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In Ghon's technique of autops, organs are removed | Refer the byte "Autopsy technique and types". | 158,300 | medmcqa_train |
Acrodynia is associated with: | Ans. (b) MercuryRef: The Essentials ofFSM by K.S. Narayan Reddy 31st ed. / 505MERCURY POISONING (HYPRAGYRISM)* Vapours of mercuric compounds are poisonous because it will be absorbed in the systemic circulation.* Mercuric compounds being soluble are more poisonous than mercurous (less soluble) compounds.Clinical Presentation of Mercury Poisoning (Remembered as MEATS)* Mercuria lentis: brownish deposition of mercury on the anterior lens.* Membranous colitis* Erethism: Characterized by shyness, irritability, tremors, loss of memory & insomnia.* Acrodynia (Pink disease): Generalized pinkish body rash starting from tips of fingers & toes# Characterized by 5 P's: Pinkish, Puffy, Painful, Paresthetic hands, and feet with Peeling of skin.* Tremors: Also known as Danbury tremors, hatters or glass-blowers shake* Salivation & gingivitis: excessive salivation associated with metallic taste, gingivitis, loosening of teeth and blue-black line on gums.Also, knowDifferent Metallic Poisoning and Their Effect on Hair And SkinPoisoningColor of Hair & SkinArsenic (As)* Yellow color of skin, hair & mucous membrane* Milk rose (Brownish pigmentation)/Rain drop pigmentation* BLACK FOOT DISEASECopper (Cu)* Jaundiced skin* Green-blue skin, hair & perspiration* Green - purple line on gumsMercury (Hg)* Blue-black line on gums with jaw necrosis and loosening of a tooth* Brown deposits on anterior lens capsule (mercurial lentils)* Acrodynia (pink disease)Lead (Pb)* Blue stippled Burtonian line on gums, especially on the upper jaw.Other Features of Mercury Poisoning*Proximal Convoluted Tubule necrosis* Prevalence of abortions are common* Minimata disease is an organic mercury poisoning due to consumption of fish poisoned by mercury. | 158,301 | medmcqa_train |
Not true about hepatoblastoma | Ans. (b) Mature hepatocytes present(Ref: R 9th/pg 870)Histology of Hepatoblastoma can be of 2 types:Epithelial type, composed of small polygonal fetal cells or smaller embryonal cells forming acini, tubules, or papillary structuresMixed epithelial and mesenchymal type, which contains foci of mesenchymal differentiation that may consist of primitive mesenchyme, osteoid, cartilage, or striated muscle.Mature appearing hepatocytes are absent. | 158,302 | medmcqa_train |
A patient with malabsorption who develops a deficiency of vitamin A is most likely to subsequently develop: | The symptoms of vitamin A deficiency result from abnormalities involving the normal functions of vitamin A. These normal functions include maintaining mucus-secreting epithelium, restoring levels of the visual pigment rhodopsin, increasing immunity to infections, and acting as an antioxidant. | 158,303 | medmcqa_train |
Young male scrotal swelling since 3 yrs on examination fluctuant swelling testis not separately felt. No trauma or fever. Diagnosis - | Ans. is 'a' i.e., Vaginal hydorcele o Vaginal hydroceleThis is common type of hydrocele; whee acumulation of fluid occurs between the layers of tunica vaginalis in scrotum. These may! be of Pvo types : Primary and secondary?In primary vaginal hydrocele, often there is not definite cause.Secondary vaginal hydrocele accompanies disease of the testis and/or epididymis. The common causes of secondary hydrocele are epididymo-orhitis, trauma and testicular neoplasm. | 158,304 | medmcqa_train |
A 7-year-old boy presents with, patchy hair loss, boggy scalp swelling and broken and fragmented hair follicles at the surface of the scalp resembling black dots. What is the next step in establishing a diagnosis: | The clinical picture is suggestive of Tinea capitis. Although culture is the gold standard in its diagnosis, KOH examination of the hair is the quick method to demonstrate spored and hyphae within and around the hair. Ref: Clinical Pediatric Dermatology By Thappa, Page 57-59, Elsevier India 2009 | 158,305 | medmcqa_train |
Which one of the following physiological event of cardiac cycle is responsible for QRS complex? | The P wave represents the wave of depolarization that spreads from the SA node throughout the atria. The QRS complex represents ventricular depolarization. Ventricular rate can be calculated by determining the time interval between QRS complexes. The isoelectric period (ST segment) following the QRS is the time at which the entire ventricle is depolarized and roughly corresponds to the plateau phase of the ventricular action potential. The T wave represents ventricular repolarization and is longer in duration than depolarization. The Q-T interval represents the time for both ventricular depolarization and repolarization to occur and therefore roughly estimates the duration of an average ventricular action potential. | 158,306 | medmcqa_train |
An accustomed way of doing things is known as: | Habit is an accustomed way of doing things. It is the usual way of action that can be performed without thinking. Chapter: Medicine and social sciences. Ref: Park 21st edition, page: 627. | 158,307 | medmcqa_train |
A neurosurgeon dropped his kid to the school then there he saw a child with uncontrollable laughing and precocious pubey. When he again went to the school in capital parents teachers meeting, he talked to the father of that boy and advised him to get an In1R1 done and the diagnosis was confirmed. What is the most probable diagnosis | Ans. a. Hypothalamic hamaoma Uncontrollable laughing and precocious pubey are suggestive of hypothalamic hamaoma. Hypothalamic Hamaoma Central precocious pubey staing before the age 3 years is often due to hypothalamic hamaomaQ . Seizures, especially laughing spells (gelastic seizures)deg are seen in children with hypothalamic hamaoma. Hypothalamic Hamaoma Central precocious pubey staing before the age 3 years is often due to hypothalamic hamaomaQ Hypothalamic hamaoma picked up by MRIQ Seizures, especially laughing spells (gelastic seizures)Qare seen in children with hypothalamic hamaoma Precocious Pubey Central precocious pubey is a.lso known as true precocious pubeyQ, peripheral precocious pubey is called pseudo-precocious pubeyQ. McCune-Albright syndrome causes pseudo-precocious pubey (Peripheral precocious pubey). | 158,308 | medmcqa_train |
Drug of choice for Huntington's chorea is | Huntigton's chorea is characterized by dopaminergic overactivity and Tetrabenazine is a dopamine depleter which is the drug of choice for this condition. | 158,309 | medmcqa_train |
Which of the following is associated with > 20% risk of chromosomal anomalies: | Omphalocele | 158,310 | medmcqa_train |
What is the end product of catabolism of pyrimidine? | The end products of pyrimidine catabolism is CO2 and H2O. | 158,311 | medmcqa_train |
Most common ovarian tumour to undergo torsion is : | Dermoid cyst | 158,312 | medmcqa_train |
Iron supplements given for anemia,is which level of prevention | Early diagnosis and treatment of disease comes under secondary level of prevention | 158,313 | medmcqa_train |
Enzyme defect in Classic Phenylketonuria | Hyperphenylalaninemias arise from defects in phenylalanine hydroxylase (type I, classic phenylketonuria (PKU), frequency 1 in 10,000 bihs), in dihydrobiopterin reductase (types II and III), or in dihydrobiopterin biosynthesis (types IV and V).Ref: Harper&;s Biochemistry; 30th edition; Chapter 29 Catabolism of the Carbon Skeletons of Amino Acids | 158,314 | medmcqa_train |
Length of Posterior vaginal wall is - | Ans. is 'd' i.e., More than anterior vaginal wall o The anterior wall is about 8 cm long and the posterior wall is about 10 cm long.Vaginao The vagins is a fibromuscular, canal forming the female copulatory organ,o It extends from vulva to uterus.o Mucous membrane is lined by non keratinized stratified squamous epithelium.o The anterior wall is about 8 cm long and the posterior wall is about 10 cm long,o The lumen is circular at the upper end because of the protrusion of the cervix into it.o Below the cervix, anterior and posterior walls are in contact.o The interior of the upper end of the vagina (or vaginal vault) is in the form of a circular groove that surrounds the protrudng cervix.o The groove becomes progressively deeper form before backwards and is arbitrarily divided into four parts called the v aginal fornices:y Anterior fornix lies in front of the cervix and is shallowest.Posterior fornix lies behind the cervix and is deepest.Two lateral fornices lie one on each side of the cervix. Lateral fornix is related to the transverse cervical ligament of pelvic fascia in which are embedded a network of vaginal vein and the ureter gets crossed by the uterine artery. | 158,315 | medmcqa_train |
