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A drug not effective in Multiple Myeloma is? | Hydroxyurea REF: Harrison 17th ed chapter 106 Drugs used in chemotherapy of multiple myeloma are: Melphan Thalidomide Lenalidomide Cyclophosphamide Vincristine Doxorubicin (Adriamycin) and liposomal doxorubici | 158,500 | medmcqa_train |
Which of following is true about allodynia? | *Allodynia describes the situation in which a non painful stimulus ,once perceived ,is experienced as painful ,even excruciating . Allodynia refers to central pain sensitization (increased response of neurons) following normally non-painful, often repetitive, stimulation. Allodynia can lead to the triggering of a pain response from stimuli which do not normally provoke pain. Ref Harrison20th edition pg 2245 | 158,501 | medmcqa_train |
In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which following organ is involved: | Pseudomyxoma Peritonei Mucinous ascites Caused by ruptured Appendiceal or Ovarian Adenocarcinoma MC primary cause - Appendix > ovary Incidence- male = female Usually seen in 4th - 5th decade Peritoneal cavity is filled with mucinous substances (JELLY like) creates pressure in abdomen compressing the bowel & simultaneously in Upright posture - Abdominal distension | 158,502 | medmcqa_train |
Low serum haptoglobin in hemolysis is masked by ? | Ans. is 'c' i.e., Bile duct obstruction Haptoglobin o Haptoglobin is a transpo glycoprotein which binds free hemoglobin in plasma and carries it to the reticuloendothelial system. It is synthesized in the liver. o A decrease in haptoglobin levels (with normal liver function) occurs when there is excess of hemoglobin in the plasma due to intravascular hemolysis ---> free hemoglobin in plasma bound to haptoglobin and this complex is rapidly cleared by mononuclear phagocytic system. o In biliary obstruction the serum haptoglobin level is increased and this may mask the decrease in serum haptoglobin due to hemolysis. | 158,503 | medmcqa_train |
Right axis detion is seen In all except- | Right axis detion also may occur as a normal variant (paicularly in children and young adults), as a spurious finding due to reversal of the left and right arm electrodes, or in conditions such as right ventricular overload (acute or chronic), infarction of the lateral wall of the left ventricle, dextrocardia, left pneumothorax, and left posterior fascicular block. The ECG in severe pulmonary hypeension shows P pulmonale, right axis detion, and RV hyperophy. In ostium secundum ASD, electrocardiogram (ECG) usually shows right-axis detion and an rSr' pattern in the right precordial leads representing enlargement of the RV outflow tract. ( Harrison&;s principle of internal medicine,18th edition,pg no.1834 ) | 158,504 | medmcqa_train |
Antral puncture is done through | Antral puncture and irrigation: Sinus cavity is irrigated with a cannula passed through the inferior meatus. Removal of pus and exudates helps the sinus mucosa to reve to normal. Ref: Dhingra 7e pg 219. | 158,505 | medmcqa_train |
Investigation of choice in whole body imaging in metastasis is - | Best investigation for bony metastasis is MRI. MRI has almost 100% sensitivity in detecting bony metastasis Investigation of choice for whole body screening for bony metastasis is Bone scan Intial investigation in symptomatic bone pain is Radiography CT is used in evaluation of focal abnormalities of bone scan and also for guided needle biopsy. | 158,506 | medmcqa_train |
Treatment for achlasia associated with high rate of recurrence : | Ans. is 'd' i.e., Botulinum toxin Treatment of Achalasia The aim of treatment is to be relieve the functional obstruction at the cardia The two main methods to achieve this are I) Forceful dilatation or 2) Esophageal myotomy (Heller's myotomy) with or without an antireflux procedure 1) Forceful dilatation (pneumatic dilatation) - The aim is to weaken or rupture the circular muscle fibres of the LES by forceful stretch. - Perforation and bleeding are potential complications 2) Extramucosal cardiomyotomy (Heller's myotomy) this involves surgical division of the muscle fibres of the lower esophageal sphincter. this procedure can be performed through a laparoscopic or thoracoscopic approach (Open surgical procedure i.e. Laparotomy or thoractomy can also be done, but the videoscopic procedure is better) - major complication is gastro-esophageal reflux. - paial fundoplication is done to prevent reflux "modified laparoscopic Heller myotomy is the operation of choice"- Sabiston Other methods of treatment Drugs Nitrates and calcium channel bockers can be used, but are ineffective for long term use. They can be used for transient relief of symptoms and in patients unfit for surgery and pneumatic dilatation. Botulinum toxin Botulinum toxin is given by endoscopic injection into the LES. It reduces LES pressure by blocking the cholinergic excitatory nerves in the sphincter. Its effect is only sho-lived and repeated injections have to be given. Used only in patients unfit for surgery and pneumatic dilatation. | 158,507 | medmcqa_train |
Most potent stimulus for secretin secretion is | Protein / acid in duodenum is the most potent stimulus for secretion of secretin. | 158,508 | medmcqa_train |
