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Shoulder dystocia is suspected during a delivery after the delivery of the head, obstetrician asks the assistants to sharply flex the legs towards the abdomen. What is this maneuver? | The McRobes maneuverThe maneuver consists of removing the legs from the stirrups and sharply flexing the thighs up toward the abdomen. The procedure caused straightening of the sacrum relative to the lumbar veebrae, rotation of the symphysis pubis toward the maternal head, and a decrease in the angle of pelvic inclination. Although this does not increase pelvic dimensions, pelvic rotation cephalad tends to free the impacted anterior shoulder.Of rotational maneuvers, Woods (1943) repoed that by progressively rotating the posterior shoulder 180 degrees in a corkscrew fashion, the impacted anterior shoulder could be released. This is frequently referred to as the Wood's corkscrew maneuver. Rubin (1964) recommended two maneuvers. First, the fetal shoulders are rocked from side to side by applying force to the maternal abdomen. If this is not successful, the pelvic hand reaches the most easily accessible fetal shoulder, which is then pushed toward the anterior surface of the chest. This maneuver most often abducts both shoulders, which in turn produces a smaller bisacromial diameter. This permits displacement of the anterior shoulder from behind the symphysis With an all- fours maneuver , also called the Gaskin maneuver, the paurient rolls onto her knees and hands. Here, downward traction against the head and neck attempts to free the posterior shoulder The Zavanelli maneuver involves replacement of the fetal head into the pelvis followed by cesarean delivery Reference: William's obstetrics; 25th edition | 155,900 | medmcqa_train |
Sclerostin is produced by? | Sclerostin (SOST) is a glycoprotein produced by osteocytes. They also synthesize receptor activator of nuclear factor kappa B ligand (RANKL). Both of these are involved in regulating bone formation and resorption. EXTRA EDGE: Romosozumab, a humanized monoclonal antibody that binds to sclerostin, prevents sclerostin from exeing this inhibitory effect. Therefore, in the presence of romosozumab, the Wnt signaling pathway is activated leading to bone formation and bone mineral density gain. | 155,901 | medmcqa_train |
Which of the following is false about Digoxin | Refer kDT 7/e p516.. Medical useEdit Irregular heabeatEdit The most common indications for digoxin are atrial fibrillation and atrial flutter with rapid ventricular response, though beta blockers and/or calcium channel blockers are often preferred. There is tentative evidence that digoxin may increase the risk of death, though another meta-analysis in 2015 repoed no change in moality. Hea failureEdit Digoxin is no longer the first choice for hea failure; it has fallen out of or in people with hea failure because it may increase the risk of death. Currently, the recommendation for hea failure is a triple therapy of ACE inhibitor, beta blocker and mineralocoicoid antagonists. Digoxin is a third-line therapy. AboionEdit Digoxin is also used intrafetally or amniotically during aboions in the late second trimester and third trimester of pregnancy. It typically causes fetal demise(measured by cessation of cardiac activity) within hours of administration. Side effectsEdit Main aicle: List of side effects of digoxin Fuher information: Digoxin toxicity The occurrence of adverse drug reactions is common, owing to its narrow therapeutic index (the margin between effectiveness and toxicity). Gynaecomastia (enlargement of breast tissue) is mentioned in many textbooks as a side effect, thought to be due to the estrogen-like steroid moiety of the digoxin molecule, but when systematically sought, the evidence for this is equivocal as of 2005. The combination of increased (atrial) arrhythmogenesis and inhibited atrioventricular (AV) conduction (for example paroxysmal atrial tachycardia with AV block - so-called "PAT with block") is said to be pathognomonic(that is, diagnostic) of digoxin toxicity. | 155,902 | medmcqa_train |
Renal Cortical imaging is done by - | Ans. is 'b' i.e., DMSAo For imaging of renal cortex Tc-99m-DMS A is used,o Other three agents (of options) are used for dynamic renal scintigraphy.Renal scintigraphy1) Static renal scintigraphyFor static renal scintigraphy Tc - 99m - DMSA (Dimercaptosuccinic acid) is used. DMSA is cleared by renal tubules. When DMSA is labeled with Tc - 99 and injected intravenously, it can be used to create an image of the renal cortex which reflects vascular flow and tubular function. It is called static scintigraphy because radiopharmaceutical is tubularly fixed in the renal cortex.Beside Tc - 99m - DMSA, other radiopharmaceuticals used for static scintigraphy are Tc - 99m - glucoheptone, (Tc-GH)Indications for static renal scintigraphy (Tc - 99m - DMSA) >Assessment of individual functionInvestigation of UTI (particularly in children)A ssessment of reflux nephropathy (scars)Space occupying lesions (cortical mass)Investigation of horse shoe, solitary or ectopic kidney2) Dynamic renal scintigraphy (functional imaging)For dynamic renal scintigraphy Tc - 99m - DTPA (Diethylene triamine pentaacetic acid) and Tc - 99m - MAG3 (mercaptoacetyltriglycine) and I-123-OIH (O - iodohippurate) are used.Tc - 99m - DTPA is filtered completely by the glomerulus but are not reabsorbed, metabolized or secreted by renal tubules. Therefore this agent can be used to measure GFR.Tc - 99m - MAG3 and I - 123 - OIH are secreted by renal tubules. These are used to determine effective renal plasma flow.Tc - 99m - MAG3 is the best (amongst three) for dynamic renal scintigraphy, but is costly.This is called dynamic scintigraphy because tracers are readily transported either by glomerulus or renal tubules (in contrast to static scintigraphy, where tracer is tubularly fixed in the renal cortex).Indications of dynamic renal scintigraphyi) Diagnosis of obstructed vs non - obstructed dilatationiv) Demonstration of vesico-urethral refluxii) Diagnosis of renal artery stenosisv) Assessment of renal transplantationiii) Assessment of perfusion in ARFvi) Renal trauma | 155,903 | medmcqa_train |
In liver, ethanol is conveed to ? | Ans. is 'c' i.e., Acetaldehyde | 155,904 | medmcqa_train |
All of the poisons caused uterine contractions EXCEPT: | ANSWER: (B) ArsenicREF: Forensic medicine and Toxicology by R N Karmakar 3rd edition page 230, Parikh 6th edition various pageABORTIFACI ENT DRUGS:EcbolicsIncreases uterine contractionErgot, Quinine, Pituitary extract, LeadEmmenagoguesIncreases menstrual flow (abortifacient in large repeated doses)Cantharides, Aloes, EstrogenGI irritantsIrritation of colon and congestion of pelvic organsArsenic, Mercury | 155,905 | medmcqa_train |
Treatment of thyroglossal cyst | Ans. (a) Sistrunk operation* Sistrunk operation: Excision of cyst and also full tract up to the foramen caecum is done along with removal of central part of the hyoid bone, as the tract passes through it.* Sistrunk operation is also named for Filarial leg surgery | 155,906 | medmcqa_train |
Metabolic abnormality seen in congenital hypertrophic pyloric stenosis is | Ans. is 'a' i.e. Hypochloremic hypokalemic metabolic alkalosis * Repeated vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic {paradoxical aciduria)Cause of paradoxical aciduria - Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated | 155,907 | medmcqa_train |
Spoke wheel calcification in an osteolytic lesion is seen in | Radiological findings in intraosseous hemangioma are : Prominent trabecular pattern Better visualization of thickened veical trabeculation: polka-dot appearance on axial images and corduroy sign on coronal and sagittal images. Lytic calvarial lesions with spoke-wheel appearance Irregular and lytic in long bones, with a honeycomb appearance | 155,908 | medmcqa_train |
All of the following statements is/are true about post streptococcal glomerulonephritis except -a) Early treatment of streptococcal pharyngitis prevents glomerulonephritisb) All cases of streptococcal infection lead to glomerulonephritisc) Hump sign may be presentd) Immune complex deposits are seene) Commonly presents with crescent formation | There is no evidence to date that the early treatment of streptococcal disease, either pharyngitic or cellulitic, will alter the risk of PSGN.