A 34-year-old man is pushing some heavy weights while doing squats. Unfounately, while maxing out, he drops the weight and immediately grabs at his upper thigh, writhing in pain. The man is admitted to the emergency depament and during physical examination is diagnosed with a femoral hernia. What reference structure would be found immediately lateral to the herniated structures | In a Femoral Hernia, abdominal contents are forced through the femoral ring, which is just lateral to the Lacunar Ligament (of Gimbernant) and just medial to the Femoral Vein. The Femoral Vein would be found immediately lateral to the Femoral Hernia. The adductor longus muscle as well as the pectineus muscle would be found deep and medial to the hernia. | 158,316 | medmcqa_train |
You are shown PA and lateral chest radiographs from a 53-year-old woman with mild dyspnea. Which one of the following is the MOST likely diagnosis? | A. Incorrect. Mesothilioma appears as a rind of tissue that encircles the hemothorax. This features is not present in the provided images. B. Incorrect. Empyema demonstrates pleural effusion with air and or thickening of the pleura. These features are not present in the provided images. C. Incorrect. Bronchogenic carcinoma appears as nodule/mass within the lung parenchyma and is often spiculated. These features are not present in the provided images. D. Correct. Solitary fibrous tumor occurs in the pleural space and appears as a mass with smooth borders and incomplete sign which suggests that the finding is extraparenchymal in nature. These features are present in the provided images. | 158,317 | medmcqa_train |
Which is most economical and best screening | Ref:Parks 23rd edition pg 137 High-risk or selective screening : Screening will be most productive if applied selectively to high-risk groups, the groups defined on the basis of epidemiological research. Types of screening : Mass screening. High-risk or selective screening. Multi-phasic screening. | 158,318 | medmcqa_train |
In a hea patient, contraceptive of choice is ? | Ans. is 'a' i.e., Sterilization o Sterilization & double barrier methods are the contraception of choice in hea patients. | 158,319 | medmcqa_train |
The peripheral nervous system develops primarily from: | The peripheral nervous system is mainly derived from the neural crest. The peripheral nervous system is primarily derived from the neural crest. Through migration and specialisation, cells of the neural crest develop into cranial, spinal, and visceral nerves and ganglia, suppo cells of the peripheral nervous system also derive from the neural crest. Neural Crest Origin: System Cell type Peripheral Nervous system (PNS) Neurons, sensory ganglia, sympathetic and parasympathetic ganglia, enteric nervous system and plexuses Sensory ganglia of CN V, CN VII, CN IX, CN X Ciliary (CN III), Pterygopalatine (CN VII), submandibular (CN VII) and otic (CN IX) parasympathetic ganglia Dorsal root ganglia Sympathetic chain ganglia Preveebral sympathetic ganglia Enteric parasympathetic ganglia of the gut (Meissner and Auerbach plexus; CN X) Abdominal/Pelvic cavity parasympathetic ganglia Neuroglial cells, olfactory ensheathing cell Schwann cells Endocrine Adrenal medulla (Chromaffin cells of adrenal medulla) Calcitonin-secreting cells Parafollicular (C) cells of thyroid Carotid body type I cells Integumentary Epidermal pigment cells Melanoblastoma (pigment cells) and Melanocytes Facial cailage and bone Facial and anterior ventral skull cailage and bones Pharyngeal arch skeletal and connective tissue components Craniofacial skeleton (frontal , parietal, squamous temporal nasal, vomer, palatine, maxillae & mandible bones) Connective tissue of head including cailage, ligaments & tendons Sensory Inner ear Corneal endothelium and stromal, choroid & Sclera of eye Neural crest contribution to Eye Endothelium of cornea & trabecular mesh work Stroma of cornea, iris, ciliary body and choroid Melanocytes of conjuctiva and Uveal tissue (Iris stroma) Ciliary muscle ganglion & nerves (Schwann cells) Orbital bones & Connective tissues Connective sheath & muscle layer of orbital blood vessels Meningeal sheath of optic nerve Sclera & pa of Vitreous (Sclera is of neural crest and mesodermal origin) Connective tissue Tooth papillae; Odontoblast (dentine of teeth) Smooth muscle, and adipose tissue of skin of head and neck Connective tissue of lacrimal, nasal, labial, palatine, oral, salivary and thyroid glands and of pharyngeal pouches i.e., thymus and parathyroid glands Connective tissue of meninges (Pia and arachnoid) Connective tissue and smooth muscle in aeries of aoic arch origin (Aoicopulmonary septum) Ref: Embryology of the Peripheral Nerves Chapter 3 in book Nerves and Nerve Injuries 2015/38 | 158,320 | medmcqa_train |
All are seen in treacher collin syndrome except | Ans. is 'd' i.e., Choanal atresia Treacher collins syndrome It is rare condition that presents several craniofacial deformities of different levels. This is a congenital malformation involving the first and second branchial arches. The disorder is characterized by abnormalities of the auricular pinna, hypoplasia of facial bones, antimongoloid slanting palpebral fissures with coloboma of the lower eyelids and cleft palate. Impoant clinical findings are :- Antimongoloid palpebral fissures Malformed malleus and incus (normal stapes) Coloboma of lower lid Conductive deafness Hypoplasia of mandible (micrognathia) and molar bones Cleft palate Malformed pinna and meatal atresia It is the most common benign neoplasm of nasopharynx. It is a highly vascular tumor and blood supply of the tumor most commonly arises from the internal maxillary aery. Juvenile nasopharyngeal angiofibroma (JNA) occurs almost exclusively in males. Female with Juvenile nasopharyngeal angiofibroma (JNA) should undergo genetic testing. Onset is most commonly in the second decades, the range is 7-19 years. The exact cause is unknown. As the tumour is predominantly seen in adolescent males in the second decade of life, it is thought to be testosterone dependent. The most common site is posterior pa of nasal cavity close to the margin of sphenopalatine foramen. The tumor stas adjacent to the sphenopalatine foramen. Large tumors are frequently bilobed or dumbbel shaped, with one poion of tumor filling the nasopharynx and the other poion extending to the pterygopalatine fossa. Clinical features Symptoms depend on spread of tumour to nasal cavity, paranasal sinuses, pterygomaxillary fossa, infratemporal fossa, cheek, orbits (through inferior orbital fissure), cranial cavity (most common site is middle cranial fossa). Nasal obstruction (80-90%) is the most common symptom, especially in the initial stages. This results in denasal speech, hyposmia, broadening of nasal bridge. pontaneous profuse & recurrent epistaxis is the second most common symptom Otalgia, conductive hearing loss, serous otitis media, due to eustachian tube obstruction. Pink or purplish mass obstructing one or both chonae in nasopharynx. Tumour in the orbit causes : proptosis; and frog-face deformity; diplopia and diminshed vision. Tumour in infratemporal fossa can cause trismus and bulge of parotid. II, III, IV, V, VI cranial nerve can be involved. Splaying of nasal bones. Swelling of cheek and fullness of face. Diagnosis and treatment Contrast CT is the investigation of choice. Biopsy should be avoided as it can cause severe bleeding. Surgical excision is the treatment of choice. | 158,321 | medmcqa_train |
Pringle maneuvar to arrest hehemorrhage is | Pringle manoeuvre is used to control hemorrhage by clamping the hepatoduodenal ligament and compressing the poal triad,thereby reducing aerial and venous inflow into the liver.But it doesn't control the backflow from inferior vena cava and hepatic veins. Reference: Bailey & Love's sho practise of surgery,25 th edition,page no348. | 158,322 | medmcqa_train |
A girl presents with hyper pigmented skin lesions, precocious puberty and some bony lesion. what is the most probable diagnosis? | The image represents cafe - au - lait spots. Precocious puberty, bony lesion like fibrous dysplasia are seen in Mc cune Albright syndrome, | 158,323 | medmcqa_train |
Function of guardian of genome p53 is whicvh of the following? | D- Reduced cell mutation rate. P53 is an example of a pro-apoptotic gene k/a Guardian of Genome. If DNA is damaged / mutated p53, repairs it. But if defect is beyond repair - Activation of pro-apoptotic machinery - Apoptosis Result: - Reduced cell mutation rate The p53 protein is the central monitor of stress in the cell and can be activated by anoxia, inappropriate signalling by mutated oncoproteins, or DNA damage. p53 controls the expression and activity of proteins involved in cell cycle arrest, DNA repair, cellular senescence, and apoptosis. DNA damage is sensed by complexes containing kinases of the ATM/ATR family; these kinases phosphorylate p53, liberating it from inhibitors such as MDM2. Active p53 then upregulates the expression of proteins such as the cyclin dependent kinase inhibitor p21, thereby causing cell-cycle arrest at the G1-S checkpoint. This pause allows cells to repair DNA damage. If DNA damage cannot be repaired, p53 induces additional events that lead to cellular senescence or apoptosis. | 158,324 | medmcqa_train |
