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Best indicator for growth measurement is- | Ans. is 'b' i.e., Weight o Measurement of weight and rate of gain in weight are the best single parameters for assessing physical growth. | 154,200 | medmcqa_train |
zone which is absent when repair is done with MTA as compared to calcium hydroxide: | Zones formed with calcium hydroxide (CH) pulp therapy from below CH to normal pulp are:
Zone of liquefactive necrosis
Zone of coagulative necrosis
Inflammatory response
Hard tissue barrier with vascular inclusions.
The necrosis with pure CH is due to its high PH. But dycal which is a hard setting CH formulation forms hard tissue barrier without causing necrosis.
Zones formed with MTA pulp therapy
Very narrow or even absent coagulative necrosis
Reparative dentinogenesis zone resulting in dentin bridge with fewer vascular inclusion (high quality).
MTA is a biocompatible material. The excellent bacteria-tight seal accounts for the success with MTA. | 154,201 | medmcqa_train |
Major bacterial enzyme responsible for putrefaction? | Ans. is 'b' i.e., Lecithinase Putrefaction Produced mainly by the action of bacterial enzymes (lecithinase -- Cl. welchii) Anaerobic organism (from bowels) Causing marked hemolysis and liquefaction in blood vessels and tissue spaces, thus producing following effects Color changes : greenish discoloration in right iliac fossa abdomen --> genitalia -4 chest --> neck --> face - arms -4 legs. Superficial veins over the root of the limbs, thighs, sides of abdomen, shoulder, chest and neck are stained greenish-brown or purplish-red, marbled appearance in 36 to 48 hours (marbling). Foul-smelling and breakdown of proteins and carbohydrates. Gases produced : CO2 + NH3 + CH4 mercaptans + mercaptans (noninflammable) + H2S (inflammable). Gas bubbles cause crepitation and give spongelike feeling. Blood-stained froth from mouth and nostrils is called postmoem purge. Distension of body 36 to 48 hours Anus and uterus prolapse : 2 to 3 days PM blisters, face distroted : more than 3 days Nail, skull sutures, and hair loss : more than 5 days Skin shows slippage, comes off in glove and stocking fashion. Postmoem luminescence due to : Photobacterium fischeri bacteria and Armillaria mellea fungi. | 154,202 | medmcqa_train |
In a healthy adult scheduled for an elective operation, solid food shoulder be withheld for at least .......... hours before surgery | Nil by mouth and regular medications Patients are advised not to take solids within 6 hours and clear fluids (isotonic drinks and water) within 2 hours before anaesthesia to avoid the risk of acid aspiration syndrome. These restrictions are fuher reduced in infants, as keeping hydrated reduces discomfo and is known to improve post- operative outcomes. If the surgery is delayed, oral intake of clear fluids should be allowed until 2 hours before surgery or intravenous fluids should be staed, especially in vulnerable groups of patients, e.g. children, the elderly and diabetics. Patients can continue to take their specified routine medications with sips of water in the NBM period. Ref: Bailey and love 27th edition Pgno : 259 | 154,203 | medmcqa_train |
Duodenal ulcer, true statement is - | Answer- A. Never MalignantDuodenal ulcer is more common in persons with blood group'O', i.e., containing no AB antigens with blood group'O" i'e"containing no AB antigens.Bleeding is more common in duodenal ulcer than in gastric ulcer. | 154,204 | medmcqa_train |
Recurrent laryngeal nerve supply all the intrinsic muscles of the larynx EXCEPT | C. i.e. (Cricothyroid) (260, 275 - Dhingra 4th)MUSCLES OF LARYNXINTRINSIC MUSCLES EXTRINSIC MUSCLES(a) Acting on vocal cords* Abductors - Posterior cricoarytenoids* Adductors - Lateral cricoarytenoid* Interarytenoid (Transverse arytenoids)* Thyro arytenoids (external part)* Tensors - Cricothyroid vocalis (Internal part of thyroarytenoid)(b) Acting on laryngeal inletOpeners of laryngeal inletThyroepiglotticClossers of the laryngeal inletInter arytenoids Aryepiglottic(a) Elevators - stylopharyngeus(Primary)- Salpingopharyngeous- Palatopharyngeus- Thyrohyoid(Secondary)- Mylohyoid- Digastric- Stylohyoid- Geniohyoid(b) Depressors- Sternohyoid- Sternothyroid- Omohyoid* All the muscles of the larynx which move the vocal cord (Abductors, adductors or tensors) are supplied by the recurrent laryngeal nerve EXCEPT the cricothyroid muscle*** Cricothyroid is supplied by external laryngeal nerve - a branch of superior laryngeal nerve*** Topical mitomycin C is useful to aid in the treatment of surgery for laryngotracheal stenosis*** | 154,205 | medmcqa_train |
Which of the following is true regarding IUGR baby is | Usually head circumference is more than abdomen circumference in intrauterine growth retardation babies Reference: GHAI Essential pediatrics, 8th edition | 154,206 | medmcqa_train |
Epidemiology of cholera in England was clasified by | An english epidemiologist John Snow studied the epidemiology of cholera in London from 1848 to 1854. Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition | 154,207 | medmcqa_train |
The mechanism by which most fungi cause disease is: | Hypersensitivity Diseases
Humans are continually exposed to air-borne fungal spores and other fungal elements present in the environment. These spores can be antigenic stimulants and depending on individual's immunological status may induce a state of hypersensitivity by production of immunoglobulins or sensitized lymphocytes. Rhinitis, bronchial asthma, alveolitis, and various forms of atopy are the clinical manifestations of hypersensitive pneumonitis. The clinical manifestations of the hypersensitivity disease are seen only in sensitized person, after repeated exposure to the fungus, fungal metabolites, or other cross-reactive materials. Allergies to the fungal spores are manifested primarily by an asthmatic reaction including rapid bronchial constriction mediated by IgE, eosinophilia, and positive hypersensitivity skin test reaction. These are caused due to immediate hypersensitivity reactions of the host to fungal spores.
Parija SC. Textbook of Microbiology & Immunology. Elsevier Health Sciences; 2014. Page:595 | 154,208 | medmcqa_train |
Vascular invasion is a characteristic feature of | Mucormycosis occurs as a systemic infection following dissemination from a primary focus in the upper respiratory tract or nasal cavity. When the lung is the primary site of infection the fungi may invade the aeries to cause thrombosis and infraction. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition | 154,209 | medmcqa_train |
A female patient with breast cancer presenting with altered sensorium. The following MRI suggests: | The epidemiology of limbic encephalitis mimics that of the underlying malignancy. Tumours which can result in limbic encephalitis include: small cell carcinoma of the lung (classic cause); testicular germ cell tumors; thymic tumours; breast cancer; ovarian carcinoma; haematologic malignancies; gastrointestinal malignancie Clinical presentation: Clinical presentation typically causes sho-term memory loss and mental status changes. Seizures and psychosis have also been repoed . Radiographic features: MRI: High T2 signal without enhancement. Appearance is similar to herpes simplex encephalitis, and changes are most evident in the mesial temporal lobes. Bilateral involvement is most common (60%). PET scan: Can show increased FDG uptake . Differential diagnosis: Herpes simplex encephalitis - acute time course, presence of fever. | 154,210 | medmcqa_train |
Laundosine is a toxic metabolite of - | Ans. is 'a' i.e., Atracurium Atracuriumo The unique feature of atracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofmann elimination) in addition to that by alkaline ester hydrolysis.o Consequently its duration of action is not altered in patients with hepatic / renal insufficiency or hypodynamic circulation - Preferred muscle relaxant for such patients as well as for neonates and the elderly.o Atracurium is metabolised to laudanosine that is responsible for seizures,o It can cause histamine release - Hypotension & bronchoconstriction. | 154,211 | medmcqa_train |
Normal paogram include the following except : | Cervical dilatation in X - axis | 154,212 | medmcqa_train |
Antigenic variation seen in which of the following - | a unique feature of influenza virus ability to undergo antigenic variation REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.499 | 154,213 | medmcqa_train |
A pregnant female infected with Rubella. Which of the following immunoglobulin is produced by in-utero infection? | IgM is the main immunoglobulin produced early in the primary immune response. IgM is present on the surface of viually all uncommitted B cells. It is the most efficient immunoglobulin in agglutination, complement fixation, and other antigen-antibody reactions and is impoant also in defense against bacteria and viruses. It can be produced by a fetus undergoing an infection. As it is not transpoed across the placenta, the presence of IgM in the fetus or newborn indicates intrauterine infection and its detection is useful in the diagnosis of congenital infections such as syphilis, rubella, HIV infection. Since its interaction with antigen can involve all ten binding sites, it has the highest avidity of all immunoglobulins. Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzneron T.A. (2010). Chapter 8. Immunology. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzneron (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 25e. | 154,214 | medmcqa_train |
Causes of restrictive cardiomyopathy are-a) amyloidb) sarcoidosisc) Viral myopathyd) Alcohole) Storage disease | Acute viral myocarditis, alcohol abuse, pregnancy., thyroid disease, cocaine use, and chronic uncontrolled tachycardia cause dilated cardiomyopathy- Harrison 17th/l481
Restrictive Cardiomyopathies (RCMs) - Harrison 17th/1485-86
The hallmark ofthe restrictive cardiomyopathies (RCMs) is abnormal diastolic function ; the ventricular wails are excessively rigid and impede ventricular filling. In late stages systolic function is also impaired.