Not all cases of streptococcal infection lead to glomerulonephritis. PSGN usually develops 1-3 weeks following acute infection with specific nephritogenic strains of group A beta-hemolytic streptococcus. The incidence of GN is approximately 5-10% in persons with pharyngitis and 25% in those with skin infection.
The characteristic ultrastructural feature of PSGN is subepithelial like dense deposits.
By immunofluorescence microscopy, there are granular deposits of IgG, IgM and C3 in the mesangium and along GBM. Focal and sparse immune complex deposits are almost universally present.
PSGN does not commonly present with crescent formation. Only in its severe form PSGN may show rapid deterioration of renal function with formation of crescent in the glomeruli It is referred to as rapidly progressive glomerulonephritis. | 155,909 | medmcqa_train |
All of the following are risk factors for postoperative infection after hysterectomy except : | Ans. is b i.e. Use of blood transfusion Friends, let's discuss each option one by one. Urinary catheterization (Option 'a) It is very obvious that urinary catheterization for > 7 days will increase the chances of post operative infection. "Almost all nosocomial UT/ are associated with preceeding instrumentation and indwelling catheter, which create a 3-10% risk of infection each day." Surgery for malignancy (Option 'c) Telinde's Operative Gynaecology 9/e, p 197 and William Gynae, l/e p 77 gives a list of risk factors for Post Operative Infection. Risk factors for Postoperative Infection : Altered immunocompetence Obesity Bacterial vaginosis Excessive intraoperative blood loss Telinde's Operative Gynaecology Radical surgery - a/w prolonged surgical procedure (>3-5 hrs) Prolonged preoperative hospitalization Operative inexperience * Lower socioeconomic status * Poor nutrition * Excessive devitalized tissue * Diabetes mellitus * Failure to use prophylactic anitbiotics * Surgery in an infected operative site. Young age/old age (Williams Gynae 1/e, p 77) From the table it is clear : Radical surgery which is carried out for carcinoma endometrium and carcinoma cervix carries risk for postoperative infection. (Option "c") As far as age is concerned : Telinde operative gynaecology 9/e. p 196 says: "Young age has been considered a risk factor for vaginal posthysterectomy infection, although the exact reason is unclear." And table in Williams Gynae lie. p 77 gives old age as a risk factors for abdominal hysterectomy and young age as a risk factor for vaginal hysterectomy. This leaves us with option 'b' i.e. use of blood transfusion. Though theoretically by blood transfusion risk of infection with - HIV. hepatitis B/C, G etc is high but practically the technique by which blood is prepared there is minimal risk . | 155,910 | medmcqa_train |
Best time for diagnosing fetal abnormalities by USG: September 2009 | Ans. B: 13-19 weeks of pregnancy | 155,911 | medmcqa_train |
Collagen accumulated in space of Disse in case of liver cirrhosis are | In the normal liver, ECM consisting of interstitial collagens(fibril forming collagen types I, II, V and XI) is present only in the liver capsule, in poal tracts and around central veins. In cirrhosis, types I and III collagen and other ECM components are deposited in the space of disse. ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE 607 | 155,912 | medmcqa_train |
Which among the following decreases absorption of Iron from the intestine? | Coffee and tea consumption at the time of a meal can significantly decrease iron absorption (the polyphenols bind the iron). Excess consumption of high fiber foods or bran supplements (the phytates in such foods inhibit absorption) and high intake of calcium also decrease the iron absorption. Tetracyclines also decrease Fe absorption. Vit-C and acids increase Fe absorption. | 155,913 | medmcqa_train |
True about obsession - compulsive disorder are A/E | C i.e. Egosyntonic- In OCD, the thought is egodystonic or egoalien (ie foreign to one's personality)(2; not ego syntonic - OCD is a neurosis, so insight is presentQ | 155,914 | medmcqa_train |
Moeller's glossitis is due to a | Atrophic glossitis. Atrophic glossitis, also known as bald tongue, smooth tongue, Hunter glossitis, Moeller glossitis, or Moller-Hunter glossitis, is a condition characterized by a smooth glossy tongue that is often tender/painful, caused by complete atrophy of the lingual papillae Ref Davidson 23rd edition pg 1036 | 155,915 | medmcqa_train |
This virus causes a mononucleosis-like syndrome caused by a latent herpesvirus; it is often a congenital infection. Large amounts of the virus are excreted in the urine; thus, urine becomes the fluid of choice for diagnosis of this disease. | Epstein-Barr virus (EBV) is a herpesvirus that causes a number of syndromes; the most common is infectious mononucleosis. It is a ubiquitous enveloped DNA virus. Only one serotype of EBV has been recognized, although molecular methods have reorganized a number of genotypes of EBV.Infectious mononucleosis is an acute disease most commonly seen in younger people. It is characterized by a proliferation of lymphocytes, lymph node enlargement, pharyngitis, fatigue, and fever. Infection in young children is usually either asymptomatic or characteristic of an acute upper respiratory infection. Diagnosis is usually made by a positive heterophil test. Heterophil antibodies are those that occur in one species (human) and react with antigens of a different species. The heterophil test may be insensitive (30 to 60%) in children. Definitive diagnosis is made by detection of antibodies to EBV components.EBV causes a variety of other syndromes including Burkitt's lymphoma, the most common childhood cancer in Africa, and nasopharyngeal carcinoma, commonly seen in China.Similar mononucleosis-like diseases are caused by cytomegalovirus (CMV) and Toxoplasma gondii, a parasite. CMV causes fewer than 10% of infectious mononucleosis-like diseases. CMV "mono" is primarily characterized by fatigue. Congenital infection with CMV almost always causes serious sequelae, such as retardation and hearing loss. T. gondii also causes a variety of clinical problems, among them encephalitis in AIDS patients and food poisoning from the ingestion of raw meat. Although CMV and T. gondii are relatively rare causes of infectious mononucleosis, they must be ruled out, particularly when EBV tests are nonreactive. | 155,916 | medmcqa_train |
In a patient presenting with abdominal trauma,fracture rib and bruise over left hypochondrium probable diagnosis is - | Ans. is 'c' i.e., Splenic rupture | 155,917 | medmcqa_train |
Most common cause of death in the age group of 1-4 years children is - | Most common cause of death of children in age group of 1-4yrs is infectionsREF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 527 | 155,918 | medmcqa_train |
A previously healthy 6 weeks old female infant is found unresponsive in her crib. In the emergency department, she is notedto be well developed and well nourished with normal blood pressure and appearance of the genitalia but with increased pigmentation other skin. Blood glucose level is 30 mg/dl.. The most likely diagnosis is: | Ans. b. Familial glucocorticoid deficiency Hypoglycemia, hyperpigmentation with normal BP and normal genitalia in a child points towards Familial glucocorticoid deficiency.Familial Glucocorticoid Deficiency* Familial glucocorticoid deficiency is a rare autosomal recessive condition.* It is characterized by adrenal insufficiency.Pathology:Pathological Examination of the Adrenal GlandZona glomerulosaWell preservedZona fasciculataAtrophiedZona reticularisAtrophiedThis causes low cortisol concentration because the zona fasciculata is primarily responsible for glucocorticoid production.* Zona glomerulosa is well preserved, mineralocorticoid action is usually unaffected.* Low circulating serum cortisol results in lack of feedback inhibition to the hypothalamus, which results in increased ACTH secretion from pituitary.Clinical features* Patients with familial glucocorticoid deficiency generally presents with signs and symptoms of''adrenal insufficiency" with the important distinction that mineralocorticoid production is always normal.* .VIC initial presenting sign is deep hyperpigmentation of the skin, mucous membrane or both as a result of the action of ACTH on cutaneous MSH receptors^.* The symptoms are compatible with glucocorticoid deficiency. May patients presents with recurrent hypoglycemia or severe infections.* In the neonatal period, frequent presenting signs include feeding problems, failure to thrive, regurgitation and hypoglycemia manifesting as seizures. | 155,919 | medmcqa_train |