Standard treatment of whole-brain radiotherapy (WB) for brain Metastasis : | Ans. B, 30 grays (Gy) in 10 fractionsWhole-brain radiotherapy (WB) to 30 grays (Gy) in 10 fractions - Standard treatment in patients with multiple brain metastases.Current study investigated the potential benefit of dose escalation beyond 30 Gy. | 158,509 | medmcqa_train |
Which of the following statement regarding Rota virus is false? | Rota virus is a double stranded RNA virus belonging to the family Reoviridae. The RNA is enclosed in a triple layered, non enveloped icosahedral capsid. It is one of the commonest cause for watery diarrhoea in children. Oral rehydration therapy is the most appropriate treatment of choice. | 158,510 | medmcqa_train |
Which of the following phospholipid is associated with apoptosis? | Lipid bilayer is asymmetric. Phosphatidylserine and phosphatidyl ethanolamine are located in the inner leaflet Lecithin and sphingomyelin are located in the outer leaflet. Flipping of phosphatidylserine to outer membrane is seen in apoptosis. This is the basis of annexin V assay | 158,511 | medmcqa_train |
Which of the following malignancy is associated with invasion of Voex Vein? | Malignant melanoma of the choroid is the most common primary intraocular tumor of adults usually between the age group 40-70 years. It is rare in blacks and is more common in whites. It arise from the neural crest derived pigment cells of the uvea as a solitary tumor and is usually unilateral. This tumor during the stage of extraocular extension burst through the sclera at limbus. This extraocular spread occur through the perivascular spaces of voex veins or ciliary vessels. Ref: Comprehensive Ophthalmology By AK Khurana, 4th Edition, Pages 162-5. | 158,512 | medmcqa_train |
A Female health worker has to teach women in Urban slum about ORS preparation. Best method will be | Demonstration -Is a carefully planned presentation where idea is to show ' how to perform' a skill/procedure Two principles : 1. Seeing is believing 2. learning by doing | 158,513 | medmcqa_train |
Which of the following Inhalation anaesthesia agent is Hepatotoxic: | Side effects of inhalation anesthetics Halothane: Auto immune hepatitis Disrupts dual blood supply Respiratory depression Sevoflurane Produce Comp A (nephrotoxic) Day care surgery Inhalational induction agent of choice Pediatric population Isoflurane Coronary steel phenomenon Procaine Local anesthetic Used in cataract surgery | 158,514 | medmcqa_train |
Degenerated neurofilaments seen in patients with Alzheimer's disease are: | Neurofibrillary tanglesThe build-up manifests in two ways:Plaques- deposits of the protein beta-amyloid that accumulate in the spaces between nerve cells Tangles - deposits of the protein tau that accumulate inside of nerve cellsBoth amyloid plaques and neurofibrillary tangles are clearly visible by microscopy in brains of those afflicted by AD.Plaques are dense, mostly insoluble deposits of amyloid - beta peptides and cellular material outside and around neurons.Senile neural plaques correlates (increases) with ageTangles (neurofibrillary tangles) are aggregates of the microtubule-associated protein tau which has become hyperphosphorylated and accumulate inside the cells themselves & are associated with severe dementiaLateral geniculate body is resistant to neurofibrillary tangles. | 158,515 | medmcqa_train |
Pepsinogen is secreted by | Chief or zymogen or peptic cells secrete pepsiongens.Parietal or oxyntic cells secrete HCl and intrinsic factor.These cells are located in the body of stomach, including the fundus.(Ref: Ganong&;s Review of medical physiology, 23 rd edition, page 431) | 158,516 | medmcqa_train |
In the work of breathing, tissue resistance contributes ___% fraction: | Work done = load x displacement. In the context of lungs, load is analogous to pressure and displacement is volume expansion of lungs. Hence, work of breathing = DP X DV. Thus, work done can be calculated as area covered under the inspiratory curve in compliance diagram. Of the total inspiratory work, 65% work is elastic work or compliance work. Remaining 35% is non-elastic work - (28% is airway resistance work, 7% is tissue resistance work.) | 158,517 | medmcqa_train |
Snow banking is typically seen in: | A i.e. Pars planitis Pars planitis (intermediate uveitis) presents with snow ball opacities Q which coalesce to form a grey white plaque called snow banking Q | 158,518 | medmcqa_train |
Non visualization of gastric fundic bubble with air-fluid level in retrocardiac region suggests:September 20003 | Ans. C i.e. Achalasia cardia | 158,519 | medmcqa_train |
Which of the ITIowing mosquitoes is invohed in the spread of-Japanese encephalitis ? | Ans. is 'c' i.e., Culex | 158,520 | medmcqa_train |
Which of the following is a content of dentinal tubules | Contents of Dentinal tubule
Odontoblastic process
Afferent Nerve terminal
Dendrites of antigen presenting cell
Dentinal fluid
intratubular dentin | 158,521 | medmcqa_train |