Which valve is present at opening of nasolacrimal duct- | Ans. is 'a' i.e., Hasner's valve o Nasolacrimal duct opens into inferior meatus and is closed by a mucosal flap called Hasner's valve,o Heister valve (spiral valve) is present in cyclic duct. | 158,325 | medmcqa_train |
Surest proof of antemoem burn is | In case of burns, if death has occurred from suffocation,aspirated blackish coal paicles are seen in the nose,mouth,larynx,trachea,bronchi,oesophagus and stomach, and blood is cherry red. Presence of carbon paicles especially in the terminal bronchioles and an elevated CO saturation together are absolute proof that the victim was alive when the fire occurred. In the absence of CO in blood and soot in the airways,death may possibly result due to poisoning with carbon dioxide or deficiency of oxygen. Sometimes inhalation of smoke produces vomiting which may be inhaled and found in the smaller bronchi. Ref: K.S.Narayan Reddy's Synopsis of Forensic Medicine and Toxicology, 29th edition, Chapter 11, page-163. | 158,326 | medmcqa_train |
Most impoant step in the repair of an indirect inguinal hernia is - | Ans. is 'b' i.e. Narrowing of the internal ring | 158,327 | medmcqa_train |
Highest incidence of anemia in the tropics is due to - | Option 1 Chronic hookworm infection with heavy worm load: In the intestine, adult worms attach to intestinal villi with their buccal teeth and feed on blood and tissue with the aid of anticoagulants. A few hundred worms in the intestine can cause hookworm disease, which is characterized by severe anemia and iron deficiency and protein energy malnutrition resulting from blood loss. Causes: Ground itch, Serpiginous tracks, Mild pneumonitis, GIT symptoms and Iron def. anemia Option 2, 3, 4 Thread worm/Pin worm/Seat worm /Enterobius vermicularis: does not cause anemia. Ascaris lumbricoides (Roundworm): causes GIT symptoms, Malabsorption, Intussusception and Loeffler syndrome. Dracunculus medinensis (Guinea worm): Causes Guinea worm disease or dracunculiasis | 158,328 | medmcqa_train |
Dilatation of upper lobe veins is a reliable sign of: | Ans. Cardiac decompensation | 158,329 | medmcqa_train |
Pulmonary function abnormalities in interstitial lung diseases include all of the following except | A group of disorders that cause progressive scarring of lung tissue. Interstitial lung disease may be caused by long-term exposure to hazardous materials, such as asbestos or coal dust, or it can be caused by an auto-immune disease such as rheumatoid ahritis. Once lung scarring occurs, it's generally irreversible. Ref: guyton and hall textbook of medical physiology 12 edition page number:327,328,329 | 158,330 | medmcqa_train |
A smoker is worried about the side effects of smoking. But he does not stop smoking thinking that he smokes less as compared to others and takes a good diet. This thinking is called as: | Ans. a. Self-exemption (Ref: style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">; Kaplan and Sadock 11/e p590)There are many psychological barriers that need to be overcome in order to successfully quit smoking. Self-exempting belief is one of them."Self-exempting beliefs: A large majority of smokers have the belief that 'it will never happen to me'. For example, someone who runs everyday and doesn't drink alcohol may think that they have less chances of developing lung cancer than the next smoker because their lifestyle 'balances out ' the cigarettes. This is not true. Every smoker has the same risk of negative health outcomes associated with smoking as the next smoker. "Prochaska and DiClemente's Stages of Change ModelStage of ChangeCharacteristicsTechniquesPre-contemplationNot currently considering change:"Ignorance is bliss"* Validate lack of readiness Clarify: decision is theirs* Encourage re-evaluation of current behavior* Encourage self-exploration, not action* Explain and personalize the riskContemplationAmbivalent about change: "Sitting on the fence"Not considering change within the next month* Validate lack of readiness* Clarify: decision is theirs* Encourage evaluation of pros and cons of behavior change* Identify and promote new, positive outcome expectationsPreparationSome experience with change and are trying to change: "Testing the waters"Planning to act within 1 month* Identify and assist in problem solving re: obstacles* Help patient identify social support* Verify that patient has underlying skills for behavior change* Encourage small initial stepsActionPracticing new behavior for 3-6 months* Focus on restructuring cues and social support* Bolster self-efficacy for dealing with obstacles* Combat feelings of loss and reiterate long-term benefitsMaintenanceContinued commitment to sustaining new behaviorPost-6 months to 5 years* Plan for follow-up support* Reinforce internal rewards* Discuss coping with relapseRelapseResumption of old behaviors: "Fall from grace"* Evaluate trigger for relapse | 158,331 | medmcqa_train |
Number of ATP generated in one TCA cycle- | Ans. is 'c' i.e., 10 o In a single TCA cycle 10 molecules of ATP are produced (12 molecules according to older calculations),o One turn of the TCA cycle, starting with acetyl Co A produces 10 ATPs. When the starting molecule is pyruvate, the oxidative decarboxylation of pyruvate, the oxidative decarboxylation of pyruvate yields 2.5 ATPs and therefore, 12.5 ATPs are produced when starting compound is pyruvate. Since, two molecules of pyruvate enter the TCA cycle when glucose is metabolized (glycolysis produces 2 molecules of pyruvate), the number of ATPs is doubled. Therefore, 25 ATP molecules, per glucose molecule, are produced when pyruvate enters the TCA cycle,o Note : Previously calculations were made assuming that NADH produces 3 ATPs and FADH generates 2 ATPs. This will amount a net generation of 30 ATP molecules in TCA per molecule glucose and total 38 molecules from starting. Recent experiments show that these values are overestimates and NADH produces 2.5 ATPs and FADH produces 1.5 ATPs. Therefore, net generation during TCA is 25 ATPs and complete oxidation of glucose through glycolysis plus citric acid cycle yield a net 32 ATPs.o Energy yield (number of ATP generated) per molecule of glucose when it is completely oxidized through glycolysis plus citric acid cycle, under aerobic conditions, is as follows :- Method of ATP formationNo of ATPs gained perglucose (new calculation)No of ATPs As per old calculationPathwayStepEnzymeSourceGlycolysis1Hexokinase- Minus1Minus 1Do3Phosphofructokinase- Minus1Minus IDo5Glyceraldehyde-3-p DHNADHRespiratory chain2.5x2 =53x2=6Do61J-BPG kinaseATPSubstrate level1x2 =21x2=2Do9Pyruvate kinaseATPSubstrate level1x2 =21x2=2Pyruvate to Acetyl CoA-PyruvateDehydrogenaseNADHRespiratory chain2.5 x 2 =53x2=6 TCA cycle3Isocitrate DHNADHRespiratory chain2.5 x 2 =53x2=6Do4Alpha keto glutarate DHNADHRespiratory chain2.5 x 2 =53x2=6Do5Succinate thiokinaseGTPSubstrate level1x2 =21x2=2Do6Succicinate DHFADH2Respiratory chain1.5 x 2 =32x2=4Do8Mai ate DHNADHRespiratory chain2.5 x 2 =53 x 2= 6Net generation in glycolytic pathway 9 minus 2=710 minus 2=8Generation in pyruvate dehydrogenase reaction=5=6Generation In citric acid cycle=20=24Net generation of ATP from one glucose mole=32=38 | 158,332 | medmcqa_train |
What is the X-ray diagnosis? | . | 158,333 | medmcqa_train |
A 26-year-woman undeakes a prolonged fast for religious reasons. Which of the following metabolites will be most elevated in his blood plasma after 3 days? | As he becomes progressively more starved, his liver will synthesize ketone bodies as an additional fuel for muscle, which cannot meet all of its energy needs from fatty acid metabolism. This spares glucose for the brain and red blood cells. Higher than normal quantities of ketone bodies present in the blood or urine constitute ketonemia (hyperketonemia) or ketonuria, respectively. The overall condition is called ketosis. The basic form of ketosis occurs in starvation and involves depletion of available carbohydrate coupled with mobilization of free fatty acids . Ref: Botham K.M., Mayes P.A. (2011). Chapter 22. Oxidation of Fatty Acids: Ketogenesis. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e | 158,334 | medmcqa_train |
Which of the following processes is not a true component of swallowing? | The movement of the tongue against the palate is the only voluntary process among the four possible answers | 158,335 | medmcqa_train |
Glycogenin primer is glucosylated by: | Ans. A. UDP Glucose(Ref: Harper 31/e page 164)Glycogenin, a 37 kDa protein is glucosylated on specific tyrosine residue by UDP glucose.Glycogenenin catalyses transfer of 7 glucose residue from UDP-Glc, in l-4 linkage to form Glycogen primer.Further Glucose on glycogen primer are added by Glycogen Synthase to nonreducing end till growing chain is at least 11 glucose residue long. | 158,336 | medmcqa_train |
