tumor/Theca cell tumor) Majority (2/3rd) of seminoma are confined to testis at the time of presentation, whereas majority of non-Seminomatous GCT have widespread metastasis at presentation Many patients would present with a history of trauma, but trauma merely draws the attention of the patients and has no etiological association with tumor Any patients with a solid form intra testicular mass must be considered to have testicular tumor unless otherwise proved Bilateral testicular tumors Bilateral testicular tumors are seen in 1-2% cases Primary bilateral testicular tumors have Tendency of same histology on both sides Seminoma is the MC histological finding in bilateral primary testicular tumor, whereas malignant lymphoma is the MC bilateral testicular tumor Ref: Bailey and love 27th edition Pgno : 1506 | 154,160 | medmcqa_train |
Suckling mice is used in the isolation of? | Arbovirus REF: Jawetz's, Melnick, & Adelberg's Medical Microbiology, 24th edition cchapter 47. Principles of Diagnostic Medical MicrobiologyRecovery of Arbovirus and detection:Virus isolation attempts require appropriate biosafety precautions to prevent laboratory infections. Virus occurs in the blood only early in the infection, usually before the onset of symptoms. Virus can also be found in cerebrospinal fluid and tissue specimens, depending on the agent. Alpha viruses and flaviviruses are usually able to grow in common cell lines, such as Vero, BHK, HeLa, and MRC-5. Mosquito cell lines are useful. Intra cerebral inoculation of suckling mice or hamsters may also be used for virus isolation. | 154,161 | medmcqa_train |
Synaptic potential can be recorded by: | Synaptic potential is recorded with inserting one microelectrode inside cell and one electrode outside the cell. | 154,162 | medmcqa_train |
True about neuroblastoma:a) Tumor of autonomic nervous systemb) Metastasis rarely presentc) Earliest detected in late childhoodd) Most common site is Adrenal medulla | Neuroblastoma is a malignant tumor of the autonomic nervous system. It is a neuroendocrine tumor, arising from any neural crest element of the sympathetic nervous system.
Neuroblastoma is a disease of early childhood with approximately 90% of patients presenting before 5-years of age and almost 50% within the first 2-years of life.
In childhood, about 40% of neuroblastomas arise in the adrenal medullae. The remainder occurs anywhere along the sympathetic chain, with the most common locations being the paravertebral region of the abdomen (25%) and posterior mediastinum (15%). Tumors may arise in numerous other sites, including the pelvis and neck and within the brain (cerebral neuroblastomas).
It is the second most common solid malignancy of childhood.
In young children, under age 2 years, neuroblastomas generally present with large abdominal masses, fever, and possibly weight loss. In older children, they may not come to attention until metastases produce manifestations, such as hone pain, respiratory symptoms, or gastrointestinal complaints.
Neuroblastomas may metastasize widely (Present in 60-70%- O.P. Ghai 7th/5990) through the hematogenous and lymphatic systems, particularly to liver, lungs, and bones, in addition to the bone marrow.
Proptosis and ecchymosis may also be present because the periorbital region is a common metastatic site. Bladder and bowel dysfunction may be caused by paraspinal neuroblastomas that impinge on nerves.