Reducing sugar in urine can be detected by ? | Ans. is 'd' i.e., All of the aboveDetection of reducing sugars Reducing propey of sugars in alkaline solution is utilized for both qualitative and quantitative determination of sugars. Reagent containing Cu' ions are most commonly used. These are generally alkaline solution of cupric sulfate :-Benedict's quantitative reagent (CuSO4, Na2CO3, sodium citrate, potassium ferrocyanide, potassium thiocyanide) can detect any reducing sugar.Fehling solution contains CuSO4, Ruchelle Salt (sodium potassium taarate) and strong alkali (NaOH/ KOH). It is not used now.Glucose oxidase method : - This method is specific for glucose. Peroxidase and oxidase enzymes are used for estimation of glucose. These enzymes are the basis of highly specific test strips used for detction of glucose in urine or blood. | 158,522 | medmcqa_train |
Ulcerative colitis what is seen? | Cryptitis The pathology in ulcerative colitis typically involves distoion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscess, and hemorrhage or inflammatory cells in the lamina propria. Pathology of ulcerative colitis. Macroscopic features Ulcerative colitis is a mucosal disease that usually involves the rectum and extends proximally to involve all or pa of the colon. The lesion is continuous and normal areas between the lesions (skip lesions) do not occur. With mild inflammation the mucosa is erythematous and has a fine granular surface that appears like sand paper. In severe cases mucosa is hemorrhagic. ulcerated and edematous. In long standing cases. inflammatory polyps (pseudopolyp) may be present as a result of epithelial regeneration. With many years of disease the mucosa becomes atrophic and featureless and entire colon becomes narrowed and shoened. Microscopic features :? The impoant pathological characteristic is that the process is limited to the mucosa and superficial submucosa with deeper layers unaffected except in fulminant disease. Two major features in ulcerative colitis suggests chronicity Distoion of the crypt architecture of the colon (cryptitits) - Crypts may be bifid and reduced in number often with a gap between crypt bases and musculoris mucosae. Diffuse predominantly mononuclear infiltrate in lanzina propria is universally present - Neutrophilic infiltration of epithelial layer produce collection of neutrophils in crypt (crypt abscess). | 158,523 | medmcqa_train |
Parachute reflex disappears by: March 2013 (c, f) | Ans. D i.e. Persists Parachute (forward) reflex When:This occurs from about 9 months of age and persists. What:If the baby is held in a position where he is dropped forward, he will outstretch his hands. This is one of the baby milestones that is protective for falling. | 158,524 | medmcqa_train |
All are true regarding vitamin D, except ? | Ans. is 'b' i.e., 1-hydroxylation in liver | 158,525 | medmcqa_train |
Marjolin ulcer | .marjolin&;s ulcer is the name given to a malignancy ( usually a squamous cell carcinoma ) which arise in any long standing wound or a scar mostly scar of an old burn it grows slowly as it is avascular it is painless | 158,526 | medmcqa_train |
Proprioception is carried by which fibers? | Ans. is'a'i.e., Fasciculus cuneatus and fasciculus gracilis(Ref: Guyton 12th/e p. 573)Posterior column (Dorsal column) (Fasciculus Gracilis and Fasciculus Cuneatus) carriesProprioception (Position of body or limb, position of joint)VibrationFine touch (two point discrimination, topognosis, stereognosis).Kinesthesia | 158,527 | medmcqa_train |
Persistent bucconasal membrane result in | Ans. b (Choanal atresia). (Ref. Diseases of ENT, PL Dhingra, 3rd ed., 78, 210, 510)# Persistant bucconasal membrane leads to choanal atresia.Choanal atresia# Is a autosomal recessive trait in which the posterior choanae unilaterally or bilaterally fail to develop properly.# Persistent bucconasal membrane is the basic etiology.# Occurs in 1 in 5,000 births; more common among girls (2:1)# Unilateral > bilateral atresia.# Because newborns are obligate nose breathers, bilateral atresia is immediately apparent as respiratory distress.# Characteristics is the history or failure to pass a rubber catheter or nasogastric tube into the pharynx.# Symptoms of choanal atresia include failure to thrive due to poor feeding and mucoid nasal discharge.# The presence of choanal atresia can be confirmed with visualization of retention material in the posterior part of the nose on a lateral radiograph with the patient in the supine position.# Anatomic characterization of the deformity with CT can be important for planning surgical procedures.# Surgical treatment methods for membranous atresia include puncture of the choanal membrane and placement of a stent for 6 weeks.# If bony atresia is present, the bony wall can be taken down transnasally with microsurgical techniques followed by placement of a stent.# When suboptimal resection for atresia or choanal stenosis occurs, transpalatal repair at 3-4 years age is advised.# The septum usually deviates to the affected side; however, more posterior examination shows atresia.# Transpalatal repair is being replaced by endoscopic techniques of repair of atresia in children and adults. | 158,528 | medmcqa_train |