Myocardial fibrosis- livpertropby. or infiltration due to a variety of causes is responsible. Myocardial involvement with amyloid1 is a common cause of secondary restrictive cardiomyopathy although restriction is also seen in the transplanted heart, in hemochromatosis, glycogen depositiong, endomyocardial fibrosis, sarcoidosis , hypereosinopbillc disease., and scleroderma; following mediastinal irradiation; and in neoplastic infiltration and myocardial fibrosis of diverse causes.
In many of these conditions, particularly those with substantial concomitant endocardial involvement, partial obliteration of the ventricular cavity by fibrous tissue and thrombus contributes to the abnormally increased resistance to ventricular filling.
Thromboembolic complications are frequent in such patients
The inability" of the ventricles to fill limits cardiac output and raises filling pressures; thus, exercise intolerance and dyspnea are usually prominent. As a result of persistently elevated systemic venous pressure, these patients commonly have dependent edema, ascites, and an enlarged, tender, and often pulsatile liver .
The jugular venous pressure is elevated and does not fall normally (or may rise) with inspiration (KussmauTssignf | 154,215 | medmcqa_train |
Salmon patch is seen in – | Salman patch appearance of cornea is seen in Interstitial Keratitis.
Salman patches on retina is seen in non-proliferative sickle cell retinopathy. | 154,216 | medmcqa_train |
Which of the following is not a cause of sudden increase pain in osteochondroma: | Ans. D. Degenerative changesDegenerative changes will lead to slowly increase in size of osteochondroma whereas other listed causes will result in sudden increase in the size of osteochondroma. | 154,217 | medmcqa_train |
Kiesselbach's plexus is plexus made up of? | Ans. is 'a' i.e., Arteries * Kiesselbach's plexus is formed by anastomosis of four arteries:-# Anterior ethmoidal artery,# Septal branch of superior labial artery,# Septal branch of sphenopalatine artery and# Greater palatine artery. | 154,218 | medmcqa_train |
The depth of respiration is controlled by | Pneumotaxic center limits inspiration by inhibiting Apneustic center Ref: Ganong 25th ed/page 65 | 154,219 | medmcqa_train |
A 40 years old male develops excessive hyperventilation. ABG reveals pH - 7.5, PCO224 mm Hg, PO2 88 mm of Hg. True statment is | Ans. is 'a' Respiratory alkalosis. This one is quite simple.pH is increased and pCO2 is decreased which indicates respiratory alkalosis | 154,220 | medmcqa_train |
Eye examination of a patient revealed lack of downward gaze and loss of convergence but has normal pupillary reactions to light. What is the MOST probable location of the lesion? | In this patient the lesion is most probably located at the level of inferior colliculus. Features of lesion at the level of inferior colliculus are normal pupillary reactions to light, lack of downward gaze and loss of convergence. It could be due to lesions of the pineal gland, multiple sclerosis, vascular diseases or Wernicke's encephalopathy. Lesions in the collicular region is caused by pressure and distoion of underlying structures in the midbrain and not by damaged to specific pathways traversing the colliculi. It can produce any combination of impaired upward gaze, impaired downward gaze, pupillary abnormalities or loss accommodation reflex can occur. The general name for the clinical picture produced is called Perinaud's syndrome. Ref: Textbook of Ophthalmology edited by Sunita Agarwal, page 284. | 154,221 | medmcqa_train |
Bevelling of inner table of skull is found in | A i.e. Firearm entry wound When a bullet traverses the skull, the apeure in the bone differs in relation to the outer & inner tables; the defect is larger in the I direction in which the bullet travelsQ | 154,222 | medmcqa_train |
All are true for oxytocin EXCEPT: March 2013 | Ans. B i.e. Secreted by anterior pituitaryOxytocin is secreted mainly by Supraoptic and paraventricular nucleus of hypothalamus and is transpoed from hypothalamus to posterior pituitary. When suitable stimuli reach the posterior pituitary from hypothalamus, oxytocin is released into blood. | 154,223 | medmcqa_train |
A 45-year-old woman is seen by her primary care physician complaining of intermittent colicky pain in the right upper quadrant (RUQ), staing sholy after eating a meal, and lasting about 30 min. During these episodes, she feels bloated and nauseated. The patient also states that over the past 2 days, her stools have become very light in color, like the color of sand, and her skin has become yellow. What is the anatomical basis for the clinical condition? | A- Gallstones in gallbladder B- Bile duct obstruction due to gall stones C- Premature activation and leakage of pancreatic enzymes This middle-aged woman has the typical symptoms of biliary colic, which is intermittent crampy abdominal pain in the epigastric region of the RUQ, sometimes radiating to the right shoulder. These symptoms typically appear after meals, paicularly fatty meals. The more concerning signs are the light-colored stools (acholic) and jaundice (icterus). Gallstones (cholelithiasis) are precipitated bile salts in the gallbladder, which may produce inflammation of the gallbladder (cholecystitis). Stones can pass into the cystic duct and into the common bile duct. Since the common bile duct is formed by the union of the cystic and common hepatic ducts, obstruction of the common bile duct prevents bilirubin produced in the liver from reaching the small intestines. The stools thus lack this pigment. As a secondary result of the obstruction, serum bilirubin is elevated, and precipitates in the skin, resulting in the yellow tint. Ultrasound (DOUBLE BARREL/DUCT SIGN) can often make the initial diagnosis. Removal of a common bile duct stone can be performed by upper GI endoscopy through the ampulla of Vater or surgically. | 154,224 | medmcqa_train |
Drug of choice for Herpes simplex Endophthalmitis is – | Acyclovir is the drug of choice for HSV infection. | 154,225 | medmcqa_train |
NMDA antagonist used in Alzheimer's disease is: | Ans: A (Memantine) Ref: Goodman and Gilman's "Phannacologica! Basis of Therapeutics'' 12th eci p.622Explanation:Memantine* It is used either as an adjunct or an alternative to cholinesterase inhibitors in Alzheimer's disease, and is also commonly used to treat other neurodegenerative dementias,Memantine is a noncompetitive antagonist of the NMDA-type glutamate receptor.It interacts with the Mg2+ binding site of the channel to prevent excessive activation while sparing normal function.Adverse effects of memantine include headache or dizziness, hut are usually mild and reversible.The drug is excreted by the kidneys and dosage should be reduced in patients with severe renal impairment. | 154,226 | medmcqa_train |
An arteriole with a damaged endothelial cell layer will not: | Ans. D. Dilate in response to adenosine diphosphate (ADP) or acetylcholineBoth adenosine diphosphate (ADP) and acetylcholine cause the release of NO from endothelial cells. The other choices involve mechanisms that function without endothelial cells. | 154,227 | medmcqa_train |
As type of tympanogram is seen in: | Ans: a (Otosclerosis) Ref: Dhingra, 3rd ed, p. 34 & 4thed, p. 26As type tympanogram indicates low compliance at or near ambient air pressure.Seen in fixation of ear ossiclesTypes of tympanogram:A -NormalAs - Otosclerosis, malleus fixationAd - Ossicular discontinuity, lax thin TM (High compliance)B - Flat / dome shaped - No change in compliance - Middle ear fluid / Thick TMC - Maximum compliance at -100 mm H2O - Retracted TM | 154,228 | medmcqa_train |
Reversion of Neisseriagonorrhoeae from a fimbriated (fim 1) to a non-fimbriated (fim 2) state would result in which one of the following phenomena? | Bacteria may shift rapidly between the fimbriated (fim +) and the non-fimbriated (fim -) states. Fimbriae function as adhesions to specific surfaces and consequently play a major role in pathogenesis. Lack of fimbriae prevents colonization of the mucosal surface by the bacterium. | 154,229 | medmcqa_train |