Drug of choice for treatment of intrahepatic cholestasis in pregnancy is ? | Ursodeoxycholic acid decreases bile salt levels and relieves pruritus. It can also decrease the chance for fetal complications Ref : Dutta book of obstetrics 8th Ed | 155,920 | medmcqa_train |
Stellate Granuloma are seen in | Ans. (a) Cat scratch disease(Ref: Robbins 9th/98)Cat-scratch disease causes rounded or stellate granuloma containing central granular debris and recognizable neutrophils; giant cells | 155,921 | medmcqa_train |
All of the following are true about lymphoma of the thyroid except | Primary thyroid lymphoma diagnosis is considered in patients with a goiter, especially one that has apparently grown significantly in a sho period. Other initial symptoms include hoarseness, dysphagia, and fever. Rapid growth, nerve involvement may raise suspicion of anaplastic carcinoma Thyroid lymphoma occurs four times more frequently in women than in men Approximately half of primary thyroid lymphomas occur in the setting of pre existing Hashimoto thyroiditis. Source : Sabiston 20 th edition Pg : 911 | 155,922 | medmcqa_train |
DOC in esophageal candidiasis in HIV- | Drug of choice for esophageal candidiasis is - Fluconazole oral or itraconazole solution. | 155,923 | medmcqa_train |
Supination in flexed elbow is produced by - | Ans. is 'b' i.e., Biceps MovementMuscles causing movementPronationPronator quadratus (strong pronator), Pronator teres (Rapid pronator).SupinationSupinator (when elbow is extended). Biceps (when elbow is flexed). | 155,924 | medmcqa_train |
Investigation of choice for solitary pulmonary nodule - | Ans. is 'b' i.e., CT ScanInvestigations of choice in respiratory systemDiseaseInvestigationo Intersitiai lung diseaseo BronchiectasisHRCTHRCT (1st choice)Bronchography (2nd choice)o Pulmonary embolismCT with i.v. Contrast (1st choice)V/Q scan (2nd choice)o Solitary' pulmonary noduleo Calcificationo Pulmonary malignancyo Superior sulcus or pancoast tumorCT scanCT scanCT scan (except in superior sulcus or pancoast tumor)MRI | 155,925 | medmcqa_train |
Bilateral proptosis and bilateral 6th nerve palsy in seen is: | In cavernous sinus thrombosis, there is bilateral orbital involvement whereas in orbital cellulitis, it is unilateral. | 155,926 | medmcqa_train |
If an anaesthetist at high altitude uses plenum vaporizers. It will deliver the vapour concentration – | Plenum vaporizer is typically set to deliver a 1-2 kPa partial pressure of anaesthetic agent. At sea level, where atmospheric pressure is around 100 kPa, this equates conveniently to a concentration of 1-2% of anaesthetic agent (1-2kPa out of 100 kPa).
At higher altitude, the atmospheric pressure is low (e.g. 75 kPa). The plenum vaporizer deliver 1-2 kPa partial pressure of anaesthetic agent. So, the concentration of anaesthetic vapours will 1.25 - 2.5% → Greater than the concentration of anaesthetic agent at same partial pressure at sea level. | 155,927 | medmcqa_train |
Aificial bruises are produced by ? | Ans. is 'b' i.e., Marking nut Semicarpus anacardium (marking nut or bhilawanl Its seed are hea shaped, conical and black with acrid oily juice which is brownish but turns black on exposure to air. Active principles are semecarpol and bhilawanol. Juice applied to skin produces irritation, painful blisters followed by itching and eczema. Therefore it is used to produce aificial bruises. It is also used by washerman to mark clothes | 155,928 | medmcqa_train |
Which of the following does not cross the cell membrane : | A i.e. Glucose-6-phosphate Glucose-6-phosphate cannot cross the cell membrane unless it in conveed into Glucose by the enzyme - Glucose-6-phosphatase.QVon Gerkes disease in deficiency of Glucose-6-phosphatase leads to accumulation of glucose-6-phosphate (and hence glycogen in the liver). In the absence of this enzyme, glucose-6-phosphate is not conveed into glucose and thus cannot enter the blood leading to hypoglycemia. | 155,929 | medmcqa_train |
To visualize vascular sling causing tracheal/external airway compression which of the following would you best prefer? | B i.e. MRI Vascular Rings Vascular rings is a condition in which an anomalous configuration of the arch and /or its associated vessels completely or incompletely surrounds the trachea & oesophagus causing compression of these structures. Neonates present with respiratory distress and older children present with stridor or dysphagia. Fouh developmental arch is most impoant. The two most common types of complete vascular rings, which account for 85-95% of cases are double aoic arch and right aoic arch with left ligamentum aeriosum Chest x-ray is the first & most commonly performed investigation. The identification of right aoic arch or ill defined arch location and compression of trachea in symptomatic child indicate the diagnosis. Many authorities consider barium oesophagoscopy to be the most impoant study in patients with suspected vascular ring and it is diagnostic in vast majority of cases. - A double aoic arch produce bilateral & posterior compression of oesophagus, which remain constant regardless of peristalsis. The right indentation is usually slightly higher than left and posterior one is usually wide & course in a downward direction from right to left. Right subclan aery takes a retrooesophageal course, there is a posterior defect slanting upward from left to right. The posterior defect is less broad than in double aoic arch. Echocardiography can be used but structures without lumen such as ligamentum aeriosum or an atretic arch are difficult to be identified. Plain x-ray & barium swallow can not reliably distinguish among the types of vascular rings. Cross section images by CT, MRI and digital substraction angiography (DSA) can be useful diagnostic tool in delineating the anatomy and aiding in presurgical planning & post surgical assessment. MR angiography (MRA) is an excellent substitute for DSA but young patients may require general anesthesia & where there is already airway compromise, this should be avoided. MRI is preferred as it is non invasive and avoids radiation riskQ. Multidetector CT is rarely used b/o radiation implication. Angiography (an invasive method) is rarely required unless cardiac catheterization is necessary for investigation of associated cardiac anomalies and if MRI is equivocal (same protocol applies for coarctation of aoa i.e. MRI > CT > Angiography). | 155,930 | medmcqa_train |
According to WHO, MMR is | (B) Death after 42 days > Late maternal death: A late maternal death is the death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy. | 155,931 | medmcqa_train |
Which of the following side effect is associated with Spironolactone | Spironolactone is an aldosterone antagonist that inhibits sodium resorption in the distal convoluted tubule of the kidney. Use of spironolactone may be limited by hyponatremia, hyperkalemia, and painful gynecomastia.If the gynecomastia is distressing, amiloride (5-40 mg/d) may be substituted for spironolactone.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 60e; Dysuria, Bladder Pain, and the Interstitial Cystitis/Bladder Pain Syndrome | 155,932 | medmcqa_train |
Medical sociology deals with - | Medical sociology is a specialization within the field of sociology its main interest is in the study of health , health behaviour, and medical institutions ref ;(page no;670)23rd edition of PARK&;s textbook of Preventive and Social medicine | 155,933 | medmcqa_train |