Empirical treatment for meningococcal meningitis is: | Ans. (A) Ceftriaxone(Ref: Harrison 19/e p767)Drug of choice for treatment of meningococcal meningitis is Penicillin G. But for empirical treatment we need to cover other likely organisms too. So, ceftriaxone is preferred that will also cover H. influenzae. Vancomycin is usually added to cover other organisms also. | 158,529 | medmcqa_train |
Pheochromocytoma are tumours of: | Ans. B. Adrenal medullaPheochromocytoma are a type of tumor of the adrenal glands that can release high levels of epinephrine and norepinephrine. As the name implies, the "ad-renal" glands are located near the "renal" area. Someone with a pheochromocytoma usually has three classic symptoms, headache, sweating, and heart palpitations (a fast heart beat) in association with markedly elevated blood pressure (hypertension). Other conditions that may accompany these classic symptoms are as follows:a. Anxiety,b. Nausea,c. Tremors,d. Weakness,e. Abdominal pain, andf. Weight loss. | 158,530 | medmcqa_train |
Primary peritonitis is more common in females because : | Ans. is a i.e. Ostia of fallopian tubes communicate with abdominal cavity Primary peritonitis refers to inflammation of peritoneal cavity without a documented source of contamination. "It occurs more commonly in children than adults and in women than in men. The later distribution is explained by entry of organisms into the peritoneal cavity through the fallopian tubes." | 158,531 | medmcqa_train |
Rhomboid major is supplied by which type of neuron- | Ans. is 'd' i.e., Multipolar * All skeletal muscles are supplied by motor neurons which are multipolar neurons.* There are following types of neurons1) Unipolor neurons These neurons have one process, with different segments (of that one process) serving as dendrite (receptive surfaces) as well as axons (releasing terminals). It is found in invertebrates.2) Bipolar neurons These are neurons with a dendrite and an axon, e.g. bipolar cells of retina.3) Pseudounipolar neurons (subclass of bipolar neurons) The neuron develops, a single process splits into two, both of which functions as axons, - one going to skin or muscle and another to spinal cord, e.g. dorsal root ganglion.4) Multipolar neurons These have one axons and many dendrites, e.g. motor neuron, pyramidal cell of hippocampus and cerebellar purkinje cells. | 158,532 | medmcqa_train |
SIADH secretion is seen in all except - | Ref - geekymedics.com | 158,533 | medmcqa_train |
All of the following provisions are included in the primary health care according to the Alma Ata declaration except | Ans. c. Provision of free medicines Primary Health Care The Alma Ata Conference has defined primary health care as -- an essential health care made universally accessible to individuals and acceptable to them, through their full paicipation and at a cost the community and country can The Alma -- Ata Declaration has outlined 8 essential components of primary health care Education concerning prevailing health problems and the methods of preventing and controlling themQ Promotion of food supply and proper nutritionQ An adequate supply of safe water and basic sanitationQ Maternal and child health care, including family planningQ Immunization against major infectious diseasesQ Prevention and control of locally endemic diseasesQ Appropriate treatment of common diseases and injuriesQ Provision of essential drugsQ The principles of primary health care include Equitable distributionQ Community paicipationQ Intersectoral co-ordinationQ Appropriate technologyQ | 158,534 | medmcqa_train |
True about first order kinetics is: | Ans. d. The rate of elimination is proportional to the plasma concentration (Ref: Katzung 12/e p43-44: KDT 7/e p30-31, 6/e p31-32)Rate of elimination is proportional to plasma concentrationQ first order kinetics (Linear kinetics).First Order Kinetics (Linear kinetics)Zero Order Kinetics (Non linear Kinetics)* Constant fraction of drug is eliminated per unit of timeQ.* Rate of elimination is proportional to plasma concentrationQ.* Clearance remains constantQ.* Half-life remains constantQ.* Most of the drugs follow first order kineticsQ.* Constant amount of the drug is eliminated per unit timeQ.* Rate of elimination is independentQ of plasma concentration.* Clearance is more at low concentrations and less at high concentrationsQ.* Half-life is less at low concentrations and more at high concentrationsQ.* Very few drugs follow pure zero order kinetics e g. alcoholQ* Any drug at high concentration (when metabolic or elimination pathway is saturated) may show zero order kineticsQ. | 158,535 | medmcqa_train |
A 35-year-old female presents with recurrent renal stone. What is not advised? | Low-calcium diets increase the risk of the incident stone formation. Low-calcium diets lead to the stone formation by reducing the amount of calcium to bind oxalate in the intestine- | urine oxalate levels. | 158,536 | medmcqa_train |
The tensile strength of wound after laparoscopic cholecystectomy in a 30 years old woman depends upon: | The recovery of tensile strength results from the excess of collagen synthesis over collagen degradation during the first 2 months of healing, and, at later times, from structural modifications of collagen fibers (cross-linking, increased fiber size) after collagen synthesis ceases.