In neonates, disseminated neuroblastomas may present with multiple cutaneous metastases with deep blue discoloration to the skin (earning the rather unfortunate designation of "blueberry muffin baby)"
About 90% of neuroblastomas, regardless of location, produce catecholamines (similar to the catecholamines associated with pheochromocytomas), which are an important diagnostic feature (i.e., elevated blood levels of catecholamines and elevated urine levels of metabolites, vanillylmandelic acid (VMA), and homovanillic acid (HVA)
Children older than age 5 years usually have extremely poor outcomes irrespective of the stage (Robbins 7th/500-503)
NB can present as a paraneoplastic syndrome of autoimmune origin manifesting as ataxia or opsomyoclonus ("dancing eye & dancing feet"). | 154,163 | medmcqa_train |
To initiate transcription RNA polymerase does not require which one of the following: | DNA polymerase can only elongate existing polynucleotide chains, and thus requires a primer. RNA polymerase can initiate RNA synthesis de novo and hence does not require a primer. Ref: Molecular Biology of the Gene Watson, 2004, Page 376 ; Lippincott's Illustrated Q & A Review of Biochemistry by Michael A. Lieberman, Rick Ricer, 2009, Page 294 | 154,164 | medmcqa_train |
Pulmonary fibrosis is an adverse effect of which of the following anti-cancer drugs? | Anticancer drugs causing pulmonary fibrosis are Bleomycin Busulfan Methotrexate Cyclophosphamide Carmustine | 154,165 | medmcqa_train |
A 30-year-old male evaluated for loss of erection is found to have low testosterone and high prolactin level in blood. What is the most likely diagnosis? | Pituitary adenomas are most commonest cause of pituitary hormone hypersecretion and hyposecretion syndromes, common in adults. Hyperprolactinemia is the most common pituitary hormone hypersecretion syndrome in both men and women. PRL-secreting pituitary adenomas (prolactinomas) are the most common cause of PRL levels >200microgram/L. Pituitary adenomas are a result of excessive secretion of prolactin, inhibiting hypothalamic release of LHRH resulting in defective LH and FSH secretion. This defective LH and FSH secretion results in decreased levels of estrogen in females and testosterone in males. This is a reason how excessive prolactin can cause hypogonadism. In men with hyperprolactinemia, diminished libido, infeility, and visual loss (from optic nerve compression) are the usual presenting symptoms. Amenorrhea, galactorrhea, and infeility are the hallmarks of hyperprolactinemia in women. If hyperprolactinemia develops before menarche, primary amenorrhea results. Basal, fasting morning PRL levels (normally <20micrograms/L) should be measured to assess hypersecretion.the diagnosis of prolactinoma is likely with a PRL level >200 micrograms/L. PRL levels <100micrograms/L may be caused by microadenomas. MRI should be performed in all patients with hyperprolactinemia. Dopamine agonists are effective for most causes of hyperprolactinemia. An ergoline derivative, cabergoline is a long-acting dopamine agonist with high D2 receptor affinity. The drug effectively suppresses PRL for >14 days after a single oral dose and induces prolactinoma shrinkage in most patients. The ergot alkaloid bromocriptine mesylate is a dopamine receptor agonist that suppresses prolactin secretion. Indications for surgical adenoma debulking include dopamine resistance or intolerance and the presence of an invasive macroadenoma with compromised vision that fails to improve after drug treatment. Ref: Harrison's Internal Medicine, 18th Edition, Pages 2880, 2887-2890, 3051, 3389, 2897-2899 | 154,166 | medmcqa_train |
All are true statement about filaria except - | - Man is the definitive host and mosquito the intermediate host in Bancroftian and Brugian filariasis. - Adults live in the lymphatic system of host. - The female worms in humans may give bih to as many as 50,000 microfilaria per day.No multiplication in the mosquito. - the extrinsic incubation period is 10-14 days . Reference : Park's textbook of preventive and social medicine, 23rd edition pg no:271 <\p> | 154,167 | medmcqa_train |
Congenital dacrocystitis, the block is at? | Ans. is 'b' i.e., Nasolacrimal duct Congenital dacryocystitis (Dacryocvstitis neonatorum) It is the inflammation of lacrimal sac in the newborn. It is due to congenital blockage of nasolacrimal duct. Congenital dacryocystitis usually presents as a mild grade chronic inflammation. It is characterized by :? Epiphora develops after seven days of bih followed by mucopurulent discharge. Regurgitation of mucopurulent discharge on pressure over the sac area, i.e.,positive regurgitation test Swelling over the sac area Treatment includes :? Massage over lacrimal sac with topical antibiotics:- Cures obstruction in about 90% of infants spontaneous recanalization of obstructed nasolacrimal duct can occur upto 9 months. Lacrimal syringing:- Syringing with normal saline and antibiotic solution is performed if the condition is not cured up to the age of 9-12 months. Probing of nasolacrimal duct:- It is performed if the condition is not cured by 1-12 months Intubation with silicon tube Dacryocystorhinostomy:- It is performed if the child is brought very late or above described procedures fail. | 154,168 | medmcqa_train |