Dosage of drug in child is calculated based on March 2013 | Ans. B i.e. Weight Drug dosage for children is calculated based on age and weight of the child. | 155,934 | medmcqa_train |
A 6 week old boy is brought to the Paediatrician in Kanpur. His parents repo that he has not had significant use of his right arm since bih. Bih history is significant for a prolonged labor with difficult breech delivery. On physical examination, his arm hangs at his side and is in a medially rotated position with the forearm in pronation. He will actively use his left arm, but does not move his affected right arm or hand. Injury to which of the following cervical nerve roots account for this patient's posture? | This patient has an Erb-Duchenne palsy, which is the result of an injury to the superior trunks of the C5 and C6 nerve roots.The C8 and T1 nerve roots are injured in a Klumpke's paralysis.The other combinations all may be injured as a result of bih palsy, but do not have distinct syndromes associated with them. | 155,935 | medmcqa_train |
Gamma motor neurons are mainly influenced by | Gamma motor neurones are mainly influenced by rubrospinal tract Ref: guyton and hall textbook of medical physiology 12 edition page number:765,766,767 | 155,936 | medmcqa_train |
Pointing index in supracondylar fracture is due to which nerve injury? (D. REPEAT Feb 2014) | Ans: B (Anterior interosseous nerve) Ref: Apley's System of Orthopaedics and Fractures. 9th ed.Explanation:Complications of Supracondylar FracturesNerve injury - 7%.Vascular injury -1%.Most common nerve injured in extension type - Median, nerve especially anterior interosseous branch.Most common nerve injured in flexion type supracondylar fracture - Ulnar nerve.Most common nerve injured iatrogenicaliy {during Kirschner wire application) - Ulnar nerve.Anterior interosseous nerve supplies deep muscles of forearm except medial half of flexor digitorum profundus.Anterior interosseous nerve supplieso Pronator quadratuso Flexor pollicis longuso Lateral half of flexor digitorum longusThe main portion of the median nerve supplies: o Superficial group:>> Pronator teresFlexor carpi radialisPaSmaris longuso Intermediate group:# Flexor digitorum superficialis muscle.Note:Anterior interosseous nerve palsy causes weakness of lateral half of flexor digitorum longus, hence the index finger does not flex at the DIP joint, causing Pointing finger. | 155,937 | medmcqa_train |
Mycosis fungoides is? - | Mycosis fungoides is a slowly evolving cutaneous T cell lymphoma occuring in middle aged adult males. The condition is often preceded by eczema or dermatitis for several years. This is followed by infilteration by CD4+T cells in the epidermis and dermis as a plaque. Reference ; HARSH MOHAN TEXTBOOK OF PATHOLOGY, 7TH EDITION.PG NO. 359 | 155,938 | medmcqa_train |
Which of the following prevents hyperextension of thigh | B. i.e. Iliofemoral ligament | 155,939 | medmcqa_train |
Which of the following statements about confidence limits/ interval is true- | . | 155,940 | medmcqa_train |
Avascular necrosis of femur head is due to which of the following aery? | Reticular aery branch of medial circumflex femoral aery supplies the head of femur. In case of femur neck fracture, this aery may be occluded leading to avascular necrosis of femur head. | 155,941 | medmcqa_train |
Following gene when mutated, protects tumor cells from Apoptosis | Ans. (a) BCL-2(Ref: Robbins 9th/pg 594-595)BCL2 antagonizes apoptosis and promotes survival of follicular lymphoma cells.BCL stands for 'B Cell Lymphoma' | 155,942 | medmcqa_train |
All of the following statements are true regarding the pudendal nerve, except: | Pudendal nerve leaves the pelvis, to enter the gluteal region, by passing through the lower pa of the greater sciatic foramen. Pudendal nerve leaves the gluteal region by passing through the lesser sciatic foramen and enters the pudendal canal, and by means of its branches supplies the external anal sphincter and muscles and skin of the perineum. Ref: Clinical anatomy for Medical Students By Richard S Snell, 6th Edition, Pages 362-3 ; B.D.Chaurasia's Human Anatomy, 5th Edition, Volume 2, Page 365 | 155,943 | medmcqa_train |
Which of the following is the first fetal bone to ossify under normal circumstances? | Ans:B.)Clavicle.Assessment of Bone Age: BoneOssification CentresClavicle,Mandible and Membranous Bones of the Skull50 days to 5 months of GestationOs Calcis(Calcaneum) and Talus22-26 weeks of gestationDistal Epiphysis of Femur31-39 weeks of gestationProximal Epiphysis of Tibia34 weeks of gestation to 5th week post-natallyCuboid36 weeks of gestation to 8th week post-natallyProximal end of Humerus37 weeks of gestation to 16 weeks post-natally | 155,944 | medmcqa_train |
Best approach for surgical repair of the injury to abdominal aoa above the level of renal aery involving superior aery, celiac trunk, and the suprarenal branch: | Left medial visceral rotation exposes entire length of abdominal aoa, celiac axis, proximal pa of mesenteric aeries and proximal left renal aery. Maneuvers for Retroperitoneal Exposure Kocher&;s Maneuvre Extended Kocher&;s Maneuver Mattox Maneuver Cattel-Braasch Maneuver Surgical maneuver to expose structures in the retroperitoneum behind the duodenum and pancreas Used for mobilization of duodenum Right sided medial visceral rotation Right colon and duodenum is reflected medially Exposes IVC, Infrarenal aoa, right renal aery and iliac vessels Recommended for drainage of Inframesocolic hematoma Left sided medial visceral rotation. Left sided viscera(Left Kidney, left colon, Spleen and Pancreas) are brought to midline Exposes entire length of abdominal aoa, celiac axis, proximal pa of mesenteric aeries and proximal left renal aery. Recommended for drainage of Central supra-mesocolic hematoma For extensive retroperitoneal exposure Right colon is fully mobilized and reflected medially Good option for exposure of the infrapancreatic segment Ref: Sabiston 20th edition Pgno: 1546 | 155,945 | medmcqa_train |
In which one of the following conditions is sling operation done : | Nulliparous prolapse | 155,946 | medmcqa_train |
A 45 yr old lady presented with recurrent uterine bleeding. On transvaginal USG thickness of endometrium was found to be 8 mm. What should be the next step in the management of this patient ? | Ans. is 'a' i.e., Histopathology Uterine bleeding in a 45 year old may also occur due to endometrial carcinoma.Transvaginal ultrasound is used to assess the endometrial thickness.Endometrial thickness depends upon the stage of the menstrual cycle.Immediately after menstruation the endometrium is homogenous, 1-4 mm thick.As the oestrogen concentration increases, endometrium proliferates and its thickness increases to 7-10 mm.After ovulation the echogenicity of endometrium increases and it becomes hyper echogenic throughout with a thickness of 8-16 mm.Transvaginal ultrasound is usually the first investigation in case of dysfunctional uterine bleeding.TVS measures endometrial thickness. The exact cut off values for endometrial thickness measurement in premenopausal women to predict endometrial neoplasia are subject to continuing debate.The British "RCOG" Guideline development group analyzed a number of studies and concluded that 10-12 mm was a reasonable cut off when using TVS preferably undertaken in follicular phase, as a method prior to more invasive procedures of endometrial assessment.In the question, the endometrial thickness is 8mm but the stage of the cycle is not mentioned.The endometrial thickness of the patient does not fulfill the criteria meted out by RCOG but still she should undergo further endometrial evaluation as her age is 45 years.Women aged 40 years or more with vaginal bleeding should have an endometrial biopsy to exclude endometrial carcinoma.According to Shaw's "It is essential to rule out endometrial carcinoma in premenopausal women with menorrhagia ",Also know | 155,947 | medmcqa_train |
Following drugs have abuse liability except - | SSRIs have no addictive property - do not produce dependence.
Opioids (Dihydroxy propoxyphene & buprenorphine) are highly addictive.