Most common complication of both acute and chronic pancreatitis is | Complications of Acute pancreatitis Sterile and infected peripancreatic fluid collections Pancreatic necrosis and infected necrosis Pancreatic pseudocyst Pancreatic ascites Pancreaticopleural Fistulas Vascular complications Pancreaticocutaneous fistula Complications of chronic pancreatitis pseudocysts splenic vein thromboses biliary and duodenal obstruction biliary cirrhosis pancreatic cancer pancreatic diabetes Ref: Sabiston 20th edition Pgno :1535 | 154,230 | medmcqa_train |
What is responsible for clearing & flushing food from the intestinal lumen in the interdigestive Period- | Ans. (b) Migrating motor complexes (MMC)(Ref: Ganong, 25th ed/p.497)MMC aids in clearing the stomach and small intestine of luminal contents in preparation for the next meal | 154,231 | medmcqa_train |
All are risk factors of pre eclampsia except | Primiparous is at a higher risk than multiparous ladyH.mole due to abnormal trophoblastic proliferation and uterine distension is at higher risk. Infact h.mole is associated with early onset preeclampsia. Previous h/o preeclampsia also increases risk . | 154,232 | medmcqa_train |
In myopia there is | (A) Increased length of eyeball > Myopia ("nearsightedness" (AmE), "shortsightedness" (BrE)) is a refractive defect of the eye in which collimated light produces image focus in front of the retina under conditions of accommodation.> Axial myopia is attributed to an increase in the eye's axial length. | 154,233 | medmcqa_train |
True regarding TT dose(s) in Pregnancy for a Primigravida woman is:- | TT in pregnancy:- Primary level of prevention (specific protection) Primigravida - 2 doses (1 month apa) of TT- ASAP in pregnancy 2 dose - total duration protection - 5 years If next pregnancy occur in 3 years of previous pregnancy - only 1 booster dose required Both doses must be completed within 8 months POG. | 154,234 | medmcqa_train |
Ancylostoma enters the human body by - | Ancylostoma enters the human body by penetration of skin. ANCYCLOSTOMA DUODONALE (Hookworm): Host - Man. Infective form - 3rd stage filariform (L3) larva. Mode of transmission- penetration of skin by 3rd stage filariform (L3) larva (by walking bare foot in dampen soil). Habitat- small intestine. | 154,235 | medmcqa_train |
Narrowest part of esophagus is at? | Ans. is 'a' i.e., Cricopharyngeal sphincter * The narrowest part of esophagus is its commencement at the cricopharyngeal sphincter. | 154,236 | medmcqa_train |
In methyl alcohol poisoning there is CNS depression, cardiac depression and optic nerve atrophy. These effects are produced due to: | Ans. (A) Formaldehyde and formic acid(Ref: Katzung 11/e p1024; KDT 8/e p422)Methyl alcohol (methanol) is metabolized to formaldehyde by alcohol dehydrogenase and then to formic acid by aldehyde dehydrogenase. These compounds are responsible for the toxicity. Formic acid can lead to coma and blindness also. Therefore, inhibitor of alcohol dehydrogenase, Fomepizole is used for treatment of methanol overdose. | 154,237 | medmcqa_train |
Selective Alpha 2a agonist is | Clonidine, Tizanidine are selective alpha 2 agonists. But dexmedetomidine is more selective acting on Alpha 2a receptors-cause sedation. Used as pre-anesthetic medication. Ref: H.L. Sharma 3rd ed Pg:179 | 154,238 | medmcqa_train |
Management of Typical Febrile seizures include except | Sponging, paracetamol ibuprofen ,intermittent diazepam are treated for febrile seizures Most children with typical febrile seizures do not require specific treatment except for vigorous antipyretic therapy during febrile illnesses. Children experiencing excessively frequent or prolonged febrile seizures may be treated using diazepam 0.5mg/kg rectally during high fevers or prophylactically using <a href=" at standard doses.</p> Ref : Ghai pediatrics eighth edition pg no 556 | 154,239 | medmcqa_train |
Mineral with antioxidant property: | Ans. b (Selenium). (Ref. Harper, Biochemistry, 25th ed., 659,766)SeleniumFeaturesConstituent of glutathione peroxidaseSynergistic anti-oxidant with vitamin EEssential trace elementSelenocysteine is an L--amino acid found in a handful of proteins. As its name implies, a selenium atom replaces the sulfur of its structural analog, cysteine. The pK3 of selenocysteine, 5.2, is 3 units lower than that of cysteine. Since selenocysteine is inserted into polypeptides during translation, it is commonly referred to as the "21st amino acid."However, unlike the other 20 genetically encoded amino acids, selenocysteine is not specified by a simple three-letter codon.Trace elements TRACE ELEMENTDEFICIENCY STATESEXCESS STATES1ArsenicAcute Fatty (Yellow)liverHCCNeurologic dysfunctionGIT diseasesSkin cancerMee's linesAngiosarcoma of liverNCPF2Cadmium-Madness, paralysis agitans,3CopperGrowth failureWilson's diseaseNeutropenia CVS disordersGenu valgumMenke's kinky hair disease04ChromiumPEM, CVS diseaseArthritisDermatitisDiarroeaSeptal perforation5IodineGoiter, growth failureJod basedow phenomenonWolf chekoff phenomenon6Lead-Abdominal ColicAnaemiaBlue gum linesBasophilic stipplingConstipationConvulsionsDeliriumPeripheral neuropathy & ParalysisFailure of kidneysMetaphyseal lines7ManganeseImpaired growthAtaxiaManganese madnessParalysis agitansCVS disorders8MolybdenumGrowth failureGout bony defects Oral & esophageal carcinomaGenu valgum9Mercury-Minimota's disease Mercural erythesim (Hatter's shake)10SeleniumPEM, muscle dystrophy, CVS diseases(DCM), diarrhea, Keshan diseaseArthritis, dermatitis11AluminiumAlzheimer's diseaseOsteodystrophy12ZincNight blindnessHypogonadismImpaired wound healingAcrodermatitis enteropathicaGI irritationGrowth retardationFlaky paint dermatitis, loss of taste | 154,240 | medmcqa_train |
Tall R wave in ECG represents: | Right ventricular hypertrophy due to a sustained, severe pressure load (e.g. due to right pulmonary valve stenosis or certain pulmonary artery hypertension syndromes) is characterized by a relatively tall R wave in lead V, (R >S wave), usually with right axis deviation. | 154,241 | medmcqa_train |
Best test for determining initial stage of renal insufficiency? | Serum creatinine REF: Harrison's Internal Medicine 17' edition chapter 274 The most impoant initial diagnostic step in the evaluation of a patient presenting with elevated serum creatinine is to distinguish newly diagnosed CKD from acute or subacute renal failure because the latter two conditions may respond to therapy specific to the disease. Previous measurements of plasma creatinine concentration are paicularly helpful in this regard. Normal values from recent months or even years suggest that the current extent of renal dysfunction could be more acute, and hence reversible, than might otherwise be appreciated. In contrast, elevated plasma creatinine concentration in the past suggests that the renal disease represents the progression of a chronic process. Even if there is evidence of chronicity, there is the possibility of a superimposed acute process, such as ECFV depletion, supervening on the chronic condition. If the history suggests multiple systemic manifestations of recent onset (e.g., fever, polyahritis, and rash) it should be assumed that renal insufficiency is pa of the acute process. From the following staging of CKD based on GFR it is clear that GFT can be even normal in initial staged of CKD Clinical action plan Stage Description GFR, mL/min per 1.73 m2 Action' 1 Kidney damage with normal or +GFR > or = 90 Diagnosis and treatment, treatment of comorbid conditions, slowing progression, CVD risk reduction 2 Kidney damage with mild +GFR 60-89 Estimating progression 3 Moderate +GFR 30-59 Evaluating and treating complications 4 Severe +GFR 15-29 Preparation for kidney replacement therapy 5 Kidney failure <15 (or dialysis) Kidney replacement (if uremia present) | 154,242 | medmcqa_train |
Muscle relaxant of choice in patient suffering from chronic liver disease | Atracurium is preferred in CLD patients since it is metabolised by Hoffmann elimination. | 154,243 | medmcqa_train |
The most comprehensive indicator of cost-effective analysis is | Cost-benefit analysis, in which benefits are compared to cost of the program. The benefits are expressed in monetary termsA cost-effective analysis is similar to cost-benefit analysis except benefits are expressed in terms of results achievedThe most commonly used outcome measure is quality-adjusted life years (QALY)Park 23e pg:871 | 154,244 | medmcqa_train |