Treatment of choice for stab injury caecum ? | Ans. is 'b' i.e., ileo-transverse anastomosis These options mentioned in the question are of the year 1989; no longer seems to be valid. The management of Colonic injuries in latest edition of Schwaz is: Currently 3 methods for managing the colonic injuries are used? a. Primary repair (it includes lateral suture repair or resection of the damaged segment with reconstruction by ileocolostomy or colocolostomy) b. End colostomy c. Primary reapir with diveing ileostomy Various trials have proven that the Primary repair is safe and effective in viually all patients with penetrating wounds. Schwaz writes- "Numerous large retrospective and several prospective studies have now clearly demonstrated that primary repair is safe and effective in viually all patients with penetrating wounds. Colostomy is still appropriate in a few patients, but the current dilemma is how to select which patients should undergo the procedure. Currently, the overall physiologic status of the patient, rather than local factors, directs decision making. Patients with devastating left colon injuries requiring damage control are clearly candidates for temporary colostomy. Ileostomy with colocolostomy, however, is used for most other high-risk patients." | 158,337 | medmcqa_train |
All of the following are true about break point chlorination, except - | The point at which the residual chlorine appears and when all combined chlorines have been completely destroyed is the breakpoint and the corresponding dosage is the breakpoint dosage. The breakpoint chlorination achieves the same result as superchlorination in a rational manner and therefore be constructed as controlled superchlorination (refer pgno:775 park 25th edition) | 158,338 | medmcqa_train |
Acute Gouty ahritis is seen early in treatment following | Allopurinol REF: Goodman Gillman manual of pharmacology and therapeutics 2008 edition page 458 "The incidence of acute attacks of gouty ahritis mayincrease duringthe early months of allopurinol therapy as a consequence of mobilization of tissue stores of uric acid. Co-administration of colchicine helps suppress such acute attacks. After reduction of excess tissue stores of uric acid, the incidence of acute attacks decreases and colchicine can be discontinued" | 158,339 | medmcqa_train |
Renal autoregulation: | Ans. D. Minimizes the impact of changes in arterial blood pressure on renal Na+ excretionIn the autoregulatory range, vascular resistance falls when arterial blood pressure falls. Changes in vessel caliber primarily occur in vessels upstream to the glomeruli (cortical radial arteries and afferent arterioles). Because autoregulatory range extends from an arterial blood pressure of about 80 to 180 mm Hg, renal blood flow is not maintained when blood pressure is low; in fact, the sympathetic nervous system will be activated and cause intense vasoconstriction in the kidneys. Renal autoregulation does not depend on nerves. | 158,340 | medmcqa_train |
Xiphoid process fuses with sternum after: DNB 09 | Ans. 40 years | 158,341 | medmcqa_train |
Intercostal vessels and nerve runs in: | (Between the innermost intercostal and internal intercostal muscle) (208-BDC-l 4th) (57-Snell 7th)* Each intercostal space contains a large single posterior intercostal artery and two small anterior intercostal arteries.* The corresponding posterior intercostal vein drain backward into the azygos or hemiazygos vein and the anterior intercostal vein drain forward into the internal thoracic and musculophrenic veinsIntercostal nerves* The intercostal nerves are the anterior rami of the first 11 thoracic spinal nerves. The anterior ramus of the 12th thoracic nerve lies in the abdomen and runs forward in the abdominal wall as the subcostal nerve* In the costal groove the nerve lies below the posterior intercostal vessels. The relationship of structures in the costal groove from above downwards is vein-artery-nerve (VAN)*** Each intercostal nerve enters an intercostal space between the parietal pleura and the posterior intercostal membrane. It then runs forward inferiorly to the intercostal vessels in the subcostal groove of the corresponding rib, between the innermost intercostal and internal intercostal muscle | 158,342 | medmcqa_train |
Most common bone involved in haemangioma? | Ans. is 'd' i.e., Veebrae Haemangioma This benign lesion, probably a hemaoma, is composed of vascular spaces lined by endothelial cells. They constitute 1-1.5% of all primary bone neoplasms. It has a peak incidence in the fifth decade (according to Maheshwari, young adults). About 50% of hemangiomas of bone occur in veebrae and are most commonly situated in lower thoracic and upper lumbar regions. Other common site of involvement (20%) is skull. Small bones of hands and feets may also be affected. Haemangioma of the veebra has a typical radiographic picture in the form of loss of horizontal striations and prominence of veebral striations. There is Polka dot appearance on CT. In the skull, hemangioma generally affects the calverium and is seen as an expansile lytic lesion which has a sunburst appearance with striation radiating from the centre. A hemangioma may be identified due to associated phlebolith and it may cause local gigantism of the invovled area. Hemangiomas are largely asymptomatic, and thus most are never discovered, leading some to describe these lesions as rare. Treatment is radiotherapy. | 158,343 | medmcqa_train |
Which agent is effective in killing spores? | Ans: D (Formaldehyde) Ref: Ammthanamyan R. Panther CKJ Textbook of Microbiology. 8th Edition. Hyderabad: Universities Press: 2009. Pg. 35-8Explanation:Formaldehyde is active against the amino group in the protein molecule.In aqueous solutions, it is markedly bactericidal and sporicidal and also has a lethal effect on viruses.It is used to preserve anatomical specimens, and for destroying anthrax spores in hair and woolDisinfectantEffective againstCharacteristicAlcoholsCompoundsActive against bacteria and fungal sporesGood general use disinfectantAldehydesActive against bacteria and virus and sporesGood activity against bacteria, virus and sporesChlorineGood disinfectant for blood and body fluid spillsActive against bacteria, virus and moderate action against spores | 158,344 | medmcqa_train |
Mucocutaneous Leishmaniasis is caused by | L. Brasiliensis causes Espundia (Mucocutaneous Leishmaniasis). | 158,345 | medmcqa_train |
Amongst the following extrapyramidal side effect is commonest with which drug? | Clozapine is an atypical antipsychotic drug and has negligible risk of extrapyramidal symptoms. Atypical antipsychotic drugs act by antagonistic actions at 5-HT2 and alpha receptors and may or may not possess D2 blocking activity. These drugs are less likely to cause extrapyramidal symptoms. However, most of these agents (except ziprasidone and aripiprazole) can result in weight gain, hyperlipidemia and new-onset diabetes mellitus. | 158,346 | medmcqa_train |
Proteins can be separated by the following methods except: | Ans. C. Gas-liquid ChromatographySeparation of Plasma proteins by:a) Salting out method (using ammonium sulphate)Three proteins are separated- Albumins- Full Saturation- Globulins-Half Saturationb) Gas Liquid chromatography is used to separate volatile substances on heating. Therefore not used to separate proteins, because they get coagulated or denatured | 158,347 | medmcqa_train |
Civatte bodies are a feature of ? | Ans. is 'b' i.e., Lichen planus Civatte bodies (cytoid bodies/ colloid bodies/ hyaline bodies)* A characteristic histopathological feature of lichen planus* They are apoptotic basal cells present at dermo-epidermal junction and papillary dermis. Formed my macrophages engulfing the melanin.Other histopathological features of lichen planus* Hydropic degeneration of basal cells (Pathognomic feature)* Hypergranulosis (thickening of the granular layer) (focal hypergranulosis clinically creates Wickham striae)* Hyperkeratosis (thickening of stratum corneum)* Acanthosis (thickening of stratum Malpighi)* Sub-epidermal lichenoid band (deposition of lymphocytes 8c histiocytes in the upper dermis)* Pigment incontinence (dropping of melanin from damaged Keratinocytes of epidermis into dermis)* Max Joseph space /cleft (separation of the epidermis in small clefts)* Sawtooth appearance (flattened rete ridges) | 158,348 | medmcqa_train |