BZDs (Alprazolam) have some addictive property, but less than barbiturates | 155,948 | medmcqa_train |
In a pregnant woman with raised phenylalanine in blood, offspring is most likely to have: | Ans: a (Mental retardation) Ref: Nelson, 17th ed, 400; 18th ed, p. 531Question is about pregnancy with hyperphenylalaninimea.Pregnant women with hyperphenylalaninimea who are not receiving phenylalanine restricted diet cany a very high risk of having an offspring with mental retardation, microcephaly and congenital heart disease.These complications are related to high levels of maternal plasma phenylalanine during pregnancy.Prospective mothers who have been treated for hyperphenylalaninimea should be maintained on a phenylalanine restricted diet before and during pregnancy, and should be made to keep blood phenylalanine level below 6 mg/dl throughout pregnancy.PHENYLKETONURIA~ Deficiency of phenylalanine hydroxylase~Normal at birth~ Progressive MR- loses 4 points in IQ/month in 1 st year~Purposeless movements- rocking / athetosis~ Fair skin and blue eyes~ Rash eczematoid / seborrheic~ Mousy/ musty odour~ Hypertonia with hyper rellexia~ 25% shows seizures 50% will have EEG abnormalities~ Microcephaly~Enamel hypoplasia~ FIT -growth retardationDiagnosis:At birth urine test is negative, blood phenylalanine may be increased.Estimation is better done after protein challenge (breast feed).Guthrie test (Bacterial inhibition test) is used to detect level of phenylalanine in blood.Ideally done 48-72 hours after protein feed.Treatment:Low phenylalanine diet (level 3-15 ng/dl)FeCk testPhenylketonuriaGreen colourMaple syrup urine diseaseNavy blue colour | 155,949 | medmcqa_train |
Superior quadrantic hemianopia is caused by: | SUPERIOR QUADRANTANOPIA / PIE IN THE SKY - Inferior fibres are damaged - Inferior fibres pass through temporal lobe - ALL PIE IN THE SKY ARE SEEN IN OPPOSITE TEMPORAL LOBE LESIONS LESIONS Disc/optic nerve lesions Same sided monocular blindness Chiasmal lesions Bitemporal Hemianopia Optic tract lesions (mc) Incongruous Homonymous hemianopia Lt. Geniculate body lesions Incongruous Homonymous hemianopia Meyer's loop (Temporal lobe) Pie in the sky Baum's loop (parietal lobe) Pie on the Floor Occipital lobe lesion Congruous Homonymous hemianopia with macular sparing Both pituitary adenoma and a craniopharyngioma can also cause chiasmal compression and produce visual field defects. However, they both end up producing typical type of junctional scotomas rather than quadrantic defects and are hence not considered to be causes for the later. Extra benefit - Junctional scotomas are visual field defects due to anterior or posterior chiasmal lesions and not typical central or temporal lesions. | 155,950 | medmcqa_train |
A 17 year old girl presents with history of generalised abdominal pain, fever, recurrent vomiting. On examination, she has a temperature of 103degF, Right Iliac fossa tenderness, and WBC are 19600/mm' ? | Ans. is 'a' i.e., Ruptured appendicular abscess Abdominal pain and vomiting suggest the most likely diagnosis of appendicitis. High temp (103degF) and high WBC count suggest appendiceal rupture. Schwaz writes - "Rupture should be suspected in the presence of fever greater than 39degC (102degF) and a WBC count greater than 18,000/mm3." Other options are less likely, as fever and vomiting is uncommon in them. Intussusception Is usually seen in children younger than 2 yrs of age Fever, leucocytosis is not seen. Ruptured ectopic pregnancy Schwaz writes - "Rupture of . tubal or ovarian pregnancies can mimic appendicitis. Patients usually give a history of abnormal menses; either missing one or two periods or noting only slight vaginal bleeding. The diagnosis of ruptured ectopic pregnancy should be relatively easy. The presence of a pelvic mass and elevated levels of chorionic gonadotropin are characteristic While the leukocyte count rises slightly (to approx. 14,000), the hematocrit level falls as a consequence of the intraabdominal haemorrhage. Vaginal examination reveals cervical motion and adenexal tenderness." Twisted ovarian cyst Shaw's writes - "A twisted ovarian cyst causes sudden pain in abdomen with occasional vomiting, but pyrexia is usually absent or very low. An abdominal lump is felt distinctly. | 155,951 | medmcqa_train |
Drug not given with ketoconazole: | (Ref: Goodman & Gillman s 13th ed. P 90)The common antifungal agent ketoconazole is a potent inhibitor of CYP3A4Therefore coadministration of ketoconazole with other CYP3A4 inhibitors like anti-HIV drug viral protease inhibitors (ritonavir, indinavir), clarithromycin, itraconazole, nefazodone, and grapefruit juice reduces the clearance of these drugs and increases its plasma concentration and the risk of toxicity. Hence these drugs are not given together. | 155,952 | medmcqa_train |
Which of the following immunoglobulin is a pentamer? | IgM Both secretory IgA (dimeric) and IgM (pentameric) have J chains 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 a pentamer composed of five H,L, units (each similar to one IgG unit) and one molecule of J (joining) chain. | 155,953 | medmcqa_train |
Which of the following is false about scapula? | The medial border is thin.it extends from the superior angle to the inferior angle. Reference BD chaurasia pageno : 9 , 6th edition. | 155,954 | medmcqa_train |
Recently approved drug for psychosis associated with Parkinsonism is? | Pimavanserin An inverse agonist at 5HT2A receptor Approved for psychosis associated parkinsonism | 155,955 | medmcqa_train |
In bacterial mRNA, Shane-Dalganro sequence is situated near which of the following codon? | Shine-Dalgarno sequence is apparently the eukaryotic small ribosomal subunit binds to the 5'end of a eukaryotic mRNA and scans along it until it encounters an AUG codon.They assist in aligning mRNA on the ribosomes. Ref: Biochemistry By Reginald Garrett, Charles M. Grisham, 2005 Page A 38 ; Biochemistry By J. Stenesh, Volume 1, Page 487 | 155,956 | medmcqa_train |
A 30-year-old male had severely itchy papulo–vesicular lesions on extremities, knees, elbows and buttocks for one year. Immunofluorescence staining of the lesions showed IgA deposition at dermo-epidermal junction. The most probable diagnosis is – | Itchy papulovesicular lesions on extensor surfaces and deposition of IgA at DEJ suggests the diagnosis of dermatitis herpatiformis, which is associated with Coeliac disease | 155,957 | medmcqa_train |
At PHC level vaccine storage is by? | .ice lined refrigerators(ILR)are mkept at the PHC level.the cabinet temperature is maintained at 2 to 8 degree celsius.at the PHC level,ILR s are used to store all UIP vaccines.they are lined with tubes or ice packs filled with water which freezes and keeps the internal temperature at a safe level.</p><p>ref:park&;s textbook of preventive and social medicine,22 nd edition ,pg no 104</p> | 155,958 | medmcqa_train |
Gunstock deformity is seen in | A most common complication of supracondylar fracture is malunion,
which further can lead to cubitus varus deformity.
This is because of the reason that fracture unites with the distal fragment tilted medially and in internal rotation.
This cubitus varus is usually termed as gunstock deformity.
Most common nerve damaged in supracondylar fracture: Anterior Interosseous Nerve. | 155,959 | medmcqa_train |
Which of the following is mature defence mechanism? | Ans. b (Humor.) (Ref. Kaplan & Sadock's Synopsis of Psychiatry, 10th ed., p. 203. Table 6.1-3)COMMON FREUDIAN DEFENSE MECHANISMSDefence mechanismShort DefinitionImportant AssociationsProjectionAttibuting inner feelings to othersParanoid behaviorsDenialSaying it is not soSubstance abuse, reaction to deathSplittingThe world composed of polar oppositesBorderline personality, good versus evilBlockingTransient inability to rememberMomentary lapseRegressionReturning to an earlier stage of developmentEnuresis, primitive behaviorsSomatizationPhysical symptoms for psychological reasonsSomatoform disordersIntrojectionThe outside becomes insideSupergo, being like parentsDisplacementSource stays the same, but target changesRedirected emotion, phobias, scapegoatRepressionForgetting, so it is nonretrievableForget and forgetisolation of affectFacies without feelingBlunted affect, la belle indifferenceIntellectualizationAffect repalced by academic contentAcademic, not emotional reactionActing outAffect covered up by excessive action or sensationSubstance abuse, fighting, gamblingRationalizationWhy the unacceptable is okay in this instanceJustification, string of reasonsReaction formationThe unacceptable transformed into its oppositeManifesting the opposite; fee love