Which of the following is false about Botulism? | Ans. is 'c' i.e.. It is an infection and not intoxication Botulismo It is a form of food poisoning.o Botulinum toxin is a potent neurotoxic protein. It paralyses the nerve endings by blocking the nerve impulses at the myoneural junction. It blocks the action of acetylcholine,o Botulism is an intoxication, not an infection. Clostridium botulinum organism does not grow in the body.o The causative organism is Cl. botulinum. It multiplies in food (sausages, tinned meat) before it is consumed, and produces a powerful exotoxin under suitable anaerobic conditions. | 154,169 | medmcqa_train |
Aboifacient causing ototoxicity is : | Quinine | 154,170 | medmcqa_train |
All constitutes Berlin definition of acute respiratory distress syndrome :-except | Berlin definition of acute respiratory distress syndrome comprises-- Timing - within 1 week of known clinical insult Chest imaging - Bilateral opacities - not fully explained by effusions collapse Origin of edema - Respiratory failure not fully explained by cardiac failure or fluid overload. Oxygenation Mild - 200<PaO2 / FiO2 < 300 with PEEP or CPAP > 5cm H2O Moderate - 100 < PaO2 / FiO2 < 200 with PEEEP > 5 cm H2O Severe - PaO2 / FiO2 <100 with PEEP > 5 cm H2O | 154,171 | medmcqa_train |
Cervical was are seen with which HPV | Cervical was are seen with HPV type 6,11 which are of low oncogenic potential and HPV type 16,18 which are of high oncogenic potential. From illustrated synopsis of dermatology and sexually transmitted diseases neena khanna 5th edition page no 287 | 154,172 | medmcqa_train |
Unconjugated hyperbilirubinemia with increased urobilinogen is seen in | . | 154,173 | medmcqa_train |
Features of arboviral infection: | Ans: c) High titre.... Ref: Microbiolgy, Green wood 17th edArbo virus induce high titresof viremia in susceptible vertebrates 1-4 days after parentral inoculation or following bites by infected arthropods. Viremia persists fupto & serves as a source of infective blood meals for other biting arthropods. | 154,174 | medmcqa_train |
Which of the following receptors mediate stretch reflex: | Muscle spindle are distributed throughout the belly of muscle & send information to Nervous system about (i) Muscle length (ii) Rate of change of muscle length Golgi tendon organ is located in muscle tendons transmits information about (i) Tendon tension (ii) Rate of change of Tendon tension Muscle stretch | Intrafusal fibers of muscle spindles stretched | Signal from muscle spindles receptor Ia afferents | Enter spinal cord & end on a motor neuron | a motor neuron carries efferent to extrafusal fibers | Brief contraction = stretch reflex (Monosynaptic) MEISNER CORPUSCLE - Present in non-hairy pas of skin (Finger tips, lips etc.) and other areas where ability to discern spatial locations of touch sensation are highly developed - They adapt in fraction of a second after stimulation hence are paicularly sensitive to movement of objects over skin surface as well as low frequency vibrations MERKELS DISC - Expanded tip tactile receptors - Transmit an initially strong but paially adapting similar then continuing weaker signal that adapt slowly - Determine continuous touch of objects against skin | 154,175 | medmcqa_train |
Which of the following incision used in diaphragm surgery is safest | Circumferential is the safest as it prevents injury to phrenic nerve to maintain the function of the diaphragm | 154,176 | medmcqa_train |
A 3-year-old child has eczematous dermatitis on extensor surfaces. His mother has a history of Bronchial asthma. Diagnosis should be – | In this question:-
The child is 3 years old
History of Asthma in mother
Extensor involvement
First two points suggest the diagnosis of atopic dermatitis (childhood pattern).
About third point (extensor involvement) :-
"Though childhood atopic dermatitis mainly involves flexural parts, less commonly extensor surfaces may also be involved".
Further, you can easily rule out other three options:-
Contact dermatitis
The family history of asthma is not important.
No history of contact to an allergen.
Seborrheic dermatitis
Occurs in adults and less frequently in infants but not in children.