PNH is associated with all of the following conditions, except : | Answer is D (Increased LAP scores) PNH is associated with a decreased Leukocyte Alkaline phosphase (LAP) score PNH: Paroxysmal Nuctunal haemoglobinuria: Review PNH is an Acquired Q Intracarpuscular (--) disorder, acquired at stern cell level (-) by loss characterised by undue sensitivity of red blood cell's membrane to complement (--) Common manifestations: PNH : Three common manifestation Hemolytic Anemia Venous Thrombosis Deficient Hematopoesis Probably due to defect at stem cell level Because of increased activation of Activation of complement indirectly Pancytopenia/Aplastic anemia complement and complement stimulates platelet aggregation and - Granulocytes mediated destruction hypercoagulability (thus thrombosis - Thrombocytes (thrombocytopenia) * despite thrombocytopenia) HemoglobinemiaQ Hemoglohinuriae HemosiderinuriaQ Elevated LDH Q Why is it called Paroxysmal Nocturnal haemoglobinuria? Basis : Acidification enhances activity of complement During night when one sleeps (noctunal) --> Relative Hypoxia --> Acidosis --> Enhanced complement activity Paroxysm of Haemoglobinuria identified by --> Complement mediated destruction of red blood cells passage of brown urine in morning. Red Cell Membrane is deficient in two factors which result in increased activation of complement 1. DAF Q :Decay accelerating factor that activates decay of complements 2. MIRL CD 59 : inhibits membrane attack complex | 158,349 | medmcqa_train |
Winging of scapula which muscle is affected | Winging of scapulaIn this condition, the veebral border of scapula becomes more prominent when the patient tries to push against the wallIt occurs in paralysis of the serratus anterior muscle in long thoracic nerve palsy(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 268) | 158,350 | medmcqa_train |
Not a Radioprotector | BUDR is a Non-hypoxic cell Radiosensitizer. | 158,351 | medmcqa_train |
A 22 year old male following a spos trauma presented with pain and stiffness in the neck. On examination, the right shoulder is drooping . Which of the following muscle is likely to be paralysed? | Drooping of the shoulder is caused by paralysis of the trapezius. The trapezius is innnervated by spinal accessory nerve (CN XI). It causes retraction of scapula, shrugging of the shoulder and overhead abduction ( along with serratus anterior). Paralysis of trapezius causes drooping of shoulder and slight winging of scapula (the superior angle of scapula becomes more prominent) Ref: Gray&;s Anatomy for students 4th edition Pgno: 101 | 158,352 | medmcqa_train |
Which of the following statements is true - | . Acute lymphoid leukemia in less than 1 year | 158,353 | medmcqa_train |
All are true regarding SCID except: | Ref: Nelson's Textbook of Pediatrics. /9th Edition, Page:Explanation:"Marked accumulations of adenosinef 22 - deoxyadenosine. and 22 -O-methyladenosine lead directly or indirectly to T-cell apoptosis, which causes the immunodeficiency " (Ref: Nelson) Severe combined ImmuntKief'iciency (SCID)Both cellular and humoral immunity affectedMC type is X-linked SCID (X-SCD) due to mutation in Common Cytokine Receptor g Chain (gC)Second most common form of SCID is absence of the enzyme adenosine deaminase (ADA)(15% patients)All patients with SCID have very small thymuses (<1 g)Thymus fail to descend from the neck, contain no thymocytes, and lack corticomeduliary distinction or Hassall corpuscles.The thymic epithelium appears histologically normal.Both the follicular and paracorticai areas of the spleen are depleted of lymphocytes.Lymph nodes, tonsils, adenoids, and Peyer patches are absent or extremely underdevelopedClinical ManifestationsAffected infants present within the 1st few months of life with Recu rrent or persistent diarrheaPneumoniaOtitis media SepsisCutaneous infectionsGrowth failurePersistent infections with opportunistic organisms including lead to deathCandida albicansPneumocystis jiroveciParainfluenza 3 virusAdenovirusRespiratory syncytial virusRotavirus vaccine virus Cytomegalovirus (CMV)Epstein-Barr virus (EBV)Varicella-zoster virusMeasles virusMMR-V vaccine virusBacillus Calmette-Guerin (BCG)Affected infants also lack the ability to reject foreign tissue and are therefore at risk for severe or fatal graft versus host disease (GVHD) from T lymphocytes in non irradiated blood products or in allogeneic stem cell transplants or less severe GVHD from maternal immunocompetent T cells that crossed the placenta while the infant was in utero.* These infants also have an absence of lymphocyte proliferative responses to mitogens, antigens, and allogeneic cells in vitro.Patients with adenosine deaminase (ADA) deficiency have the lowest absolute lymphocyte counts, usually <500/mm3.Serum immunoglobulin concentrations are low or absentNo antibodies are formed after immunizations.T cells are extremely low or absentTreatmentSCID is a true pediatric emergency.Unless immunologic reconstitution is achieved through stem cell transplantation, death usually occurs during the 1st yr of life and almost invariably before 2 yr of age. | 158,354 | medmcqa_train |
Elimination after 4 half lives in first order Kinetics is - | Ans. is 'b' i.e., 93% Half life Elimination I t1/2 50% 2 0/2 75% 3 t1/2 87.5% 41% 93.75% 5 t1/2 96.875 | 158,355 | medmcqa_train |
Pemphigus vulgaris is caused by: | Ans: (c) AutoimmuneHarrison 19th ed. / 370# PEMPHIGUS* Pemphigus is an autoimmune blistering disorder* It results from the loss of integrity of normal intercellular attachments with the epidermis.* Commonly affects indiciduals of age between 40-60.* Equal prevalence among males and females.* There are five variants of pephigus:# Pemphigus Vulgaris: most common type# Pemphigus Foliaceous: superficial pemphigus# Pemphigus Vegetans: least common type# Pemphigus Erythematous# Fogo Selvagem: an endemic form of pemphigus foliacious.* Refer to above table | 158,356 | medmcqa_train |
The valve of Hasner is | Nasolacrimal duct (NLD) opens into the Inferior meatus through the Hasner`s valve.The direction of NLD--downward, backward, and laterally from the lacrimal sac to the nose, Length- 1.8 cmSphenoid sinus and posterior ethmoids open into the sphenoethmoidal recess (Superior meatus)Frontal, Maxillary and Anterior ethmoids open into the middle meatus.Ref: Hazarika; 3rd ed; Pg 240 | 158,357 | medmcqa_train |
In which of the following conditions, the medical treatment of ectopic pregnancy is contraindicated: | Ans. is c, i.e. Presence of fetal heart activityRef Dutta Obs. 7/e, p 186; Leon Speroff 7/e, p 1287, 1288; Novak 14/e, p 624; Williams Gynae 7/e, p 166Methotrexate: It is a folic acid analogue which inhibits dehydrofolate reductaseQ and prevents synthesis of DNA.QCandidates for methotrexate (Williams 24/e, p 384, Table 19.2): --Leon Speroff 7/e, p 1290Absolute requirementsHemodynamic stabilityQNo evidence of acute intra-abdominal bleedingQReliable commitment to comply with required follow-up careQNo contraindications to treatment viz woman should not be breast feeding/renal/hepatic dysfunction.Preferable requirementsAbsent or mild painSerum beta hCG level less than 5,000IU/L (best results seen with HCG<2000IU/L)Q It is the single best prognostic indicator of treatment success.Absent embryonic heart activityQEctopic gestational mass less than 4 cm in diameter without cardiac activity and < 3.5 cm with cardiac activityQFriends, there is no doubt on this issue that presence of cardiac activity is a relative contraindication according to books like Williams Obs 23/e, Williams Gynae 1/ed and Leon Speroff 7/ed."Fetal cardiac activity - Although this is a relative contraindication to medical therapy; the admention is based on limited evidence." --William Obs. 23/e, p 247"The presence of embryonic heart activity is not an absolute contraindication for medical management but the likelihood of failure and the risk of tubal rupture are substantially increased (therefore it is a relative contraindication)." --Leon Speroff 7/e, p 1287As far as fluid in cul-de-sac is concerned: Earlier, it was also considered a relative contraindication to medical treatment, but studies have shown that free peritoneal fluid can be seen in almost 40% of women with early unruptured ectopic pregnancy and so it's presence and absence does not accurately predict the success or failure of medical treatment.Contraindications to methotrexate treatment: (Williams 24/e, p 384, Table 19.2)Breast feedingQ Immunodeficiency statesQAlcoholism or evidence of chronic liver disease (elevated transaminases) QRenal disease (elevated serum creatinine) QHematological abnormalities (severe anemia, leukopenia or thrombocytopenia) QKnown sensitivity to methotrexateQActive pulmonary diseaseQPeptic ulcer disease. QEvidence of tubal rupture | 158,358 | medmcqa_train |
In blood transfusion, blood group most impoant is | . Kell | 158,359 | medmcqa_train |
Microangiopathic hemolytic anemia is associated with: March 2005 | Ans. C: Hemolytic uremic syndrome Mechanism of HUS -RBCs damaged by injured vessel endothelium HUS is microangiopathic hemolytic anemia with fragmented RBC's in peripheral blood smear, thrombocytopenia and acute renal failure Infection is the triggering factor and if associated indicates a poor prognosis | 158,360 | medmcqa_train |
Which of the following is the main colonizer of sebaceous gland - | Propionibacterium acnes are the commonest agent causing acne in teenagers as it has affinity for sebaceous glands.