'Recovery of Tensile Strength: Fibrillar collagens (mostly type I collagen) form a major portion of the connective tissue in repair sites and are essential for the development of strength in healing wounds. Net collagen accumulation, however, depends not only on increased collagen synthesis but also on decreased degradation. When sutures are removed from an incisional surgical wound, usually at the end of the first week, wound strength is approximately 10% that of unwounded skin.
Wound strength increases rapidly over the next 4 weeks, slows down at approximately the third month after the original incision, and reaches a plateau at about 70% to 80% of the tensile strength of unwounded skin. Lower tensile strength in the healed wound area may persist for life. The recovery of tensile strength results from the excess of collagen synthesis over collagen degradation during the first 2 months of healing, and, at later times, from structural modifications of collagen fibers (cross-linking, increased fiber size) after collagen synthesis ceases.'- Robbins 8/e p105-106 | 158,537 | medmcqa_train |
A 53-year-old woman with known kidney disease presents to a hospital because her pain has become increasingly more severe. A physician performing kidney surgery must remember that: | The left renal vein runs anterior to both the aoa and the left renal aery.. The right renal aery runs behind the IVC and is longer than the left renal aery. Because of the large size of the right lobe of the liver, the right kidney lies a little lower than the left kidney. 4 coverings around the kidney from inside to outside are as follows: True capsule (Renal capsule):Collagen-rich connective tissue. Perinephric fat (adipose capsule): It is present b/w renal capsule and renal fascia. Renal fascia- Lies external to the perirenal fat and internal to the pararenal fat, Surrounds the suprarenal gland. Paranephric fat | 158,538 | medmcqa_train |
The major role of 2,3 DPG in RBC includes | The normal BPG in the blood keeps the O2-hemoglobin dissociation curve shifted slightly to the right all the time. In hypoxic conditions that last longer than a few hours, the quantity of BPG in the blood increases considerably, thus shifting the O2-hemoglobin dissociation curve even faher to the right. This shift causes O2 to be released to the tissues at as much as 10 mm Hg higher tissue O2 pressure than would be the case without this increased BPG. Therefore, under some conditions, the BPG mechanism can be impoant for adaptation to hypoxia, especially to hypoxia caused by poor tissue blood flow.Ref: Guyton and Hall textbook of medical physiology 13th edition. Page:532 | 158,539 | medmcqa_train |
A lady on long term hemodialysis developed carpel tunnel syndrome. The cause was diagnosed to be amyloidosis by using a biopsy. What is the type of amyloid that is seen? | Ans. is 'a' i.e. Beta 2 microglobulin Dialysis-related amyloidosis (DRA) is a disorder caused by tissue deposition of beta2 microglobulin as amyloid fibrils.The clearance of beta2 microglobulin, a component of the major histocompatibility complex that is present on cell surfaces, normally occurs by glomerular filtration with subsequent reabsorption and catabolism in proximal tubules. Clearance therefore declines in patients with reduced kidney function, leading to plasma accumulation and slow tissue deposition.The tissue deposition of amyloid detected histologically occurs much earlier than any clinical or radiographic manifestations of the illness.In contrast to fragments of immunoglobulin light chains in primary amyloidosis and serum amyloid A in secondary amyloidosis, the amyloid protein in DRA is composed primarily of beta2- microglobulin.The amyloid found in the bone cysts and synovial tissue in patients with DRA is similar to other forms of amyloid in its staining properties with Congo red and in exhibiting apple-green birefringence under polarized light. It has been proposed that beta2- microglobulin has a high affinity for collagen, an effect that could explain the predominance of joint and bone diseaseClearance of beta2-microslobulinUnderlying the tissue deposition of beta2-microglobulin among patients with end-stage renal disease is the inability to adequately clear this substance, even with modem high flux hemodialysis and/or convective therapies. Bones and diseasesLess tendency to deposit in gastrointestinal organsRarely involvesp2 amyloid has preference for deposition in bones joints and synoviump2 amyloid has affinity for collagenCarpal tunnel syndromeScapulohumeral periarthritisEffusive arthropathySpondyloarthropathyBone diseasesColonStomachEsophagusSmall