but show hate: "Girls have cooties."UndoingAction to symbolically reverse the accaptableFixing or repairing, obsessive-compulsive behaviorsPassive-aggressivePassive nonperformance after promiseUnconscious, indirect hostilityDissociationSeperating self from one's own experienceFugue, depersonalization, amnesia, multiple personalityHumorA pleasant release from anxietyLaughter hides the painSublimationMoving an unacceptable impulse into an acceptable channelArt, literature, mentoringSuppressionForgetting, but is retrievableForget and rememberPsychodynamic PsychotherapyDEFENSE MECHANISMS# The way & means that the Ego wards off anxiety & controls instinctive, urges & unpleasant affects (Emotions)# All Defense Mechanisms are Unconscious (except Suppression), Discrete, Dynamic & Irreversible, Adaptive & Maladaptive# Highly adaptive (mature)- Altruism, Humor, Sublimation & Suppression# Less adaptive- Displacement, Intellectualization, Isolation of Affect, Rationalization, Reaction Formation & Repression# Primitive (immature)- Acting out, Denial (deletion from consciousness), Projection & Splitting# Transference & Countertransference- Brings unconscious topics into consciousness# Transference# Feelings of patient toward therapist# Occurs in all patient/physician relationships- Countertransference# Feelings of therapist toward patient# Occurs in all patient/physician relationships# Interpretation- Therapist identifies feelings, drives, and defenses in action | 155,960 | medmcqa_train |
At what angle hallpike thermal calorie test is done | Dix Hillpike manoeuvre: Patient sits on a couch. Examiner holds the patient's head, turns it 45deg to the right and then places the patient in a supine position so that his head hangs 30deg below the horizontal. Patient's eyes are observed for nystagmus. The test is repeated with head turned to left and then again in straight head-hanging position. Four parameters of nystagmus are observed: latency, duration, direction and fatiguability Ref: Dhingra 7e pg 44. | 155,961 | medmcqa_train |
All are true about rectal cancer except: | Ans. (c) Dissection lateral to endopelvic fascia investing the mesorectum causes local recurrence* Total mesorectal Excision (TME) provides least recurrence* Most common symptom is bleeding PR* Sigmoidoscopy is used to localize the tumor* RT given for ca rectum is 60 Gy. | 155,962 | medmcqa_train |
Hepatic secretory function is evaluated using | Answer- D. Prothrombin time (PT)The most widely used tests are those measuring the blood concentration of aspaate aminotransferase (AST) and alanine aminotransferase (ALT).Congulation proteins: The easiest way to estimate the concentration of the coagulation factors is by measuring the prothrombin time (PT), which is normally l0 to 13 seconds. Prolonged PT is a sensitive index of liver function loss. | 155,963 | medmcqa_train |
A person with AIDS related complex is most likely suffering from: | Ans. (a) Oppounistic infection Natural course of HIV infection can be divided into following stages: HIV infectioh. Seen in 30% of individuals within 3-6 weeks of infection. They present with low grade fever, headache, malaise some time with rash and ahropathy resembling glandular fever. Spontaneous rresolution occurs within weeks. Tests for HIV antibodies are usually negative at the onset of illness but become positive during its course. So this stage is also called as seroconversion illness. `,symptomatic or Latent Infectio. Seen in all patients. This phase which lasts upto several years, patient remain asymptomatic. HIV antibody test is positive in this phase and patients are infectious. This period of clinical latency does not mean viral latency as virus multiplication goes on throughout. "ercictant generalized lvninhadenonathy This stage is defined as presence of enlarged lymphnodes at least 1 cm in diameter in two or more non-contagious extrainguinal sites, that persist for at least three months, in absence of any current illness or medication that may cause lymphadenopathy. AIDS related corn /Ilex. This group include patients with considerable immunodeficiency suffering from various constitutional symptoms or minor oppoinistic infections like oral candidiasis herps zoster, hairy cell leukoplakia. AIDS: This is the endstage representing the irreversible breakdown of immunodefence mechanisms leading to progressive oppounistic infection and malignancies. merr"- During the period of clinical latency 10 billion HIV paicles are produced and destroyed every day. Half life of virus in plasma is about 6 hours. Virus life cycle (from the time of infection of a cell to the production of new progeny that infect the next cell) averages 2.6 days | 155,964 | medmcqa_train |
Not a muscle of Ist layer of foot | Flexor digitorum accessorius is a muscle of 2nd layer of foot | 155,965 | medmcqa_train |
Lesh Nyhan syndrome is associated with deficiency of | REF :DM VASUDEVAN TEXTBOOK :7th EDITION ;Page no :403 Disease deficient enzyme GPD Deficiency G6PD Gaucher's disease beta glucosidase Lesch-Nyhan syndrome HGPase | 155,966 | medmcqa_train |
Acantholysis is seen in all except ? | Ans. is 'D'.e., Bullous pemphigoid Acantholysis Separation of epidermal keratinocytes due to loss of intercellular bridge is referred to as acantholysis . Diseases causing acantholysis are : ? Pemphigus (Pemphigus vulgaris, P. vegetans, P.foilaceous, P. erythematosus) Eosinophilic spongiosis Darrier's disease Grover's disease (Transient acantholytic dermatosis) Hailey-Hailey disease (Familial benign chronic pemphigus) Infections with HSV-1 & 2. Staphylococcus scalded skin syndrome. | 155,967 | medmcqa_train |
Aldosterone synthesis is stimulated by which of the following? | Mineralocoicoid secretion is stimulated by hyperkalemia, angiotensin-H, ACTH and hyponatremia, in reducing order of efficacy. 1. Aldosterone secretion in response to hyperkalemia is the most impoant and forms the basis for renal regulation of body potassium balance. 2. Stimulation of aldosterone by angiotensin II (through renin-angioensin system) is impoant for the correction of hypovolemia and hypotension in conditions like salt depletion or renal ischemia. 3. Stimulation of aldosterone secretion by ACTH results in diurnal variation of aldosterone secretion. 4. However, ACTH is not an impoant physiological regulator for aldosterone secretion. Hyponatremia is a weak stimulator of aldosterone secretion REF : HARRISONS 21ST ED | 155,968 | medmcqa_train |
A patient with an abdominal malignancy underwent procedure for celiac plexus block. Which of the following can be the most common complication in this patient? | The most common complication of celiac plexus block is postural hypotension, from block of the visceral sympathetic innervation and resultant vasodilation. For this reason, patients should be adequately hydrated intravenously prior to this block. Other complications include, Accidental intravascular injection into the vena cava Accidental intra aoic injection Pneumothorax Retroperitoneal hemorrhage Injury to the kidneys or pancreas Sexual dysfunction Paraplegia (due to injury to the lumbar aery of Adamkiewicz) Increased gastrointestinal motility and diarrhea Back pain Ref: Butterwoh IV J.F., Mackey D.C., Wasnick J.D. (2013). Chapter 47. Chronic Pain Management. In J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e. | 155,969 | medmcqa_train |
Small bones are supplied by | Periosteal arteries
These are especially numerous beneath the muscular and ligamentous attachments.
They ramify beneath the periosteum and enter the Volkmann's canals to supply the outer 1/3 of the cortex.
In miniature long bones, the infection begins in the middle of the shaft rather than at the metaphysis because, the nutrient artery breaks up into a plexus immediately upon reaching the medullary cavity. In the adults, however, the chances of infection are minimized because the nutrient artery is mostly replaced by the periosteal vessels.
KEY CONCEPT:
Short bones are supplied by numerous periosteal vessels which enter their nonarticular surfaces. | 155,970 | medmcqa_train |
The PEFR of a group of 11 year old girls follow a normal distrubution with mean 300 1/min and standard deviation 20 1/min - | 1 SD includes → 68% of values
2 SD includes → 95% of values
3 SD includes → 99.7% of values
In this question
Mean PEFR = 300 L/min
SD = 2 L/min
Area around 1SD on either side of mean (x ± 1SD) will include 68% of values, i.e.
x± 1SD=300±20
So, 68% of girls have PEFR between 280 & 320 L/min.
Area around 2SD on either side of mean (x ± 2SD) will include 95% of values, i.e.
x±2SD=300±40
So, 95% of girls have PEFR between 260 & 340 L/min.