Infantile eczematous dermatitis
Occurs in Infant. | 154,177 | medmcqa_train |
Fungus causing otomycosis most commonly is | Otomycosis Otomycosis is a fungal infection of the ear canal that often occurs due to Aspergillus niger, A. fumigatus( niger > fumigatus) or Candida albicans. It is seen in hot and humid climate of tropical and subtropical countries. Secondary fungal growth is also seen in patients using topical antibiotics for treatment of otitis externa or middle ear suppuration. clinical features: include intense itching, discomfo or pain in the ear, watery discharge with a musty odour and ear blockage. The fungal mass may appear white, brown or black and has been likened to a wet piece of filter paper. Examined with an otoscope: A. niger appears as black- headed filamentous growth, A. fumigatus as pale blue or green and Candida as white or creamy deposit. Meatal skin appears sodden, red and oedematous. Ref:- Dhingra; pg num:-52 | 154,178 | medmcqa_train |
Ibalizumab was approved by FDA in 2018 April for | Ibalizumab was approved for HIV in 2018 Ibalizumab belongs to a new class of HIV drugs called post-attachment inhibitors. Post-attachment inhibitors work by attaching to the CD4 receptor on the surface of the immune cells. When ibalizumab attaches to the CD4 receptor, HIV cannot attach to, enter, or infect the cell. Ref - Harrisons 203 pg 1457 , pubmed.com | 154,179 | medmcqa_train |
Mamillary body receive afferent fibers | Mammillary body receive afferent fibers Fornix C - shaped bundle of nerve fibers which acts as major output tract of hippocampus They are association fibers(connects one brain center to another) It is pa of limbic system (Papez circuit) Papez circuit - for memory consolidation, emotions & behavior | 154,180 | medmcqa_train |
Contraindications for oral contraceptive are following except : | More than 30 years old | 154,181 | medmcqa_train |
You have checked the blood oestradiol levels of your patient and it comes as 150 pg/ml. The woman is LEAST likely to be in which phase of menstrual cycle? | The normal oestradiol and progesterone levels during menstrual cycle is given below Oestradiol Follicular phase 30 - 200 pg/ml Ovulation phase 200 - 600 pg/ml Luteal phase 30 - 200 pg/ml Progestrone Follicular phase 0.06 - 3 mg/ml Luteal phase 4.5 - 20 pg/ml Ref: Essentials of Gynaecology by Lakshmi Seshadri, Edition 1, page - 43. | 154,182 | medmcqa_train |
Taxidermy is:- | Taxidermy Process of preparing dead bodies for the purpose of anatomy dissections by injecting solutions of arsenic sulphide or oxide, lead sulphide, potassium carbonate with or without into the femoral and other big aeries. | 154,183 | medmcqa_train |
Small intestinal peristalsis is controlled by : | Myenteric (Auerbach&;s) plexus is situated b/w and innervates outer longitudinal & middle circular muscular layers and is primarily concerned with motor controlQ. Submucosal (meissner&;s) plexus situated between middle circular layer and mucosa is primarly concerned with control of intestinal secretionQ as it innervates glandular epithelium, intestinal endocrine cells & submucosal blood vessels. Ref: Guyton 12th Ed. | 154,184 | medmcqa_train |
Teduglutide is a recently introduced drug for Sho Bowel Syndrome- What is it | Teduglutide: GLP-2 Analogue:- * Randomized controlled trials have shown that teduglutide, a GLP-2 analogue that is resistant to degradation by the proteolytic enzyme dipeptidyl peptidase 4 and therefore has a longer half-life than GLP-2, is well tolerated and has led to the restoration of intestinal functional and structural integrity through significant intestinotrophic and pro absorptive effects. Ref:- Surgery Sixer 3rd Edition; Pg num:- 425 | 154,185 | medmcqa_train |
Paranoid delusions are a/w use of: | A i.e. Cocaine Marijuana (cannabis, THC) causes perception of relaxation, mild euphoria, impairs thinking, concentration, perception and psychomotor functions. Most common physical effcts of cannabis are dilation of conjunctival blood vessels (red eye) or conjunctival injection, and tachycardia > increased appetite (the munchies) and drymouthQ. At high doses ohostatic hypotension may appear. Cannabis intoxication commonly heightens users sensitivity to external stimuli, reveals new details, make colors seem brighter and richer than in the past, and subjectively slows the appreciation of timeQ. In high doses it produces depersonalization and derealization. Motor skills are impaired (interfering with the operation of motor vehicle and heavy machinery) remains for 8-12 hrs after euphoriant effects have resolved. If