True about surgical wounds are all except | Preoperative antibiotic prophylaxis does not significantly reduce the frequency of postoperative wound infection in clean elective general surgical operations.So the routine prophylactic use of antibiotics in clean general surgical operations is not recommended. Incision of abscess comes under diy wounds. Infection rate of clean contaminated is less than 10% Bailey and love 26th edition Pg 63 | 154,245 | medmcqa_train |
An investigator into the life expectancy of IV drug abusers divides a sample of patients into HIV-positive and HIV-negative groups. What type of data does this division constitute? | Nominal data (also known as nominal scale) is a type of data that is used to label variables without providing any quantitative value. Given question is about HIV-positive and HIV-negative groups; since there is no order of characteristic and it cannot be measured directly. So,it can't be an ordinal data or metric data respectively. It is nominal data as its division is based only on names, i.e. HIV-positive and HIV-negative groups. | 154,246 | medmcqa_train |
Working formulation in staging of non-hodgkins lymphoma is based on: March 2010 | Ans. A: Morphology of cells The 1982 Working formulation is a classification of non-hodgkin lymphoma. It excluded the Hodgkin lymphomas and divided the remaining lymphomas into four grades (Low, Intermediate, High, and Miscellaneous) related to prognosis, with some fuher subdivisions based on the size and shape of affected cells. This purely histological classification included no information about cell surface markers, or genetics, and it made no distinction between T-cell lymphomas or B-cell lymphomas. The working formulation was widely accepted at the time of its publication but is now obsolete. It was superseded by subsequent classifications but it is still used by cancer agencies for compilation of lymphoma statistics and historical comparisons. | 154,247 | medmcqa_train |
Which condition is associated with Congenital Adrenal Hyperplasia? | (B) Female pseudohermaphroditism[?]Congenital Adrenal Hyperplasia (CAH) is the most common cause of female pseudohermaphroditism & virilization, & decreased cortisol synthesis owing to reduction or loss of 21-hydroxylase enzyme function is the most common biochemical cause of CAH.ABERRANT SEXUAL DIFFERENTIATION DEVELOPMENTAL DISORDERSFemale PseudohermaphroditismMale Pseudohermaphroditism*. Congenital virilising adrenal hyperplasia of fetus*. Maternal androgen excess*. Virilizing ovarian tumor*. Iatrogenic: Treatment with androgens or certain synthetic progestational drugs*. Androgen resistance*. Defective testicular development*. Congenital 17-hydroxylase deficiencyDisorders of Embryonic Sexual Development:Hermaphroditism occurs when individuals have both ovary & testis tissue.Pseudohermaphrodites have either testes or ovaries but have accessory organs & external genitalia that are incompletely developed or inappropriate.Most common cause of female pseudohermaphroditism is congenital adrenal hyperplasia.In males, one cause is testicular feminizing syndrome in which testes are normal but there are no receptors for Testosterone.-Individual develops very female appearance but is infertile.Causes of Female Pseudohermaphroditism:Congenital Adrenal Hyperplasia (CAH):It is caused by a defect in an enzyme (21-hydroxylase) in the steroid hormone synthesis pathway in the adrenal gland. It is the most common cause of ambiguous genitalia in newborns.Causes females to be masculinized due to a deficiency of the enzyme 21- hydroxylase.It is present in about one in 15,000 newborns. It is inherited by an autosomal recessive gene.Overproduction of male hormones before birth:It is often due to adrenal gland abnormality (as described in CAH above).High levels of male hormones may also enter the placenta via the mother (when receives progesterone to prevent a miscarriage or has a hormone-producing tumor).The common cause: Congenital Adrenal Hyperplasia (CAH):95% of CAH:Hypocortisolism; Enzyme 21-hydroxylase deficiency.Increased 17-hydroxy progesterone or 17-OHP. Manifest as virilization (Clitoromegaly, acne etc.,)Cortisol substitution - less masculine & potentially fertile. May cause Addison's Crisis.Newborn female CAH - presence of ambiguous genitalia.Newborn male CAH - similar symptoms with Hypertrophic Pyloric Stenosis (HPS), to differentiate it:-CAH: Hyperkalemia, metabolic acidosis; HPS: Hypokalemia, metabolic alkalosisOther Options[?]True hermaphroditism:Glands of both the sexes must be present in the same individual (cases are very rare).Accessory sex gland is atrophic and shows no evidence of functional activity.Sex gland consists partly of ovarian & partly of testicular tissue.[?]Pseudohermaphroditism:Sex glands are of one sex while the external genitalia are of the opposite sex.[?]Female pseudohermaphroditism ovaries may descend within the inguinal canal to lie in the labia majora, and if the clitoris is hypertrophied, it may at first glance resemble the penis, and the fused labioscrotal folds resemble a rudimentary scrotum.[?]Male pseudohermaphroditism type, the testis fails to descend into the scrotum, the penis is ill developed, and as a result of extreme hypospadias, the external genitalia resemble those of the female. | 154,248 | medmcqa_train |
Which of these is not responsible for removal of free radicals? | Ans. (c) NADPH oxidase(Ref: R 9th/pg 48; 8th/pg 13,14)AntioxidantsEnzymesNon enzymes* Catalase- Present in peroxisomes Q decomposes H2 O2 Antioxidants- vitamins E, A and C glutathione in the cytosol.*. Superoxidase dismutases: O2- to H2 O2 *. Manganese-SOD, which is localized in mitochondria,*. Copper-zinc-SOD, which is found in the cytosol.Transferrin, ferritin, lactoferrin, and ceruloplasmin Q - Minimise the reactivity of metals by binding with themGlutathione peroxidase: H2 O2 +2GSH-GSSG+2H2 O*. Important indicator of the cell's ability to detoxify ROSQNADPH oxidaseOxidizes NADPH Q (reduced nicotinamide-adenine dinucleotide phosphate) and, in the process, reduces oxygen to superoxide. Q | 154,249 | medmcqa_train |
All are true about central retinal artery occlusion (CRAO) except? | Ans. (a) Most commonly occurs due to thromboembolism; (c) Sudden painful loss of visionRef: Kanski 7/e, p. 559, 563* Presentation is with sudden and profound loss of vision, Painless, except in Giant cell arteritis* Atherosclerosis related thrombosis at the level of lamina cribrosa is by far the most common underlying cause of CRAO, accounting for 80% cases | 154,250 | medmcqa_train |
Pseudomonas exotoxin inhibits protein synthesis by inhibiting ? | Ans. is 'b' i.e., EF-2 Exotoxin 'A' of P. aeruginosa inhibits protein synthesis through interference with adenosine diphosphate ribosylation of elongation factor - 2. Remember Bacterial toxins inhibiting protein synthesis : Exotoxin A of P aeruginosa Shiga toxin (Shigella) Diphtheria toxin Shiga like toxin or verocytotoxin of EHEC. | 154,251 | medmcqa_train |
Filigree burn occur in - | FILIGREE BURNS OR ARBORESCENT OR LICHTENBERG'S FLOWERS: occur due to lightning injury These are superficial thin irregular and touous markings on the skin resemble branches of a tree the fernlike pattern of erythema in the skin usually on shoulders and flanks may develop instantly or within a few minutes CAUSES: 1. Staining may be due to lysis of hemoglobin or rupture of small blood vessels 2. They may be superficial burns producing erythema of the skin 3. Minute deposition of copper in the dermis and disappears in one or two days if survived REF: The Synopsis of Forensic Medicine and Toxicology 29th edition page no: 168 | 154,252 | medmcqa_train |
Wave length of UV A2 rays is | Ultraviolet light * Ultraviolet light (UV) is made up of: # Vacuum UVC (10-200 nm) # UVC (200-280 nm) # UVB (280-320 nm) # UVA (320-400 nm) divided into UVAII (320-340 nm) and UVAI (340-400 nm). Ref:- Review of Dermatology by Alikhan; pg num:-13 | 154,253 | medmcqa_train |
Which of the following is not a step in the ‘three step build up’ of direct filling gold? | A. Three step build-up for the restoration
“Tie formation”
This involves connecting two opposing point angles or starting points filled with gold with a transverse bar of gold. Such a “tie” forms the foundation for any restoration in direct gold. Of course, its resistance to displacement should be tested before proceeding to the next step.