Area around 3SD on either side of mean (x ± 3SD) will include 99.7% of values, i.e. -
x ±3SD = 300 ± 60
So, 99.7% of girls will have PEFR between 240 & 360 L/min. | 155,971 | medmcqa_train |
Which is predominant in normal healthyhuman ? | Ans. is 'b' i.e., LDH2 IsoenzymeSubmit compositionIssuePercentage in serrumLDH IHHHHMyocardium, RBC30LDH2HHHMMyocardium, RBC35LDH3HHMMBrain, Kidney20LDH4HMMMSkeletal muscle, Liver10LDH 5MMMMSkeletal muscle, Liver5 | 155,972 | medmcqa_train |
Which one of the following is the level of residual free chlorine recommended for swimming pool water disinfection? | Chlorination is the most widely used method of pool disinfection. Various workers have stated that continuous maintenance of 1mg/litre(1ppm) of free residual chlorine provides adequate protection against bacterial and viral agents. Park's Textbook of Preventive and Social Medicine, 25th edition, Page No. 788 | 155,973 | medmcqa_train |
Which of the following is not a source of Indoor air pollution? | Sources of Indoor air pollution: Indoor air pollutants Sources Respirable paicles Tobacco, smoke, stove, aerosols Carbon monoxide Combustion equipments, stove, gas, heaters Nitrogen dioxide Gas cookers, cigarettes Sulphur dioxide Coal combustion Carbon dioxide Combustion, respiration Formaldehyde Paicle board, carpet adhesives, insulation Organic vapours (benzene, toulidine) Solvents, adhesives, resins, aerosols Ozone Electric aecing, UV light Radon Building materials Asbestos Insulation, fire-proofing Mineral fibers Appliances | 155,974 | medmcqa_train |
Which is the best fluid for resuscitation during shock state? | ANSWER: (A) CrystalloidsREF: Schwartz's Principles of Surgery 9th ed chapter 5"Fluid resuscitation is a major adjunct to physically controlling hemorrhage in patients with shock. The ideal type of fluid to be used continues to be debated; however, crystalloids continue to be the mainstay of fluid choice"Several studies have demonstrated increased risk of death in bleeding trauma patients treated with colloid compared to patients treated with crystalloid. In patients with severe hemorrhage, restoration of intravascular volume should be achieved ivith blood products.Ongoing studies continue to evaluate the use of hypertonic saline as a resuscitative adjunct in bleeding patients. The benefit of hypertonic saline solutions may be immunomodulatory. Specifically, these effects have been attributed to pharmacologic effects resulting in decreased reperfusion-mediated injury with decreased O2 radical formation, less impairment of immune function compared to standard crystalloid solution, and less brain swelling in the multi- injured patient. The reduction of total volume used for resuscitation makes this approach appealing as a resuscitation agent for combat injuries and may contribute to a decrease in the incidence of ARDS and multiple organ failure. | 155,975 | medmcqa_train |
Commonest cause of hematogenous osteomyelitis: March 2011 | Ans. B: Staph. aureus Staphylococcus aureus is the commonest causative organism causing acute osteomyelitis Osteomyelitis: Earliest site of involvement in bone: Metaphysis Brodie's abscess: A static cavity remains in bone, without fuher enlargement. Blood culture are positive in 65% of cases Periosteal reaction may be the radiological sign visible (after 10 days) MC cause of acute osteomyelitis: Staph. Aureus | 155,976 | medmcqa_train |
Cardiac arrest developed due to local anaesthetic systemic absorption. All are management except- | Vasopressin not used Advanced Cardiac Life Suppo algorithms for cardiopulmonary resuscitation must be followed should cardiac arrest occur. Chest compressions should be initiated immediately and continued until return of spontaneous circulation. If epinephrine is used, small initial doses of <=1 ug[?]kg-1 are preferred to avoid impaired pulmonary gas exchange and increased afterload. Vasopressin is not recommended for use as it has been associated with adverse outcomes in animal models. In the absence of rapid recovery following advanced life suppo measures and intravenous lipid emulsion therapy, early consideration should be given to cardiopulmonary bypass for circulatory suppo. The inotropic effect of lipid emulsion therapy only occurs once the myocardial LA levels are below a threshold that corresponds to ion channel blocking concentrations. This emphasizes the impoance of effective chest compressions to ensure coronary perfusion is sufficient to reduce LA tissue levels in order to obtain the benefit of lipid emulsion therapy. If cardiac output is maintained but there are deleterious CVS effects - such as arrhythmias, conduction block, progressive hypotension, and bradycardia - standard Advanced Cardiac Life Suppo algorithms should be followed with the omission of LA, such as lidocaine, for the treatment of arrhythmia. Amiodarone is the first-line antiarrhythmic in the event of ventricular dysrhythmia. | 155,977 | medmcqa_train |
Pasteurised milk is tested by: | Ans: a (Phosphatase test) Ref; Park, 19 ed, p. 522Tests for pasteurised milk:Phosphatase testStandard plate countColiform countOTA test--for detection and estimation of free and combined chlorine in chlorinated water.Benzidine test--chemical test for the detection of blood stainParaffin test--detection of gun powder residuesMethylene blue reduction test--It is an indirect method for detection of micro-organisms in milk.This test is carried out on milk accepted for pasteurizationMethods of pasteurization:Holder or Vat method:In this the milk is kept at 63- 66oC for atleast 30 min and then cooled to 5degCHigh temperature short time method: (HTST)Milk is rapidly heated to temperature of nearly 72degC and held at that temperature for not less than 15 sec and is then cooled to 4degC.Most widely used method now.UHT method / Ultra high temperature method:Milk is rapidly heated usually in 2 stages to 125degC (second stage under pressure.)Thermodynamic bacteria and bacterial spores are resistant towards pasteurization. | 155,978 | medmcqa_train |
Serotonin is synthesized from- | Ans. is 'c' i.e., Tryptophan o Hvdroxytryptamine (serotonin) is synthesized from tryptophan. | 155,979 | medmcqa_train |
Hypoxic pulmonary vasoconstriction: | The great reduction in pulmonary vascular resistance during the transition from placental to normal respiration is largely brought about by the process of hypoxic pulmonary vasoconstriction. The other choices are incorrect because the PO2 of alveolar gas is much more impoant than the PO2 of mixed venous blood, CO2 uptake is irrelevant, the constriction paly dives blood flow from poorly ventilated, not well-ventilated regions of diseased lungs, and the inhalation of nitric oxide paly reverses hypoxic pulmonary vasoconstriction. | 155,980 | medmcqa_train |
Alternative parenteral drug for multi drug resistant malaria is | Multidrug-resistant P. falciparum malaria : Either aemether-lumefantrinec (1.5/9 mg/kg bid for 3 days with food) or Aesunatec (4 mg/kg qd for 3 days) plus Mefloquine (25 mg of base/kg--either 8 mg/kg qd for 3 days or 15 mg/kg on day 2 and then 10 mg/kg on day 3) Aemisinin and derivatives (aemether, aesunate) : Good oral absorption, slow and variable absorption of IM aemether; aesunate and aemether biotransformed to active metabolite dihydroaemisinin; all drugs eliminated very rapidly; t1/2: <1 h (Harrison's Principles of internal medicine, 20th edition, page 1699) | 155,981 | medmcqa_train |
An enzyme produced by Staphylococcus aureus that dissolves fibrin clots is: | Pathogenic bacteria release exoenzymes that increase their ability to invade body tissue. These include coagulase, kinases, lipase, hyaluronidase, and collagenase. All Staphylococci produce catalase, an enzyme responsible for conversion of toxic hydrogen peroxide to water and oxygen which accumulates during bacterial metabolism or is released following phagocytosis. Kinases dissolve fibrin clots thus enabling the organism to invade and spread throughout the body. Staphylococcus aureus produces staphylokinase which is fibrinolytic. Coagulase is the exoenzyme produced by Staphylococcus aureus and it clots the plasma. Lipase hydrolyzes lipids, and aids in the survival of staphylococci in the sebaceous glands. Hyaluronidase enables pathogen to spread through connective tissue by breaking down hyaluronic acid, the "cement" that holds tissue cells together. Ref: Francis C.W., Crowther M. (2010). Chapter 23. Principles of Antithrombotic Therapy. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e. | 155,982 | medmcqa_train |
Curie is a unit of- | Ans. is 'a' i.e. Radioactivity * Old unit of radioactivity is Curie and new unit (SI) is Becquerel.* Old unit of radiation exposure is Roentegn and new unit (SI) is Columb/cmQuantity measuredOld unitNew (SI)unit RadioactivityCurieBecquerel1 curie = 3.7 x 101 becquerel -2.7 x 10Radiation exposureRoentgenColumb/cm Absorbed doseRadGray100 rad = 1 gray1 rad = 0.01 grayDose equivalentRemSievert (Sv)100 rem = 1 SvIrem = 0.01 Sv | 155,983 | medmcqa_train |