Lesions in acne develop with in the sebaceous follicle. | 158,361 | medmcqa_train |
All of the following statements are true about Benedikt's syndrome except | . *Benedikt's syndrome involve injury to red nucleus results in ipsilateral oculomotor palsy and contralateral tremor,chorea and athetosis. Benedikt's Syndrome describes an ipsilateral III nerve palsy accompanied by contralateral 'cerebellar' tremor - a slow rhythmic tremor of the contralateral hand and foot, increased by excitement and voluntary movement, absent in sleep Ref Harrison20th edition pg 2456 | 158,362 | medmcqa_train |
Bleeding ear discharge is mostly due - | Ans. is 'a' i.e., Glomus tumour Differential diagnosis of blood stained ear discharge :* ASOM* Acute mastoiditis* CSOM* Aural polyp* Granulations* Glomus tumor | 158,363 | medmcqa_train |
Which one of the following is the treatment of choice for a 4cm retroperitoneal lymph node mass in a patient with non seminomatous germ cell tumor of the testis ? | Ans. is 'b' i.e., High orchidectomy + RPLND | 158,364 | medmcqa_train |
In ERG 'A' waves corresponds to NOT RELATED-MEDICINE | ERGA wave Activity of rods and conesB wave Bipolar cellC wave Retinal pigment epithelium(RPE) | 158,365 | medmcqa_train |
Why a TB patient is recommend a regimen of 4 drugs on 1st visit - | Ans. is *a' i.e., To avoid emergence of persistors 6. Two phase chemotheraphyo There are two phase of treatment of tuberculosisIntensive phaseThis is short phase in the early course of treatment and lasts for 1-3 months.Three or more drugs are given to kill as many bacilli as possible, w hich prevents emergence of persisters.The risk of re lapse is also lessened.Continuation phaseIt is aimed at sterilizing the smaller number of dormant or persisting bacilli,o Multidrug treatment in TB is given to -Prevent emergence of persistersPrevent relapsePrevent emergence of resistanceShorten the duration of treatment | 158,366 | medmcqa_train |
Gallow's traction is used for fracture - | Gallows traction is used for treatment of fracture shaft femur, in infants and children < 2 yrs of age. | 158,367 | medmcqa_train |
Critical period of development of fixation reflex is | A. i.e. 2-4 months Unilateral cataract in children should be operated early in life because the critical period for development of fixation reflex is between 2" & 4th months of age.Q Age Visual Development At Bih * * * * Eye appear to move randomly & there is no central fixation Fovea is not fully developed & visual acuity is roughly 6/60. The retina is almost fully developed at bih, apa from macula which fuher develops after bih till 4-6 months of ageQ Myelination of optic nerve begins in the 7th month in utero & reaches lamina cribrosaQ(ie is completed) * Hypermetropia of +2 to +3D(2 * Orbit is more divergent (500)Q as compared to adult (450) . * A-P diameter of eyeball is 16.5 mmQ (70% of adult size which is attained by 7-8 years) * Corneal diameter is 10 mm.Q Adult size 11.7 mm is attained by 2 yrs. of age * The anterior chamber is shallower, the angle deep & the lens is more spherical as compared to the adult eye. 6 weeks (11/2 months) * Fixation reflex first becomes apparent and eye can follow bright light for a sho distance 2-4 months * Critical period for development of fixation reflexQ 4-6 months * Refixation reflex develops firmly * Macula differentiates 6-8 months * Depth perception stas developingQ 6 years * Fovea develops completely * Full visual acuity of 6/6 attained If visual developmental process is interrupted during this period by any means (eg. high anisometropia, congenital cataract) it results in amblyopia which becomes irreversible after few years. If the stimulus deprivation occurs bilaterally & severe by the age of 6 months it results in pendular nystagmus on attempted fixation. PAX6 is the master gene for eye development. Binocular Vision Psycho-optical Reflex Fusion Reflex Fixation & Refixation Reflex When a normal individual fixes * Retinal areas which coordinate visually in the Since the most accurate his visual attention on an object occipital coex so that such an object is seen vision is attained by fovea of regard, the image is formed on with both eyes as single object are k/a it is necessary that the eyes the fovea of both the eyes corresponding points. The most impoant pair be rapidly oriented so that separately, but the individual of which is foveae. Nasal half of one retina image of an object of perceives a single image. This corresponds to temporal half of other retina in interest falls upon them or state is called Binocular Single occipital coex. that of a moving object vision. It is a conditional reflex * Points on two retinae which are not retained on them. This which is not present since bih corresponding points in this sense of term are ascendancy of fovea is but is acquired during 1., 6 called disparate points and if object forms its maintained by Fixation monthsQ and is completed during retinal images on these, it will be seen double Reflex first few years. (Psycho-optical (binocular diplopia). If disparity is slight there reflex) is tendency to move the eyes so that images may be fused by means of Fusion Reflex | 158,368 | medmcqa_train |
Which of the following is involved in peristalsis by causing relaxation ? | Ans. is 'c' i.e., VIP In peristlasis :- Acetylcholine & substance P - Causing smooth muscle contraction. VIP, NO & ATP - Producing relaxation ahead of stimulus. | 158,369 | medmcqa_train |
Function of phospholipid in cell membrance is: | B i.e. Transduction of signals | 158,370 | medmcqa_train |
Which of the following is an atypical antidepressant? | Ans. is 'c' i.e., Venlafaxine Antidepressants A. Typical Tricyclic antidepressants NA + 5HT reuptake inhibitors :- Imipramine, Trimipramine, Amitriptyline, Clomipramine. Predominantly NA reuptake inhibitors :- Desipramine, Noriptyline, Amoxapine, Reboxetine. Selective serotonin reuptake inhibitors :- Fluoxetine, Paroxetine, Sealine, Citalopram, Scitalopram. B. Atypical :- Trazodone, Mianserine, Mitrazapine, Venalafaxin, Duloxetine, Tianeptine, Amineptine, Bupropion. c. MAO inhibitors :- Tranylcypramine, Meclobemide, Clorgyline. | 158,371 | medmcqa_train |
Surfactant deficiency causes ? | Ans. is 'b' i.e., Respiratory distress syndromeInfant respiratory distress syndrome is due to deficiency of surfactant. Dipalmitoylphosphatidylcholine (Dipalmitoyllecithin) is the major constituent of surfactant.SurfactantSurfactant is a Soap-like substance secreted by the type-II pneumocytes of the alveolar epithelium. It is a mixture of dipalmitoyl-phosphatidycholine (dipalmitoyl-lecithin), phosphatidylglycerol, other phospholipids, neutral lipids, Surfactant proteins A, B, C and D (SP-A, SP-B, SP-C and SP-D), and carbohydrates. o Surfactant reduces the alveolar surface tension.This has three impoant physiological consequences : ?1) It reduces the collapsing tendency of lungs.2) It reduces the natural tendency of the smaller alveoli to collapse and empty into the larger ones. This is called alveolar stabilization.3) It reduces the tendency of the alveolar interstitial fluid to transudate out into the alveolar space. | 158,372 | medmcqa_train |
Which of the following is seen in Churg-Strauss syndrome? | Churg-Strauss syndrome is a small vessel vasculitis. The acute presentation includes skin lesions, eosinophilia and asymmetric mononeuritis multiplex. There can be a prodromal period lasting many years in which the patient can have allergic rhinitis, nasal polyposis and asthma. Treatment is by high dose steroids and cyclophosphamide. Maintenance therapy is by low dose steroids, azathioprine, methotrexate and mycophenolate mofetil. Ref: Davidson's Principles and Practice of Medicine, 22nd edition, p1118 | 158,373 | medmcqa_train |
Which of the following pontic designs require surgical procedure? | The ovate pontic is the pontic design that is most esthetically appealing. Its convex tissue surface resides in a soft tissue depression or hollow in the residual ridge, which makes it appear that a tooth is literally emerging from the gingiva.
Careful treatment planning is necessary for successful results. Socket-preservation techniques should be performed at the time of extraction to create the tissue recess from which the ovate pontic form will appear to emerge.
For a preexisting residual ridge, surgical augmentation of the soft tissue is typically required. When an adequate volume of ridge tissue is established, a socket depression is sculpted into the ridge with surgical diamonds, electrosurgery, or a dental laser.