intestineCardiacPulmonarycutaneousTissue histologyIn contrast to fragments of immunoglobulin light chains in primary amyloidosis and serum amyloid A in secondary amyloidosis, the amyloid protein in DRA is composed primary of beta2-microglobulinThe amyloid found in the bone cysts and synovial tissue is similar to other forms of amyloid in its staining properties with Congo red and in exhibiting apple-green birefringence under polarized light - Biopsy remains the "gold standard" for the diagnosis of beta2- microglobulin amyloidosis. Despite this, the diagnosis of DRA is usually clinical and relies upon the combination of typical clinical features plus characteristic radiographic findings. Abdominal fat pad aspirates are not useful for the diagnosis of DRA.Type of AmyloidosisMajor Fibril proteinPrecursor proteinSystemic Amyloidosis Primary amyloidosisSecondary amyloidosisHemodialysis associated amyloidosisALAAAb2 microglobulinImmunoglobulin light chainSSAb2 microglobulinHereditary amyloidosis Familial Mediterranean feverFamilial amyloidotic neuropathiesSystemic senile amyloidosisAAATTRATTRSAATransthyretinTransthyretinLocalized amyloidosis Senile cerebral(Alzheimer's)Medullary ca thyroidIslet of LangerhansIsolated atrial amyloidosisAbAcalAIAPPAANIAPPCalcitoninIslet amyloid peptideAtrial natriuretic factor | 158,540 | medmcqa_train |
Contrast used for MRI – | Gadolinium is the most commonly used MR contrast agent. | 158,541 | medmcqa_train |
True about diabetic mother is : | Ans. is b i.e. High incidence of congenital hea anomalies is common | 158,542 | medmcqa_train |
Earliest presentation of Friedrich's ataxia is? | Answer is A (Ataxia): In most patients ataxia of gait and stance is the first manifestation of the disease.- Clinical Neurology by Goetz 2"d/742 Friedreich's ataxia presents with progressive staggering gait, frequent falling and titubation- Harrison Note: The first pathological changes in Friendreich's Ataxia are thought to occur is dorsal root ganglia with loss of large sensory neurons. | 158,543 | medmcqa_train |
Laproscopic tubal ligation contraindication - | Ans. is 'a' i.e., Postpartum state "The operation is done in the interval period, concurrent with the vaginal termination of pregnancy or 6 weeks following delivery. Should not be done within 6 weeks following delivery." | 158,544 | medmcqa_train |
All are the Complication of CVP line except - | IMMEDIATE: Failure of procedure Pneumothorax Haemothorax Retroperitoneal haematoma Aerial puncture Local haematoma Guidewire-induced arrhythmia Thoracic duct injury Guide wire embolism Air embolism EARLY: catheter blockage chylothorax catheter knots LATE: Infection : 2.5 infections/ 1000 catheter days catheter fracture vascular erosion vessel stenosis thrombosis osteomyelitis of clavicle (sub clan access) | 158,545 | medmcqa_train |
which of the following is derived from surface ectoderm- | Ans. is 'c' i.e., Lens PrecursorDerivativesNeural ectodermSmooth muscle of the iris, opticle vesicle and cup, iris epithelium, ciliary epithelium, Part of the vitreous, Retina, Retinal pigment epithelium, fibres of the opric nerve.Surface ectodermConjunctiva] epithelium , Corneal epithelium. Lacrimal glands, Tarsal glands. Lens .MesodermExtraocular muscles, corneal stroma, sclera, iris. Vascular endothelium. Choroid, Part of the vitreous.Neural crestCorneal stroma, keratocytes and endothelium, Sclera, Trabecular meshwork endothelium. Iris stroma, Ciliary muscles, Choroidal stroma. Part of the vitreous, Uveal and conjunctival melanocytes. Meningeal sheaths of the optic nerve, Ciliary ganglion, Schwann cells, orbital bones, Orbital connective tissue, Connective tissue sheath and muscular layer of the ocular and orbital blood vessels. | 158,546 | medmcqa_train |
Golden S is seen in | Golden "S" sign is a Reverse "S" sign seen on Frontal Chest Radiograph In patients with Bronchogenic Ca with Right Upper lobe collapse Lower convexity of the Reverse S is due to the mass Upper concavity of the "S" is due to Right UPPER LOBE atelectasis with the upward shifting of the horizontal fissure. | 158,547 | medmcqa_train |
The structure marked A begins to close by what time frame and due to what cause? | The structure marked is ductus aeriosus which begins to close 10-15 hours after bih due to withdrawal of prostaglandins and exhibits functional closure by 7 days and anatomical closure by 4 weeks after bih. | 158,548 | medmcqa_train |