“Banking of walls”
This is accomplished by covering each wall from its floor or axial wall to the cavosurface margin with the direct gold material. A wall should be banked in a way that will not obstruct tie formation or banking of other walls in the cavity preparation. “Banking” should be performed simultaneously on the surrounding walls of the preparation.
“Shoulder formation”
Sometimes, to complete a build-up, it is necessary to connect two opposing walls with the direct gold material. These three steps should completely fill up the cavity preparation, but the build-up should continue until the preparation is overfilled.
Ref: Marzouk .page 399 | 154,254 | medmcqa_train |
Helitrope rash is seen in: | Dermatomyositis | 154,255 | medmcqa_train |
Hypoglossal nerve is related to - | Hypoglossal nerve is a content of both digastric and carotid triangles. | 154,256 | medmcqa_train |
Not true about content composition of an Egg is:- | Egg composition: - 6g - Fat - 6g - Protein - 30 mg - Calcium - 1.5 mg - Iron - 70 Kcal - Energy - 250 mg - Cholesterol Also remember, egg is Richest sources of cholesterol. Height NPU (Net protein utilization) - 96, hence known as reference protein. Poor In carbohydrates & vit c. | 154,257 | medmcqa_train |
Obstruction to the flow of CSF at the aqueduct of sylvius will most likely lead to enlargement of: | . Both lateral and third ventricles | 154,258 | medmcqa_train |
Pulmonary veins develops from: | Development of pulmonary veinsAt 27-29 days' gestation, the primitive pulmonary vein appears as an endothelial out-pouching from either the posterior superior left atrial wall or from the central pa of the sinus venosus proximal to the primordial lung venous plexus.Connection between the primitive pulmonary vein and pulmonary venous plexus occurs by 30 days' gestation.The common pulmonary vein enlarges and incorporates into the left atrium, and, normally, the pulmonary venous pa of the splanchnic plexus gradually loses its connection with the cardinal and umbilicovitelline veins. | 154,259 | medmcqa_train |
Which of the following are alkylating agents: | ALKYLATI NG AGE NTS These compounds produce highly reactive carbonium ion intermediates which transfer alkyl groups to cellular macromolecules by forming covalent bonds. The position 7 of guanine residues in DNA is especially susceptible, but other molecular sites are also involved. Alkylation results in cross linking/ abnormal base pairing/ scission of DNA strand. Cross linking of nucleic acids with proteins can also take place. >Mechlorethamine (Mustine HCL) >Cyclophosphamide >Ifosfamide >Chlorambucil >Melphalan >Thio-TEPA >Busulfan >Nitrosoureas >Dacarbazine(DTIC) ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:821,822 | 154,260 | medmcqa_train |
Average gain in length in first year is | Length at bih- 50cms At 3 months- 60cms At 6 months- 65cms At the end of 1st yr- 75cms Hence gain in length in first year is (75-50= 25cms) Ref: Ghai,9th edition, Table 2.1 | 154,261 | medmcqa_train |
A 63-year-old woman presents with symptoms of palpitations and atrial flutter on the ECG. Which of the following is the most likely mechanism of this arrhythmia? | Atrial flutter is characterized by regular atrial activation with an atrial rate of > 240 beats/min. The ventricular response depends on the conduction of the AV node, usually there is 2:1 or 3:1 conduction. It is now known that the predominant mechanism for atrial flutter is right atrial macro reentry with circular activation. Atrial flutter typically originates from the right atrium and most often involves a large circuit that travels around the area of the tricuspid valve. This type of atrial flutter is referred to a typical atrial flutter. Less commonly, atrial flutter can result from circuits in other areas of the right or left atrium. | 154,262 | medmcqa_train |
Autosomal recessive disease have incidence of 1/ 250000 in a population. What is the carrier state of population? | .incidence is calculated as the total number new cases in a given time period divided by population at risk during that period.multiplied by 1000.so here total no of carrier states is given by 1divided by 250000 multiplied by 1000,that is 1/250. ref:park&;s textbook,ed 22,pg no 58 | 154,263 | medmcqa_train |
The laryngeal mask airway allows positive pressure ventilation with maximum pressure of:- | The LMA allows a positive pressure of 20 cm of H2O for ventilation . | 154,264 | medmcqa_train |
Elderly primi is above : | 30 years | 154,265 | medmcqa_train |
Shoulder pain post laparoscopy is due to | Laparoscopy Needle used for pneumoperitoneum : Veress needle Most commonly used gas: CO2 Flow of gas : 1L/min Intra abdominal pressure : 12-15mmHg Trocar is inseed at or just below the umbilicus penetrating skin, superficial & deep fascia, fascia transversalis & parietal peritoneum Post-laparoscopy shoulder pain is due a to CO2 retention causing irritation of diaphragm & referred pain to the shoulder through phrenic nerve Ref: Sabiston 20th edition Pgno : 394-396 | 154,266 | medmcqa_train |
A 20 year old primigravida is admitted with-term pregnancy and labour pains. At 4.00 AM she goes into active labor. Membrance rupture during p/v exmination showing clear liquor. A repeat p/v examination after 4 hours of good uretine contractions reveals cervical dilataion of 5 cm. What should be the next step in management : | Reassess for occipitoposterior position and cephalopelvic dispropoion | 154,267 | medmcqa_train |
All of the following statements about mosquito are true except - | Man is the definitive host and mosquito is the intermediate host of Bancroftian and Brugian filariasis. Park's Textbook of Preventive and Social Medicine, 25th edition, Page No. 832 | 154,268 | medmcqa_train |
First line of treatment of osteoporosis in postmenopausal woman? | Hormone replacement therapy is cornerstone in both prophylaxis and treatment of osteoporosis in menopausal women. Estrogen delays and protects against osteoporosis by 50% in all skeletal and not limited to trabecular bones of spine, wrist and upper hip. Rest of the drugs used in H for osteoporosis are natural estrogens, progesterone, tibolone and raloxifene. Bisphosphonates may be used are primary treatment in late osteoporosis in postmenopausal women Bisphosphonates include: Alendronate, Risedronate, Ibandronate, Zoledronate. These agents chemically bind to calcium hydroxyapatite in bone and decrease bone resorption by blocking the function and survival but not the formation of osteoclast. | 154,269 | medmcqa_train |
Medical etiquettes are between which of the following categories? | Medical etiquette deals with the conventional laws of couesy observed between members of the medical profession. A doctor should behave with his colleagues as he would have them behave with himself. Ethical behaviour is a self-imposed duty upon each doctor. A doctor should not criticise or denigrate the professional ability of another doctor, while dealing with a patient. Ref: The Essentials of Forensic Medicine and Toxicology by Dr. K. S. Narayan Reddy, 27th edition, Page 1. | 154,270 | medmcqa_train |
Drugs used in GTCS is/are: | Carbamazepine, phenytoin are the first line drugs in GTCS. Valporate, phenobarbitone are the second choice of drugs. Alternative/add on drugs are Lamotrigine, Gabapentine, topiramate, methadone, levetiracetam. Ethosuximide is used in absent seizures. Propofol is a general anesthetic. Ref: K D Tripati 8th edition Table 30.1 | 154,271 | medmcqa_train |
Which of the following is the best parameter for monitoring septic shock? | Definitions of sepsis, severe sepsis, and septic shock Sepsis category Sepsis-3 2001 Sepsis CMS Sep-1 Sepsis SOFA score> 2 + suspected infection 2 of 4 SIRS criteria + suspected infection 2 of 4 SIRS criteria + suspected infection Severe Sepsis Not applicable Sepsis + organ dysfunction, hypoperfusion or hypotension Sepsis + sepsis - induced organ dysfunction Septic Shock Vasopressor requirement to maintain MAP> 65 mm Hg + Serum lactate level > 2 mmol/L in the absence of hypovolemia Sepsis induced hypotension persisting after adequate IV fluid resuscitation + presence of perfusion abnormalities or organ dysfunction Lactate > 4 mmol/L SBP <90 mm Hg. not responsive to IV fluids MAP <70 mm Hg not responsive to IV fluids | 154,272 | medmcqa_train |