Key Concept:
For a preexisting residual ridge, surgical augmentation of the soft tissue is typically required. When an adequate volume of ridge tissue is established, a socket depression is sculpted into the ridge with surgical diamonds, electrosurgery, or a dental laser. | 158,374 | medmcqa_train |
Mild hoarseness with stridor is seen in: | (b) Bilateral abductor palsy(Ref. Current Diagnosis & Treatment Otolaryngology, Lalwani, 3rd ed., 478)Laryngomalacia and tracheal stenosis do not affect the VC hence voice remain normal in these though stridor is present. | 158,375 | medmcqa_train |
Bruxism occurs in _______ phase of sleep | Bruxism can occur in any stage of sleep or at arousal from sleep. It is most common in stage N1 and N2 and least common during REM sleep Ref: guyton and hall textbook of medical physiology 12 edition page number: 721,722,723 | 158,376 | medmcqa_train |
An infant presents with hypotonia and hyporeflexia. During his intrauterine period there was polyhydramnios and decreased fetal movements. Most probable diagnosis is - | Ans. is 'a' i.e., Spinal muscular atrophy o Out of the given options only spinal muscular atrophy is able to cause hypotonia and hyporeflexia during infancy. Rest of them either present late in childhood or do not give the symptoms. o Polyhydromnios and decreased fetal movements can occur in any neuromuscular disorder which present during intrauterine life. o Lets see each option one by one. Spinal muscular atrophy (SMA) SMA is a degenerative disease of motor neurons that begin in fetal life and continue to progress in infancy and childhood. o The cardinal features are: Hypotonia Generalized weakness Absent tendon stretch refluxes Involvement of tongue face and jaw muscle but sparing of extraocular muscle and sphincters. Congenital mytonia o Congenital myotonia or myotonia congenita is a chloride channel defect of skeletal muscle. o There is weakness and generalized hyperophy of muscles. o Its ruled out as Presents in early childhood (2-3 years age) Deep tendon reflexes are preserved. Congenital myaesthenia o Its a disease of neuromuscular junction similar to myasthenia gravis except that its not autoimmune but rather due to genetic mutations. o It presents in infancy and childhood with symptom similar to myasthenia gravis. o It can be ruled out as? o It does not present in the intrauterine life (so does not cause polyhydramnios). DTRs are preserved Muscular dystrophies o Muscular dystrophy refers to a group of hereditary progressive diseases. o It includes Duchenes muscular dystrophy Limb-girdle Congenital myopathies Becker Myotonic dystrophica o All of these except congenital myopathies are easily ruled out as they present in childhood age. some may rarely present in infancy but never in the intrauterine life. o Congenital myopathies are the most difficult one to rule out. They present with hypotonia in infancy. It may also present in intrauterine life. o Only reason I'm with 'Spinal muscular atrophy' is that congenital myopathy is a very rare disease. | 158,377 | medmcqa_train |
Sterilization control used in membrane filters is | Sterilization control for membrane filters is Brevundimonas diminuta and sarratia marcescens. | 158,378 | medmcqa_train |
Halo sign and handkerchief test are positive in- | Ans. is 'a' i.e., CSF Rhinorrhoea Detection of CSF Leak in CSF Rhinorrhoea1) Biochemical testso Concentrations of Glucose are higher in CSF than in nasal discharge. Glucose value > 30-40 mg% protein value <100 mg % (max 200 mg %) support a diagnosis of CSF leako Presence of b2 transferrin is the most definitive test for detection of CSF and b2 transferrin assay is the test of choice when a confirmatory test is needed, because of high sensitivity as well as specificity.o b-trace protein (prostaglandin D synthase) is also used, however it is nonspecific as it is also present in human testes, heart and seroma.2) Basic clinical testso Tissue test (Handker chief test):- Unlike nasal mucous, CSF does not cause a tissue to stiffeno Filter paper test:- Sample of nasal discharge on a filter paper exhibits a light CSF border and a dark central area of blood, i.e., double ring sign or halo sign.o Queckensted test:- Compression of the jugular vein leas to increased CSF leak due to increase in ICPo Rhinoscopy:- Visualization of CSF leak from paranasal sinus.3) CSF tracerso Intrathecal fluorescein dye adminstration, radionuclide cisternography, CT cisternography. | 158,379 | medmcqa_train |
Rotavirus vaccine- contraindication are all of the following EXCEPT? | ROTAVIRUS VACCINE- - Live oral vaccine - Given at 6,10 & 14 weeks (maximum age- 1 year) - Strain used- 116E strain of Indian origin - Contraindications: SCID Previous history of Intussusception / severe allergic reaction to a previous dose of the vaccine. | 158,380 | medmcqa_train |
Which of the following prostaglandin analogues used in Glaucoma | (Latenoprost): Ref: 88-KDT, 394-Khurana 3rd (147-KDT 6th)* Prostagland analogues used in Peptic ulcer are - Misoprostol Enprostil, Rioprostil (588-KDT)* LATANOPROST (0.0005%) It is synthetic drug which is an ester analogue of prostagland in F2a* It acts by increasing uveoscleral outflow and by causing reduction in episcleral venous pressure* Side effects - conjunctival hyperaemia, foreign body sensation and increased pigmentation of the iris. | 158,381 | medmcqa_train |
Which can cause loose body in the joint - | Ans. is 'c' i.e., OA o Causes of loose bodies includei) Osteoarthritisiii) Osteochondral fracture (injury) v) Synovial chondromatosisii) Osteochondritis dessicansiv) Charcot's disease o Among these, osteochondral fracture causes single loose bodies, while all other can cause multiple loose bodies, maximum by synovial chondromatosis (up to hundrades). | 158,382 | medmcqa_train |
Which of the following is an example of disability limitation? | Resting affected limbs in neutral position Repeat from May 06 & 07 Disability limitation is the mode of intervention used if the patient presents in late pathogenic phase. The objective is to prevent the transition of the disease proecess from impairment to handicap. The sequence of events leading to disability and handicap are: Disease ---> impairment -4 disability -4 handicap Impairment - is defined as any loss or abnormality of psychological, physiological or anatomical structure or function eg. loss of foot, defective vision or mental retardation. Disability - it is inability to carry out ceain activities considered normal for human beings, because of his 'impairment'. Handicap means that the individual with 'disability' is not able to perform his duties and obligations expected of him in the society. For example: Accident is the disease (or disorder) Loss of foot is the impairment Cannot walk is the disability Unemployed is the handicap Lets see other Modes of intervention in the disease process. Modes of Intervention Modes of intervention can be defined as any attempt to interrupt the usual sequence of any disease process (right from the risk factors to handicap) There are 5 modes of intervention: Health promotion Specific protection Early diagnosis Disability limitation Rehabilitation I. Health promotion Health promotion is not directed against any paicular disease, but is intended to improve the health of people through a variety of interventions like: i) Health education ii) Environmental modifications - Like provision of safe water, installation of sanitary latrines, control of insects and rodents etc. iii) Nutritional interventions - Like food foification, child feeding programmes. iv) Lifestyle and behavioural changes 2. Specific protection is directed against specific disease through interventions such as : - Immunization - Chemoprophylaxis - Protection from carcinogens etc. 3. Early diagnosis and treatment It involves detecting and treating the disease while the biochemical morphological and functional changes are still reversible. Thus it prevents ove disease and disablement. Early diagnosis and treatment are the only effective mode of intervention in following diseases. - Tuberculosis - Leprosy - STD 4. Disability limitation - Already described 5. Rehabilitation It is the combined and coordinated use of medical, social, educational and vocational measures for enabling the handicapped persons to achieve social integration (social integration is defined as the active paicipation of disabled and handicapped people in the mainstream of community life) Option 'a' - Reducing occurence of polio by immunization is specific protection Option 'b' - Arranging for schooling of child suffering from PRPP is rehabilitation Option 'c' - Resting affected limbs in neutral position disability limitation Option 'd' - Providing calipers for walking rehabilitation | 158,383 | medmcqa_train |
MRI is the investigation of choice in all of the following complications of CSOM except: | MRI gives little information in bone disease and is not useful in coalescent mastoiditis' in which CT scan would be the investigation of choice. It shows bone destruction and coalescence of mastoid air cells. In Bezold abscess, size, extent and location of abscess in soft tissues can be appreciated.Similarly, extradural abscess and cerebral abscess are better appreciated in MRI. | 158,384 | medmcqa_train |
When launching a study, many respondents are invited, some of whom fail to come, this is called | . | 158,385 | medmcqa_train |
A patient with salicylic acid poisoning has the following arterial blood gas analysis report: pH = 7.12; PCO2 = 18 mmHg; HCO3 = 12 mmol/L. The resulting acid-base abnormality can be best labeled as: | Ans. is 'a' i.e. Metabolic acidosis with respiratory alkalosisRef. Harrison 17th/e p 288 & 16th/e p 2591, 266 (15th/e page 284, 286,187)Also see June 2000 Q. No. 94.In patients with salicylate poisoning, initially the acidic metabolites of salicylic acid accumulate and cause metabolic acidosis.This causes the following acid base reaction to shift to left (because of addition of H) CO2 + H20 = H2CO3 = H+ + HCO3-This causes decrease in extracellular HCO3* This in turn stimulates the medullary chemoreceptors to increase ventilation and return the ratio of / PaCO2 and thus pH towards normal* The formula given to predict the degree of compensation required for simple form of metabolic acidosis is PaCO2 = 1.5 x + 8 or you can say that the PaCO2 is expected to decrease 1.25 mm of Hg for each mmol/L decrease in The normal values of PCO2 and HCO3-Arterial PC02 - 40 +- 2 mm HgArterial - 24 +- mm HgThus a patient with metabolic acidosis and of 12 mmol/L would be expected to have a PaCO2 between 24 and 28 mm Hg. (to compensate for the acidosis)Values of PaCO2 below 24 or greater than 28 mm Hg will mean mixed disturbance.If PaCO2 is < 24 it means metabolic acidosis + respiratory alkalosis (hyperventilation has led to excess CO2 washout causing respiratory alkalosis)If PaCO2 > 28 it means - metabolic acidosis respiratory acidosisHere is a table giving predictions of compensatory response on simple acid base disturbance. Prediction of Compensatory Responses on Simple Acid-Base DisturbancesDisorderPrediction of CompensationMetabolic acidosisPaCO2 =(1.5xHCO3-) +8 OrPaCO2 will | 1.25mmHg per mmol/L | in OrPaCO22 = + 15Metabolic alkalosisPaCO2 will | 0.75 mmHg per mmol/L | in orPaCO2 will | 6 mmHg per 10-mmol/L | in OrPaCO2 = + 15Respiratory AlkalosisAcute will | 2 mmol/L per 10-mmHg | in PaCO2Chronic will | 4 mmol/L per 10-mmHg | in PaCO2Respiratory acidosisAcute will | 1 mmol/L per 10-mmHg T in PaCO2Chronic will | 4 mmol/L per 10-mmHg | in PaCO2 | 158,386 | medmcqa_train |