All are indicated in a 30-year-old patient with increased serum cystine and multiple renal stones except: | The clinical diagnosis of profile given in the question is CYSTINURIA . Cystinuria- AR,defect in re-absorptive transpo of cystine and the dibasic amino acids ornithine, arginine, and lysine from the luminal fluid of the renal proximal tubule and small intestine. Urinalysis- hexagonal shaped crystals: pathognomonic of cystinuria. The foundation of cystine stone prevention is adequate hydration and urinary alkalinization. When this conservative therapy fails, the addition of drugs, such as D-penicillamine and captopril. -The clinical profile should not be confused with Cystinosis which is treated with Cysteamine. | 158,549 | medmcqa_train |
A Ten year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis amongst the following is: | Answer is D (Coarctation of Aoa) Isolated upper extremity hypeension (200 / 140 mm Hg), together with absent/ diminished femoral pulses is a characteristic feature of coarctation of aoa. Although coarctation of aoa does not commonly present with seizures, these may be seen as a consequence of severe hypeension (BP = 200/140) or complications like intracranial haemorrhage (from Berry aneurysms which are more common in patients with coarctation. Coarctation of Aoa is the most likely diagnosis: Approach (Nelson/Hurst) The classic sign of coarctation of aoa is a disparity in pulsations and blood pressure in arms and legs. The femoral, popliteal, posterior tibial and dorsalis pedis pulses are weak (or absent in upto 40% of patients) in contrast to bounding pulses in the arms and carotid vessels. The blood pressure is the legs is lower than in the arms and 90% of patients with coarctation have hypeension in an upper extremity greater than 95" perecentile for age Age (yrs) 95th percentile (mm Hg) > 1 yrs 110 60 I -- 5 yrs 115 /75 6-10 yrs 125 /85 11 -- 18 yrs 140 /90 A blood pressure of 200 /140 mm Hg in a 10 year old boy suggests severe hypeension (95" percentile at 10 years -- 125/85) Severe hypeension may be seen as a consequence of persistant hypeension in an individual who has not undergone corrective surgery for coarctation, and this usually appears in the second or third decade of life (Hurst) Children with severe/malignant hypeension may develop headaches, seizures and stroke (haemorrhage from Berry aneurysms which are more common in patients with coarctation). Takayasu Aooaeritis may also present with severe hypeension and absent femoral pulses due to acquired midaoic coarctation but this is an uncommon presentation in Takavasu aooaeritis (and hence not the single best answer of choice) Takayasu aeritis (or non specific aooaeritis) is a chronic vasculitis disease of medium and large sized aeries with a strong predilection for aoic arch and its branches. This may lead to stenosis of the involved vessels and hence a picture of acquired coarctation. It may thus produce a clinical picture similar to that of coarctation with disparity in pulsations and blood pressure in arms & legs with hypeension depending on the site of the acquired stenosis. However, this condition is more common in women and most commonly affects the subclavican aery. Hence it more commonly presents with claudication, along with unequal and reduced pulses / BP in the upper extremity than the lower extremity. Also systemic symptoms are more common is Takayasu than in coarctation. Neveheless Takayasu aeritis may affect the Thoracic or Abdominal aoa and present with absent lower limb pulses and upper extremity hypeension like coarctation of aoa. Takayasu aeritis can be picked as the answer if Coarctation of aoa is not provided amongst the options | 158,550 | medmcqa_train |
A 30 year-old male has jaundice. Blood examination shows total serum bilirubin 28 mg%, direct bilirubin 16 mg % and alkaline phosphatase 184 KA units. The Diagnosis is : | Answer is D (Obstructive jaundice): The patient in question has high conjugated bilirubin levels (direct bilirubin > 50% of total bilirubin), along with alkaline phosphatase levels more than 6 times normal. The answer of choice therefore is obstructive jaundice. Approach: If direct conjugated bilirubin is greater than 15O of the total bilirubin, it is termed as direct bilirubinemia. | 158,551 | medmcqa_train |
In differential diagnosis of lump in right fornix which is not true : | Submucosal fibroid | 158,552 | medmcqa_train |