'Foification spectra' are feature of NOT RELATED-PATHOLOGY | . | 154,273 | medmcqa_train |
Strength of wound after 2 months is governed by- | Ans. is 'a' i.e., Collagen cross linking Wound strengtho At the end of first week, wound strength is approximately 10% that of normal skin,o Strength increases rapidly over the next 4 weeks.o At the end of third months, the strength reaches a plateau of about 70 to 80% of the normal skin, a condition that may persist for life.So, (Remember following facts)o Tensile strength never reaches the normal strength of unwounded tissue (i.e., 100%).o Maximum strength is achieved by the end of 3 months.o Maximum strength is 70-80% of normal tissue.How does tensile strength change with time ?o During first 2 months it is due to excess collagen deposition.o After that it is due to structural modification of collagen, i.e., cross-linking, increased fiber size. | 154,274 | medmcqa_train |
Agent of first choice in an acute attack of Prinzmetal's angina is: | Answer is B (Nitrates) "Sublingual nitroglycerine is the drug of choice" -- CMDT Nitrates decrease aeriolar and venous tone, reduce preload and afterload, and reduce the oxygen demand of the hea. Nitrates may also improve myocardial blood flow by dilating collateral channels in the presence of increased vasomotor tone, or coronary stenosis. | 154,275 | medmcqa_train |
Which of the following is a cognizable offence | Refer the byte "Cognizable and Non cognizable offences". | 154,276 | medmcqa_train |
A 53-year-old woman with ovarian tumor presents with breathlessness and right-sided chest pain. The chest X-ray shows obliteration of the right costophrenic angle. Diagnosis? | Ans. A PleurisyRef. CMDT 2019 pg. 323Ovarian tumor (Fibroma and thecoma) can be associated with a right-sided pleural effusion (Meigs syndrome). The obliteration of CP angle on X-ray is another pointer for pleural involvement of this patient. | 154,277 | medmcqa_train |
All of the following statements about Philadelphia Chromosome in CML are true, except: | Answer is D (The Philadelphia chromosome with the oncogenic BCR-ABL gene is found on chromosome 9) The Philadelphia chromosome with the oncogenic BCR-ABL gene fusion is the truncated chromosome 22 (and not chromosome 9). The Philadelphia chromosome results from a reciprocal translocation between the ABL-1 oncogene on the long arm of chromosome 9 (region q34) and the breakpoint cluster region (BCR) on the long arm of chromosome 22(region q I I ) This reciprocal translocation, creates an elongated chromosome 9 (der 9), and a truncated chromosome 22. The oncogenic BCR-ABL gene fusion is found on the shoer derivative 22 chromosome (Philadelphia Chromosome). BCR-ABL encodes an oncogenic protein with tyrosine kinase activity (Tyrosine Kinase Inhibitors are therefore used for treatment) In agreement with the International System for Human Cytogenetic Nomenclature (ISCN), this chromosomal translocation is designated as t(9;22)(q34;q11). ABL stands for "Abelson", the name of a leukemia virus which carries a similar protein. | 154,278 | medmcqa_train |
Post-styloid space of parapharyngeal space contains all, EXCEPT: | The parapharyngeal space is a potential space, shaped like an inveed pyramid spanning the skull base to the hyoid. The boundaries of the space are separated by the styloid process and its associated fascial attachments into the "prestyloid" and "poststyloid" compaments. The contents of the prestyloid space are the parotid, fat, and lymph nodes. The poststyloid compament is composed of CNs IX to XII, the carotid space contents, cervical sympathetic chain, fat, and lymph nodes. Ref: Schwaz's principle of Surgery 9th edition, chapter 18. | 154,279 | medmcqa_train |
Which of the following is used with local anesthetics to potentiate their action? | Adrenaline is a vasoconstrictor that prolongs duration of local anesthetics & prevents systemic toxicity.
Sodium bicarbonate speeds the action of local anesthetics by increasing the unionized form. | 154,280 | medmcqa_train |
8 yrs. old child presents with lethargy multiple epiphyseal breaks, wormian bones with growth retardation and mental retardation Diagnosis is? | Ans. is 'b' Hypothyroidism (Ref. : O.RGhai, 6/e, p 482 (5/e, p447))Presence of mental retardation, growth retardation and wormian bones clinch the diagnosis in favour of hypothyroidism.In Hypothyroidism both mental retardation * and growth retardation * are present andthe skull X-ray shows large fontanelle, wide sutures * and wormian bones *Rickets -Wormian bones are also present in rickets but mental retardation is not seen in ricketsScurvy and Hypoparathyroidism have a radically different symptomatic profile.Important causes of wormian boneHypothyroidism *Hypophosphatasia *Rickets *Cleidocranial dysplasia *Osteogenesis imperfecta * | 154,281 | medmcqa_train |
All are complication of PEEP except :- | Positive end expiratory pressure decreases venous return and decreases cardiac output and hence blood pressure decreases and decreased perfusion so urine output can reduce. Pulmonary barotrauma is a frequentcomplicationofPEEPtherapy. Pneumothorax, pneumomediastinum, and interstitial emphysema may lead to rapid deterioration of a patient maintained on mechanical ventilation with an already compromised respiratory status. Positive end-expiratory pressure PEEP is a mode of therapy used in conjunction with mechanical ventilation. At the end of mechanical or spontaneous exhalation, PEEP maintains the patient's airway pressure above the atmospheric level by exeing pressure that opposes passive emptying of the lung. This pressure is typically achieved by maintaining a positive pressure flow at the end of exhalation. This pressure is measured in centimeters of water. PEEP therapy can be effective when used in patients with a diffuse lung disease that results in an acute decrease in functional residual capacity (FRC), which is the volume of gas that remains in the lung at the end of a normal expiration. FRC is determined by primarily the elastic characteristics of the lung and chest wall. In many pulmonary diseases, FRC is reduced because of the collapse of the unstable alveoli. This reduction in lung volume decreases the surface area available for gas exchange and results in intrapulmonary shunting (unoxygenated blood returning to the left side of the hea). If FRC is not restored, a high concentration of inspired oxygen may be required to maintain the aerial oxygen content of the blood in an acceptable range. Applying PEEP increases alveolar pressure and alveolar volume. The increased lung volume increases the surface area by reopening and stabilizing collapsed or unstable alveoli. This splinting, or propping open, of the alveoli with positive pressure improves the ventilation-perfusion match, reducing the shunt effect. After a true shunt is modified to a ventilation-perfusion mismatch with PEEP, lowered concentrations of oxygen can be used to maintain an adequate PaO2. PEEP therapy may also be effective in improving lung compliance. When FRC and lung compliance are decreased, additional energy and volume are required to inflate the lung. By applying PEEP, the lung volume at the end of exhalation is increased. The already paially inflated lung requires less volume and energy than before for full inflation. When used to treat patients with a diffuse lung disease, PEEP should improve compliance, decrease dead space, and decrease the intrapulmonary shunt effect. The most impoant benefit of the use of PEEP is that it enables the patient to maintain an adequate PaO2 at a low and safe concentration of oxygen (< 60%), reducing the risk of oxygen toxicity . Because PEEP is not a benign mode of therapy and because it can lead to serious hemodynamic consequences, the ventilator operator should have a definite indication to use it. The addition of external PEEP is typically justified when a PaO2 of 60 mm Hg cannot be achieved with an FIO2 of 60% or if the estimated initial shunt fraction is greater than 25%. No evidence suppos adding external PEEP during initial setup of the ventilator to satisfy misguided attempts to supply prophylactic PEEP or physiologic PEEP. | 154,282 | medmcqa_train |