Which of the following drugs is best for reducing pro teinuria in a diabetic patient? | ACE inhibitors like lisinopril, perindopril, ramipril and ARBs like losaan, telmisaan could decrease the incidence of diabetic nephropathy by decreasing protein levels in the urine especially albumin They r DOC for diabetes with HTN. Ref: KD Tripathi 8th ed. | 158,387 | medmcqa_train |
Drug of choice for precocious pubey: | Treatment of precocious pubey: Rx the underlying cause Long acting GnRH analogues (Leuprolide) | 158,388 | medmcqa_train |
Awareness of having a disease is | Ans. a (Insight). (Ref. Psychiatry by Niraj Ahuja, 5th ed., 14, 41, 57, 72, 85, 95, 171)Term DefinitionPerseverationis persistent repetition of words beyond their relevance.Verbigerationis senseless repetition of same words or phrases.Delusionsare false unshakable belief in something that is not true.Insightis awareness of being diseased or sick.Insight is preserved in OCD.Insight is rated on six point scale from one to six:# Complete denial of illness# Slight awareness of being sick and need help, but denying# Awareness of being sick, but attributed to external/physical factors.# Awareness of being sick due to something unknown in itself.# Intellectual insight.# True emotional insight. | 158,389 | medmcqa_train |
Carbohydrate-related to blood grouping? | The major blood groups of this system are A, B, AB, and O.O type RBCs lack A or B antigens. These antigens are carbohydrates attached to a precursor backbone, may be found on the cellular membrane either as glycosphingolipids or glycoproteins, and are secreted into plasma and body fluids as glycoproteins. H substance is the immediate precursor on which the A and B antigens are added. This H substance is formed by the addition of fucose to the glycolipid or glycoprotein backbone. The subsequentaddition of N-acetylgalactosamine creates the A antigen, whereas the addition of galactose produces the B antigen.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 138e; Transfusion Biology and Therapy | 158,390 | medmcqa_train |
All of the following factors decrease the minimum alveolar concentration (MAC) of an inhalational anaesthetic agent except | MINIMUM ALVEOLAR CONCENTRATION: The MAC of an inhaled anesthetic is the alveolar concentration that prevents movement in 50% of patients in response to a standardized stimulus (eg, surgical incision). MAC is a useful measure because it mirrors brain paial pressure, allows comparisons of potency between agents, and provides a standard for experimental evaluations. Ref: Miller&;s anesthesia 8th edition Ref: Morgan & Mikhail&;s clinical anesthesiology 6e | 158,391 | medmcqa_train |
A 27-year-old patient with a chief complaint of mild veigo of 3-months duration is seen by a neurologist. Examination reveals a positional (horizontal and veical) nystagmus that is bidirectional. The patient repos the absence of tinnitus. Which of the following is the most likely etiology of veigo? | Pathologic veigo is generally classified as peripheral (labyrinthine) or central (brainstem or cerebellum).The clinical presentation, in this case, is most consistent with central veigo. Positional (especially horizontal) nystagmus (to-and-fro oscillation of the eyes) is common in the veigo of central origin, but absent or uncommon in peripheral veigo. The chronicity of the veigo is characteristic of central veigo, whereas the symptoms of peripheral veigo generally have a finite duration and may be recurring.Tinnitus and/or deafness is often present in peripheral veigo, but absent in central veigo. The flocculonodular lobe, or vestibulocerebellum, is connected to the vestibular nuclei and paicipates in the control of balance and eye movements, paicularly changes in the vestibuloocular reflex (VOR), which serves to maintain visual stability during head movement.A lesion of this area of the cerebellum may result in veigo and nystagmus, whereas the spinocerebellum is involved in the coordination of limb movement. | 158,392 | medmcqa_train |
Cephalosporin that does not require dose reduction in patient with any degree of renal impairment is: | CEPHALOSPORINS These are a group of semisynthetic antibiotics derived from &;cephalosporin-C&; obtained from a fungus Cephalosporium. They are chemically related to penicillins; the nucleus consists of a P-lactam ring fused to a dihydrothiazine ring, (7-aminocephalosporanic acid). By addition of different side chains at position 7 of [3-lactam ring (altering spectrum of activity) and at position 3 of dihydrothiazine ring (affecting pharmacokinetics), a large number of semisynthetic compounds have been produced. Cefoperazone: Like ceftazidime, it differs from other third generation compounds in having stronger activity on Pseudomonas and weaker activity on other organisms. It is good for S. typhi and B. fragilis also, but more susceptible to Beta lactamases. The indications are-severe urinary, biliary, respiratory, skin-soft tissue infections, meningitis and septicaemias. It is primarily excreted in bile; half life is 2 hr. It has hypoprothrombinaemic action but does not affect platelet function. A disulfiram-like reaction with alcohol has been repoed. Dose: 1-3 g i.m./i.v. 8-12 hourly ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:705,706 | 158,393 | medmcqa_train |
Germ cell tumor(s) of paediatric includes all except? | Ans. is 'b' i.e., Leydig cell tumor Germ cell tumors o Germ cell tumors, as the name suggests, arise from Primordial germ cells (Precursor germ cells or gametocytes), o Germ cells develops early in life. In growing fetus, germ cells migrate from their point of origin to the gondal area. o Germ cells that still have to reach the gonads are called primordial germ cells. o After reaching to gonads these become mature germ cells and the end products of germ cell cycle are the egg or sperm. o Germ cell tumors arise from primordial germ cells. o Therefore germ cells tumor may be : Gonadal (In testis or ovary) ii) Extragonadal : - When primordial germ cells fail to reach the right location and divide at the site of arrest. Extra-gonadal germ cell tumors may occur at mediastinum (most common site), retroperitonium (2nd most common site), brain, pineal gland, sacrococcygeal region. o Germ cell tumor are : Seminoma/dysgerminoma Embryonal carcinoma Yolk/sac (endodermal sinus) tumor Choriocarcinoma Teratoma Non-germ cell gonadal tumors o These tumors occur in adults. These may occur very rarely in children and occur predominantly in ovary. Tumors are : - i) Surface epithelial tumors : - Serous tumor, mucinous tumor, Brenner tumor etc. ii) Sex cord stromal tumors : - Granulosa-theca cell tumor, Seoli-Leydig cell tumor. | 158,394 | medmcqa_train |
Regarding the action of Anti Diuretic Hormone (ADH) all are true, except: | ADH/Vasopressin is stored in the posterior hypothalamus and is released into the blood stream when the effective osmotic pressure of plasma is increased above 285mOsm/kg. Its secretion is regulated by osmoreceptors located in the anterior hypothalamus. Vasopressin secretion is increased in: Increased effective osmotic pressure of plasma Decreased ECF volume Pain, emotion, stress, exercise Nausea and vomiting Standing Clofibrate, carbamazepine Angiotensin II Vasopressin Secretion Decreased Decreased effective osmotic pressure of plasma Increased ECF volume Alcohol Effects of vasopressin: It increases the permeability of the collecting ducts of the kidney so that water enters the hypeonic interstitium of the renal pyramids. V1A receptors mediate the vasoconstrictor effect of vasopressin and is potent stimulator of vascular smooth muscle. It cause glycogenolysis in the liver. V1B receptors in the anterior pituitary mediate increased secretion of ACTH from the coicotropes. | 158,395 | medmcqa_train |
The medium of choice culturing yeast form of dimorphic fungi is: | Ans. is 'c' i.e., SDA with antibioticsSDA with antibiotics (Chloramphenicol) is always preferred over plain SDA to avoid bacterial contamination and make it more selective. | 158,396 | medmcqa_train |
True statements regarding DMPA includes all the following except : | Risk of endometrial cancer is substantially reduced by past use of DMPA Noncontraceptive benefits of DMPA:Anemia, PID, Ectopic pregnancy, and Endometrial cancer are repoedDMPA benefits women with sickle cell diseaseRef: Novak and Bereks Gynecology; 15th Edition; Chapter 10 | 158,397 | medmcqa_train |
Which of the following does not come in contact with anterolateral surface of left kidney? | A small medial area of the superior pole is related to the left suprarenal gland. Approximately the upper two-thirds of the lateral half of the anterior surface is related to the spleen. A central quadrilateral area lies in contact with the pancreas and the splenic vessels. Above this a small variable triangular region, between the suprarenal and splenic areas, is in contact with the stomach. Below the pancreatic and splenic areas, a narrow lateral strip which extends to the lateral border of the kidney is related to the left colic flexure and the beginning of the descending colon. Ref: Gray's anatomy 40th edition, Chapter 91. | 158,398 | medmcqa_train |
Which of the following is TRUE regarding classical spontaneous bacterial peritonitis ? | Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complications of cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. .UGI bleeding and abdominal pain were the most common presenting symptoms of SBP SBP is an acute ascites infection an ascitic fluid polymorphonuclear (PMN) cell count of >=250 cells/mm3 both with or without a positive ascitic fluid bacterial culture. SBP can be differentiated from secondary bacterial peritonitis by the absence of a surgically treatable intra-abdominal source of infection Ref Davidson edition23rd pg 811 | 158,399 | medmcqa_train |
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