intact reality testing is not present, the diagnosis is cannabis induced psychotic disorder. It is rare; transient paranoid ideation (delusional belief) is more commonQ. The psychotic episodes are k/a hemp insanity (Kaplan -419) Persons use cocaine for its characteristic effects of elation, euphoria, heightened self esteem and perceived improvement on mental and physical tasks. With high doses, features of intoxication include agitation, irritability, impaired judgement, impulsive & potentially dangerous sexual behavior, aggression , a generalized increase in psychomotor activity and symptoms of mania, with tachycardia, hypeension and mydriasis. Paranoid delusions and hallucinations can occur in upto 50% of all persons who use cocainQ. Cocaine induced psychotic disorders are most common in IV and crack users (men > women). Paranoid delusions are the most common psychotic symptomsQ. Auditory hallucinations are also common, but visual and tactile hallucinations (formication = sensation of bugs crawling just beneath the skin) are less common than paranoid delusions. | 154,186 | medmcqa_train |
A 55 years aged chronic alcoholic male, presented with irrelevant talks, tremor and sweating. He had his last drink 3 days back. What will the probable diagnosis? | The description of symptoms is related to the condition "Delirium Tremens" * Delirium Tremens / Alcohol Withdrawal Delirium (AWD): * Most severe form of ethanol withdrawal manifested by, # Altered mental status (Global confusion) # Autonomic hyperactivity (Sympathetic overdrive) * Mechanism: * Alcohol abuse affects neurotransmitter systems in brain mainly by, # Loss of GABA inhibitory mechanism - Reduces chloride ion influx. # Alcohol acts as NMDA receptor antagonist - Withdrawal increases the excitatory neurotransmitter. * The clinical manifestations of ethanol withdrawal are combination effects of GABA & NMDA receptor activity. * Thus causing tremors, diaphoresis, tachycardia, anxiety & in severe cases Seizure. REF: DAVIDSONS 10TH ED | 154,187 | medmcqa_train |
Internal hordeolum is due to inflammation of- | Internal hordeolum It is suppurative inflammation of the meibomian gland which is associated with blockage of the duct. C/F: acute severe pain and swelling of eye lid away from the margin, mild watering and photophobia The pain is more intense in internal than external hordeolum, due to the swelling being embedded deeply in the dense fibrous tissue. External hordeolum- It is an acute suppurative inflammation of lash follicle and its associated glands of Zeis or Moll. | 154,188 | medmcqa_train |
Mousy odour urine is seen in | Mousy order urine is seen in phenylketonuria due to the presence of excessive phenylalanine and its metabolites.Mousy body odour is also present due to the excretion of phenyl lactic acid,its metabolite through sweat. Reference:Essential pediatrics-Ghai,8th edition,page no:652. | 154,189 | medmcqa_train |
Sodium Thiopentone is ultra short acting d/t – | All iv inducing agent has rapid redistribution, therefore reversal occurs very early. | 154,190 | medmcqa_train |
Which of the following statements is false | It is impoant to recognize that hypoxia in tumours can result from two quite different mechanisms. Chronic hypoxia results from the limited diffusion distance of oxygen through tissue that is respiring. The distance to which oxygen can diffuse is largely limited by the rapid rate at which it is metabolized by respiring tumour cells. Many tumour cells may remain hypoxic for long periods of time. In contrast to chronic hypoxia, acute hypoxia is the result of the temporary closing of a tumour blood vessel owing to the malformed vasculature of a tumour, which lacks smooth muscle and often has an incomplete endothelial lining and basement membrane. Tumor cells are exposed to a continuum of oxygen concentrations, ranging from the highest in cells surrounding the capillaries to almost anoxic conditions in cells more distant from the capillaries. This is significant because both chronic and acute hypoxia has been shown to drive malignant progression.Reference: Eric J Hall Textbook of Radiobiology for Radiologist; 5th edition | 154,191 | medmcqa_train |
Primary Amenorrhea:a) Absence of Menarche by 14 Years without secondary sexual charactersb) Absence of Menarche by 16 Yrs with secondary sexual charactersc) Absence of secondary sexual characters by Yrsd) Endometriosis | Primary amenorrhea is a condition when a female has not attained menarche by the age of 14 years in the absence of growth or development of secondary sexual characteristics.