Rate limiting step in Gluconeogenesis is catalyzed by - | Ans. is 'a' i.e., Fructose -1,6 phosphatase Rate limiting steps in various biochemical reactions taking place inside cells is of vital importance while formulating drugs to fight specific diseases affecting these reactions. So these rate-limiting steps are frequently asked in various entrance exams. Glycolysis - Phosphofructokinase Glycogen synthesis - Glycogen synthetase Glycogenolysis - Glycogen Phosphorylase Gluconeogenesis - Phosphoenolepyruvate; Fructose 1,6 biphosphatase TCA cycle- Isocitrate dehydrogenase Cholesterol synthesis- HMG CoA Reductase Bile acid synthesis - 7 alpha hydroxylase Fatty acid synthesis - acetyl CoA carboxylase Ketone body synthesis -HMG CoA synthetase Uric acid synthesis - Xanthine Oxidase Norepinephrine(catecholamine) synthesis- Tyrosine hydroxylase Tyrosine------->DOPA(Tyrosine hydroxylase) Acetylcholine synthesis- Uptake of choline Urea synthesis - Carbamoyl transferase Bio-chemistry facts - Rate limiting step in synthesis of bile salts: cholesterol hydroxylation= Enzyme: 7 alpha -hydroxylase - Rate limiting step in Glycolysis: Fructose 6-phosphate to fructose-1,6 biphosphate = Enzyme: phosphofructokinase (PFK) - Rate limiting step in Fatty acid synthesis: Carboxylation of Acetyl CoA: Enzyme: Acetyl CoA carboxylase (biotin dependent) - Rate limiting step in cholesterol synthesis: Mevalonate formation: Enzyme: HMG CoA reductase - Rate limiting step in HMP pathway: Glucose-6-phosphate to 6-phospho gluconolactone : Enzyme : Glucose 6-phosphate dehyrogenase - Rate limiting step in Gluconeogenesis: Fructose-1,6 bisphosphate to fructose-6-phosphate : Enzyme : Fructose -1,6 phosphatase (rate limiting step/enzyme) Reactions of gluconeogenesis o Gluconeogenesis involves glycolysis, the citric acid cycle plus some special reactions. Glycolysis and gluconeogenesis share the same partway but in opposite direction. Seven reactions of glycolysis are reversible and therefore are used with same enzyme in the synthesis of glucose by gluconeogenesis. However, three of the reactions of glycolysis are irreversible and must be circumvented by four special reactions which are unique to gluconeogenesis and catalyzed by : (1) Pyruvate carboxylaseQ, (ii) Phosphoenolpyruvate carboxykinase, (iii) Fructose-1,6- bisphosphataseQ, (iv) Glucose-6-phosphatase. These four enzymes are the key enzy mes of gluconeogenesis (or gluconeogenesis enzymes). Among these four, pyruvate carboxylase is a mitochondrial enzyme and other three are cytoplasmic enzymes. o All three irreversible steps of glycolysis should be bypassed for gluconeogenesis to occur. These three bypass steps are circumvented by four special reactions. First bypass (conversion of pyruvate into phosphoenol pyruvate): - Conversion of pyruvate into phosphoenol pyruvate takes place through two reactions. Carboxylation of pyruvate : - First, pyruvate enters the mitochondria and is converted into oxaloacetate by pyruvate carboxylase. Pyruvate carboxylase is a mitochondrial enzyme, therefore this reactions occurs in mitochondria only. Conversion of oxaloacetate to phosphoenolpyruvate : - Oxaloacetate produced in the mitrochondria cannot cross the membrane. It is first reduced to malate, which then moves across the mitochondrial membrane into the cytosol. Malate is, then, reoxidized to oxaloacetate in the cytosol. Oxaloacetate is converted to phosphoenol pyruvate by phosphoenolpyruvate (PEP) carboxykinase. Second bypass: - Conversion of fructose-1,6-bisphosphate into fructose-6-phosphate is catalyzed by fructose- 1,6-bisphosphatase (PGI 05). Its presence determines w hether a tissue is capable of synthesizing glucose (gluconeogenesis) or glycogen (glyconeogenesis (PGI 05).) not only from py ruvate, but also from triose phosphate. It is present in liver, kidney, and skeletal muscle, but is probably absent from heart and smooth muscle. C) Third bypass : - Conversion of glucose-6-phosphate to glucose is catalyzed by glucose-6-phosphatase. | 154,283 | medmcqa_train |
A patient got his SBP reduced by 10mmHg when he stood up and he gained only 8mmHg. What was the gain? | Correction here is = –8mmHg
Error persists even after correction = 10 – 8 = +2
Gain = Correction / Error
= –8 / +2
= –4 | 154,284 | medmcqa_train |
Triage refers to? | Ans. is `b' i.e., Categorization of patients according to level of severity Triage consists of rapidly classifying the injured and the likelyhood of their survival with prompt medical intervention. | 154,285 | medmcqa_train |
Lipoprotein involved in transfer of cholesterol from tissues to Liver is? | ANSWER: (D) HDLREF: Lippincott's biochemistry 4th Ed page 236See previous question | 154,286 | medmcqa_train |
Which type of pulmonary TB is most likely to give sputum positive - | Ans. is 'c' i.e., Cavitary "Sputum smears are usually positive in patients with laryngeal TB, endobronchial TB and cavitary pulmonary- TB"-- Kelley's"Patients with cavitary pulmonary TB have high bacterial load in their sputum " --Internet | 154,287 | medmcqa_train |
Drug given for metaclopramidr induced dystonic reaction is: | Acute muscle dystonia caused by antiemetic-antipsycotic drugs is promptly relieved by parentral promethazine or hydroxyzine.this is based on central anti cholinergic action of the drugs. Promethazine is an first generation anti histaminic which has maximum anticholinergic activity.(ref: KDT 6/ep157) | 154,288 | medmcqa_train |
Run-Amok is a feature of : | Ans. is 'c' ie Cannabis Run-amok: is a condition resulting from the continued use of cannabis or even its consumption for the first time.It is characterized by a frenzied desire to commit murders.A number of individuals are killed, the first ones being those against whom the assailant has some real or imaginary enmity, followed by others who are in the way, until the homicidal tendency lasts. The person may then commit suicide or surrender himself to the police.There are four important forms of cannabis used in India.They all are derived from different parts of the same plant:Bhang - derived from dried leaves & fruit shoots*Ganja - Consists of dried flowering tops*Charas - consists of resinous exudate from the leaves and stems of the plant* (also k/a hashish)Majun - its a sweetmeat made with bhang, flour, milk and butter.Active ingredient of cannabis * - Tetrahydrocannabinol (THC)*. | 154,289 | medmcqa_train |
Treatment of choice for uterine prolaspe in a 40-year- old married female with completed family? | Ans. C. Vaginal hysterectomy with pelvic floor repair. (Ref. Shaw Gynecology 15th/pg. 340; Novak's Gynecology 13th/pg. 290; Stenchever Gynecology 4,h/pg.580)UTERINE PROLAPSE# Woman < 20 yr old.unmarried=Sling Operation# Young Woman (20-40 yrs) of child bearing age = FothergilFs operation.# Woman > 40 yrs with completed family & not desirous of keeping childbreaing and menstrual function = Vaginal hysterectomy with pelvic floor repair.# Older women who are no longer sexually active = Le Fort's operation.A prolapse into the upper barrel of the vagina is called first degree. If the prolapse is through the vaginal barrel to the region of the introitus, it is second degree. If the cervix and uterus prolapse out through the introitus, it is called third degree or total. In total prolapse the vagina is everted around the uterus and cervix and completely exteriorized. When this occurs, the patient is in danger of developing dryness, thickening, and chronic inflammation of the vaginal epithelium. Stasis ulcers may result as edema and interference with blood supply to vaginal wall occur. These ulcers rarely become cancerous.The treatment for prolapse is:Conservative management of prolapse usually involves fitting the patient with a pessary.A. Conservative:Abdominal and perineal exercises, massage vaginal pessaryAsymptomatic prolapse does not need treatment. An exception is a woman with stress incontinence and prolapse who is about to undergo surgical bladder neck suspension.Symptomatic prolapse can be treated conservatively or surgically, depending on the individual. Pelvic muscle exercises may be of benefit to women with stress incontinence.B. Surgical: Vaginal hysterectomy with pelvic floor repairAnterior colporrhaphyPosterior colporraphy and colpoperineorrhaphyFotehrgill's repair (Manchester operation)Shirodkar's procedureLeforf s repairAbdominal sling operationsOperations for Vaginal ProlapseVaginal Hysterectomy:Operative repair for prolapse of the uterus and cervix generally involves a vaginal hysterectomy with anterior and posterior colporrhaphy. The advantage of vaginal hysterectomy is that it allows other vaginal surgery (e.g., anterior and posterior colporrhaphy or enterocele repair) to be performed at the same time, without the need for a separate incision or for repositioning the patient.F other gill Operation:This operation combines an anterior and posterior colporrhaphy with the amputation of the cervix and the use of the cardinal ligaments to support the anterior vaginal wall and bladder. In this operation, the bladder is dissected off the cervix, which is then amputated. The cardinal ligaments are sewn to the anterior cervical stump, and the posterior vagina is closed over the rest of the opening. This operation is usually performed in conjunction with an anteroposterior colporrhaphy, and it is usually done for the sake of expediency in patients who are poor surgical risks and who do not desire future fertility. The loss of the cervix may interfere with fertility or lead to incompetence of the internal cervical os. The operation has value in older women who have an elongated cervix and well-supported uterus because it is technically easier and has a shorter operative time.Manchester/Fothergill Operation -Operation of choice in third degree prolapse of uterus in patients who are poor surgical risks and who do not desire future fertility.Uteropexy (Abdominal sling operation) :In a young nullipara who desires to retain her fertility. If prolapse cannot be managed successfully with a pessary, such patients present a surgical challenge. The older abdominal uterine suspension operations (Baldy-Webster, Gilliam, ven- trofixation, or hysteropexy) do not work for patients with significant uterine prolapse. Abdominal sling operations include:# Abdominocervicopexy# Shirodker's abdominal sling operation# Khanna abdominal sling operationParavaginal Defect Repair Operation:Anterior vaginal prolapse has been treated with anterior colporrhaphy, plicating the endopelvic fascia in the midline under the bladder neck. If the anterior vaginal prolapse results from a lateral detachment of the endopelvic fascia from the lateral pelvic sidewall, however, better results will be obtained by performing a lateral repair. In this technique, the endopelvic fascia is reattached to the arcus tendineus fasciae pelvis through what is referred to as a paravaginal defect repair operation.Posterior Colporrhaphy:Repair of posterior vaginal prolapse for rectocele and enterocele is also performed vaginally using posterior colporrhaphy. In a rectocele repair, the posterior vagina is opened, the rectum is dissected away from the pararectal fascia, and the levator ani muscles are plicated over the rectum in the midline, after which the vaginal epithelium is closed. Because of concern over postoperative dyspareunia, recent modifications of posterior colporrhaphy have included site-specific repair.Le Fort's operationIn older women who are no longer sexually active a simple procedure for reducing prolapse is a partial colpocleisis. The classic procedure was described by Le Fortand involves the removal of a strip of anterior and posterior vaginal wall, with closure of the margins of the anterior and posterior wall to each other.The Goodall-Power modification of the Le Fort operation allows for the removal of a triangular piece of vaginal wall beginning at the cervical reflection or 1 cm above the vaginal scar at the base of the triangle, with the apex of the triangle just beneath the bladder neck anteriorly and just at the introitus posteriorly. This procedure works well for relatively small prolapses, whereas the Le Fort is best for larger ones. | 154,290 | medmcqa_train |
Ectopic rest of normal tissue is known as ? | Ans. is 'a' i.e., Choristoma o Normally arranged tissue at a different anatomical site (ectopic site) --> Choristoma. o Abnormally arranged tissue present at normal site -->Hamaoma | 154,291 | medmcqa_train |
A 13 years boy presented with swelling in the cheek with recurrent epistaxis. Most likely diagnosis is | (Angio fibroma) (230-Dhingra 4th)* Nasopharyngeal Fibroma (Juvenile nasopharyngeal angiofibroma)Clinical features* Almost exclusively in male age 10-20 years* Profuse and recurrent epistaxis *** Progressive nasal obstruction and denasal speech* Conductive hearing and serous otitis media* Mass in the masopharynx* Other clinical features like - broadening of the nasal bridge, proptosis, swelling of chest infratemporal fossa or involvement of Ilnd, Illrd , IVth Vlth cranial nerve* CT-scan of the head with contrast enhancement is now the investigation of choice* Surgical excision Transpalatinei Sublabial (Sardana's approach) is now the treatment of choice | 154,292 | medmcqa_train |
Not a sign/symptom of aconite poisoning: JIPMER 12 | Ans. Hypeension | 154,293 | medmcqa_train |
True about anal membrane | Before the urorectal septum has an oppounity to fuse with the cloacal membrane, the membrane ruptures, exposing the urogenital sinus and dorsal anorectal canal to the exterior. Later on, an ectodermal plug, the anal membrane, forms to create the lower third of the rectum. ref - Semantischolar.org ref - BDC vol2 | 154,294 | medmcqa_train |
Which of the following is the predominant cell type in the intra-epithelial region of small intestinal mucosa? | T lymphocyte predominantly of cytotoxic phenotype (CD8+) constitute the predominant cell type in the intra epithelial region of the mucosa of intestine. The lamina propria consist of helper T cells (CD4+) and educated B cells. Ref: Robbins Pathologic Basis of Disease, 6th Edition, Page 804 | 154,295 | medmcqa_train |
A 6 year old boy has presented to you with progressive muscle weakness and difficulty in walking upstairs. He has difficulty in walking and has a waddling gait. On examinations Gower's sign is present and there is hypertrophy of calf muscles. His CPK is 10,000 IU. Which of the following is the most probable diagnosis? | Ans. A. Duchenne Muscular hypertrophyDuchenne muscular dystrophy (DMD) is a severe type of muscular dystrophy. The symptom of muscle weakness usually begins around the age of four in boys and worsens quickly. Females with a single copy of the defective gene may show mild symptoms. The disorder is X-linked recessive. Early features include a gait abnormality, which classically is a waddling, wide-based gait with hyper lordosis of the lumbar spine and toe walking. The Gower sign is a classic physical examination finding in MD and results from weakness in the child's proximal hip muscles. The second important phase in Duchenne MD is the loss of ambulation. This usually occurs between the ages of 7 and 13 years, with some patients becoming wheelchair-bound by age 6 years. Duchenne MD is a terminal disease in which death usually occurs by the third decade of life (mostly from cardiopulmonary compromise). Other clinical findings in Duchenne MD include absent deep tendon reflexes in the upper extremities and patella (though the Tendo Achillis reflex remains intact even in the later stages of this disease), pain in the calves with activity (<30% of patients), pseudohypertrophy of the calf (60%), and macroglossia (30%). | 154,296 | medmcqa_train |
Contractile Dysfunction is the dominant feature of which of the following types of cardiomyopathies | Ref Harrison 19 th ed pg 1556 An enlarged left ventricle with decreased systolic function as mea- sured by left ventricular ejection fraction characterizes dilated car- diomyopathy ). Systolic failure is more marked than diastolic dysfunction. Although the syndrome of dilated cardiomyopathy has multiple etiologies, there appear to be common pathways of secondary response and disease progression. | 154,297 | medmcqa_train |
Banana shaped gametocytes in peripheral smear are seen in infection with: | Banana shaped or crescent shaped gametocytes are seen in P. Falciparum. | 154,298 | medmcqa_train |
HLA marker of bechet's syndrome ? | Ans. is 'c' i.e., HLA-B51 | 154,299 | medmcqa_train |
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