The % of coincidence between sore throat and acute rheumatic fever is - | Ans. is 'a' i.e., 3% Only a small propoion of patients with streptococcal pharyngeal infection develops Rheumatic fever. Attack rate is less than 3% | 155,984 | medmcqa_train |
Major Disadvantage of peripheral line is | Ref: Bailey and love 27th edition Pg no :287 | 155,985 | medmcqa_train |
Not true about angioneurotic edema - | Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes.The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs.Often it is associated with hives, which are swelling within the upper skin.Onset is typically over minutes to hours The underlying mechanism typically involves histamine or bradykinin. The version related to histamine is due to an allergic reaction to agents such as insect bites, foods, or medications. The version related to bradykinin may occur due to an inherited problem known as C1 esterase inhibitor deficiency, medications known as angiotensin-conveing enzyme inhibitors, or a lymphoproliferative disorder. Effos to protect the airway may include intubation or cricothyroidotomy. Histamine-related angioedema can be treated with antihistamines, coicosteroids, and epinephrine.In those with bradykinin-related disease a C1 esterase inhibitor, ecallantide, or icatibant may be used.Fresh frozen plasma may be used insteadIn the United States the disease affects about 100,000 people a year. The skin of the face, normally around the mouth, and the mucosa of the mouth and/or throat, as well as the tongue, swell over the period of minutes to hours. The swelling can also occur elsewhere, typically in the hands. The swelling can be itchy or painful. There may also be slightly decreased sensation in the affected areas due to compression of the nerves. Uicaria (hives) may develop simultaneously. In severe cases, stridor of the airway occurs, with gasping or wheezy inspiratory breath sounds and decreasing oxygen levels. Tracheal intubation is required in these situations to prevent respiratory arrest and risk of death. Sometimes, the cause is recent exposure to an allergen (e.g. peanuts), but more often it is either idiopathic (unknown) or only weakly correlated to allergen exposure Ref Davidson 23rd edition pg 461 | 155,986 | medmcqa_train |
An 10 month-old baby is brought to the pediatric clinic with symptoms of diarrhea, hair loss and failure to thrive. On clinical examination, there is inflammation of the skin around the mouth and the perianal region. The mineral deficiency responsible for this disease is a cofactor for all of the following enzymes except? | The above features, strongly suggest a diagnosis of Acrodermatitis enteropathica which is due the deficiency is of zinc and it is a cofactor for Lactate dehydrogenase. It is an autosomal recessive disease due to a defect in zinc absorbing transmembrane protein. Symptoms: Growth retardation Diarrhea Alopecia Dermatitis around the orifices Gonadal atrophy Impaired wound healing Zinc acts as a cofactor for: Carbonic anhydrase Carboxypeptidase Lactate dehydrogenase Alcohol dehydrogenase Alkaline phosphatase Reference: Harpers illustrated biochemistry 30th edition | 155,987 | medmcqa_train |
Paralysis of 3rd, 4th, 6th, nerves with involvement of ophthalmic division of 5th nerve, localizes the lesion to - | Cavernous sinus lesions may be associated with paralysis of 3rd, 4th, 5th (ophthalmic and maxillary divisions) and 6th nerve on account of its characteristic relations. | 155,988 | medmcqa_train |
Locally invasive gastric carcinoma. Investigation of choice to know depth of cancer invasion: | The best way to stage the tumor locally is EUS, which gives fairly accurate (80%) information about the depth of tumor penetration into the gastric wall, and can show enlarged (>5mm) perigastric and celiac lymph nodes | 155,989 | medmcqa_train |
In presence of unusually high outliers, preferred measure of central tendency is: | The mean is vitiated due to presence of outliers. Outliers are unusually high or unusually low values that do not go with other values. Whenever such values are present, mean is not a good choice. In such cases, the median is used as it is not really affected by unusually high or low values. Ref: Medical biostatistics, 1st edition pg: 115 | 155,990 | medmcqa_train |
Lady with central obesity & abd. Skin showing purple striae- | centripetal obesity, and broad violaceous cutaneous striae in abdomen classical presentation of Cushing's syndrome ( Harrison 17 pg 2255) | 155,991 | medmcqa_train |
Which of the following is used for staging of CKD? | e-GFR and albuminuria- used for staging of CKD | 155,992 | medmcqa_train |
Long acting barbiturate is ? | Ans. is 'c' i.e., Phenobarbitone Long acting barbiturates -4 Phenobarbitone, Mephobarbitone. Sho acting barbiturates-4 Butobarbitone, secobarbitone, Pentobarbitone. Ultrasho acting -4 Thiopentone, Methohexitone, Hexobarbitone. | 155,993 | medmcqa_train |
Which of the following enzymes is stable at acidic pH | Optimum pH for Pepsin- 1.6-3.2 | 155,994 | medmcqa_train |
In irreversible pulpitis, pain in which of the following sites is most likely to radiate to the ear? | Mandibular molar. The perception of pain in one part of the body that is distant from the actual source of the pain is known as referred pain. Teeth may refer pain to other areas of the head and neck. Referred pain is usually provoked by stimulation of pulpal C-fibers, the slow conducting nerves that, when stimulated, cause an intense, dull, slow pain. It always radiates to the ipsilateral side. Posterior teeth may refer pain to the opposite arch or periauricular area. Mandibular posterior teeth tend to transmit referred pain to the periauricular area more often than do the maxillary posterior teeth. | 155,995 | medmcqa_train |
Treatment of choice in SSPE is | . | 155,996 | medmcqa_train |
Chemoprophylaxis of chloroquine includes - | - Chemoprophylaxis is recommended for travellers from non endemic areas to highly endemic areas of malaria. - chloroquine tablet for chemoprophylaxis in adults include a dose of 300 mg base once a week on the same day each week. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:268 <\p> | 155,997 | medmcqa_train |
Common precursor of mineralocorticoid, glucocorticoids and sex steroids: | Ans. (a) Pregnenolone(Ref: Ganong, 25th ed/p.362)Adrenal steroid hormones are derived from cholesterolIn the mitochondria, cholesterol is converted to pregnenolone by cholesterol desmolase, also called as side- chain cleavage enzyme | 155,998 | medmcqa_train |
Nerve supply to musculature of urinary bladder is ? | Ans. is 'c' i.e., BothParasympathetic supply is motor to detrusor muscle and inhibitory to sphinchter vesicae. Sympathetic supply is motor to sphincter vesicae and inhibitory to detrusor muscle.Nerve supply of bladderBladder is supplied by both sympathetic and parasympathetic fibers.Parasympathetic : Preganglionic fibers arise from S2 to S4 cord segments, pass pelvic splanchnic nerves. After relay in ganglion cells in pelvic plexus (inferior hypogastric plexus) and in bladder wall, postganglionic fibers supply detrusor muscle. Contraction of detrusor muscle is mediated by cholinergic muscarinic receptors(M3).Preganglionic parasympathetic neurons at S2,and S4cord segments innervating bladder form sacral micturition center.Sympathetic : Preganglionoic fibers arise from lateral horn cells of T1-L2 cord segments and pass lower lumbar splanchnic nerves, superior hypogastric plexus (presacral nerve of Latarjet) to reach inferior hypogastric (pelvic) plexus. After relay in pelvic ganglia, postganglionic sympathetic fibers (i) stimulate sphincter vesicae (internal urethral sphincter) a, adrenoceptors and (ii) cause relaxation of detrusor muscle 132 adrenoceptors. It can also inhibit presynaptically the parasympathetic ganglia a, adrenoceptorsVisceral afferents : (1) pain fibers from bladder pass through both parasympathetic and sympathetic pathway and enter TH-L2 and S2-S4 cord segments, hence referred pain is felt in lower pa of anterior abdominal wall (hypogastrium), upper pa of front of thigh, scrotum or labium majus, penis or clitoris, and perineum. Centrally, spinothalmic pathway conducts pain impulses from bladder.Stretch afferents : arising from stretch receptors in the bladder wall pass pelvic splanchnic nerves, enter S2, S3 and S4 cord segments and establish reflex connections with sacral micturition center, which innervates detrusor.So afferent and efferent limb of this micturition reflex is formed by pelvic splanchnic nerves.Sacral mictruition center and the micturition reflex are controlled by facilitatory and inhibitory centers located in pons and paracentral lobule of frontal lobe of cerebum. | 155,999 | medmcqa_train |
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