OR
No menarche by the age of 16 years regardless of the presence of normal growth and development of secondary sexual characteristics. | 154,192 | medmcqa_train |
the above marked structures are seen in all except ? | GAMMA GANDY BODIES WERE SEEN IN SICKLE CELL ANEMIA ,CML AND CIRRHOSIS .THEY ARE DEPOSITS IN CONGESTIVE SPLEENOMEGALY WHICH CONTAINS : IRON +CALCIUM + FIBROUS TISSUE OF SPLEEN Sickle Cell Anemia 1) Single nucleotide substitution ("point mutation") in the gene for the beta chain of hemoglobin. 2) Different amino acid gets placed in the peptide chain.. 3) Beta chain synthesized from the sickle-cell allele does not "fold" correctly and hempglobin molecules "clump" together forming a red blood cell that resembles a sickle. 4) Sickled cells die early (10-20 days vs. 120 days) producing anemia. 5) Sickled cells clog the fine capillaries, leading to lack of oxygen in target organs. * A blood test can check for hemoglobin S -- the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is pa of routine newborn screening done at the hospital. But older children and adults can be tested, too. * In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, fuher tests will be done to determine whether one or two sickle cell genes are present. Check for a low red blood cell count (anemia) will be done. REF: ROBBINS 10TH ED | 154,193 | medmcqa_train |
All of the following are true about Rett's disease, Except : | Rett's disease is more common in females. | 154,194 | medmcqa_train |
Which of the following is the new drug for the treatment of multi drug resistant tuberculosis | Refer Harrison 19th/p1115 Bedaquline is a new drug approved for MDT tuberculosis. It acts by inhibiting ATP synthatase in mycobacterium . Major adverse effects of this drug is "QT prolongation | 154,195 | medmcqa_train |
A 40 year old patient has undergone an open chlecystectomy. The procedure was reported as uneventful by the operating surgeon. She has 100 ml of bile output from the drain kept in the gallbladder bed on the first post operative day. On examination she is afebrile and anicteric. The abdomen is soft and bowel sounds are normally heard. As an attending physician. What should be your best possible advice? | Ans. is 'd' i.e. Clinical observation 100 ml. of Bile output from the patient on the 1st postop. day without any other abnormality is of no clinical significance, so does not warrant any action from the surgeon. But remember if passing of 100 ml of bile continues for 5-6 days then it is considered abnormal. It denotes bile duct injury.Oxford textbook of Surgery writes - "Even after a straightforward cholecystectomy there may be a little bile in the drain the following day."Textbook of Liver and Biliary Surgery writes - "A small amount of biliary> drainage following cholecystectomy should cause no alarm because it usually disappears within 1 or 2 days. However, excessive biliary drainage through the wound or drain site, jaundice, sepsis, or a combination of these events early in the post op. period should suggest a bile duct injury, as should copious biliary drainage for more than a few post-op days". | 154,196 | medmcqa_train |
True regarding osteosarcoma is - | Osteosarcoma arises from primitive bone forming cells.
Sunray appearance and Codman's triangle indicate periosteal new bone formation.
Osteosarcoma occurs in childhood or young adult (10-25 years).
Blood metastasis is most common (not lymphatic). | 154,197 | medmcqa_train |
Which of the following infection is transmitted through rat urine? | Humans are infected when the leptospires in water contaminated by the urine of carrier animals (rats, dogs, cattle, and pigs), enters the body through cuts or abrasions on the skin / through intact mucosa of mouth, nose or conjunctiva. The incubation period is 2-20 days. Ref: Current Medical Diagnosis and Treatment 2012, Chapter 34 ; Textbook of Microbiology By Ananthanarayan and Panicker, 8th Edition, Pages 381-383 | 154,198 | medmcqa_train |
Late deceleration indicates : | Ans. is c i.e. Fetal hypoxia | 154,199 | medmcqa_train |
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