A patient presents with symptoms of Hypoglycemia. Investigations reveal decreased blood glucose and increased Insulin levels. C-peptide assay is done which shows normal levels of C- peptide. The most likely diagnosis is: | Answer is C (Accidental exogenous Insulin administration): Normal / Reduced levels of C- peptide in the presence of increased insulin suggest a diagnosis of exogenous insulin administration as the cause of hypoglycemia. Approach to a patient with Hypoglycemia and Increased Insulin levels: Role of C- peptide Assay Normally Endogemous Insulin is secreted from (3-cells of pancreas in the form of Pro-insulin This proinsulin is then broken down to Insulin and C- peptide such that for each molecule of endogenous insulin, one molecule of C-peptide is produced. C-peptide levels are thus increased whenever endogenous insulin is increased e.g. Insulinomas, Sulfonylureas, Autoimmune processes and in cases of Insulin resistance (type II DM). | 158,553 | medmcqa_train |
Methemoglobinemia may be caused by all of the following drugs, EXCEPT: | Drugs causing methemoglobinemia are: Nitrous gases, chloroquine and primaquine, phenazopyridine, sulfonamides, sulfones, aniline dye derivatives, phenacetin, dapsone, local anesthetics, and nitrobenzenes. Hemoglobin becomes methaemoglobin when iron is oxidized from the ferrous to the ferric form. This conversion of hemoglobin to methaemoglobin result in tissue hypoxia by decreasing both delivery of oxygen and removal of carbon dioxide. When levels of methaemoglobin exceeds : 10% of total haemoglobin: cyanosis without any shoness of breath 15% of total haemoglobin: blood appears chocolate brown 25% of total haemoglobin: peripheral and perioral cyanosis 35-40% of total haemoglobin: patients experience lassitude, fatigue, and dyspnea 60% of total haemoglobin: coma and death may occur Ref: Morgan D.L., Borys D.J. (2011). Chapter 47. Poisoning. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e. | 158,554 | medmcqa_train |
A patient came with abduction limitation of right eye and horizontal diplopia. Which nerve can possibly be paralyzed | Lateral rectus Palsy 1. Lesion of Abducens nerve 2. Abduction limitation due to paralysis of lateral rectus 3. Convergent squint and diplopia (horizontal) on long standing palsy. 4. Patient present with turn towards the side of affected muscle Associations Millard Gubler syndrome: Ipsilateral 6th nerve palsy with contralateral hemiplegia Mobius Syndrome O Expressionless face O Facial palsy O 6th and 7th cranial Nerve involved O Lateral rectus paralyzed O Missing fingers & Bone abnormalities O The muscle weakness also causes problems with feeding that become apparent in early infancy. O Hypotonia O Intelligence is normal O Cleft palate O Missing and misaligned teeth | 158,555 | medmcqa_train |
Most common cause of acute parotitis - | Ans. is 'a' i.e., Staph Aureus o MC organism is staph aureus >> str. viridans >> pneumococcus. | 158,556 | medmcqa_train |
The most commonly affected tissues in neurocysticercosis is - | Larvae penetrate the intestine -MC sites of deposition in- CNS (60-90%)> Eye > muscle. in CNS - subarchanoid >parenchymal Option 1, 2, 3, 4 Cysticercosis: Caused by T. solium (Pork tapeworm) Potentially dangerous systemic disease. Neurocysticercosis (NCC) NCC: MC parasitic CNS infection of man and MC cause of adult onset epilepsy in world. MC site: Sub-arachnoid space followed by parenchyma. | 158,557 | medmcqa_train |
Which scientific principle is the basis for thermodilution method used in measurement of cardiac output by pulmonary catheter? | Ans. b. Stewart-Hamilton equation (Ref: Ganong 23/e p513; Guyton 11/e p244)Stewrt-Hamilton equation is the basis for thermodilution method used in measurement of cardiac output by pulmonary catheter.Stewart Hamilton equationThe thermodilution technique has become the de-facto clinical standard for measuring cardiac output because of its ease of implementation and the long clinical experience using it in various settings.It is a variant of the indicator dilution methodQ, in which a known amount of a substance is injected into peripheral vein and its concentration change measured over time in serial arterial samples.As its name implies, the thermodilution method uses a thermal indicator, whereas other indicator dilution methods use various substances, such as indocyanine green dye.The fundamental physical basis for the indicator dilution method is given by the Stewart-Hamilton equationQ, named after the two investigators who were instrumental in the development of this technique. | 158,558 | medmcqa_train |
Which of the following muscle lies between superficial and deep pas of submandibular salivary gland? | Submandibular gland is a large salivary gland situated in the anterior pa of the digastric triangle. It is roughly J-shaped,being indented by the posterior border of the mylohyoid which divides into a larger pa superficial to the muscle,and a small pa lying deep to the muscle. Reference: B D Chaurasia's human anatomy; 5th edition, page.166. | 158,559 | medmcqa_train |
Most common cause of chronic pancreatitis: | Ref. API Textbook of Medicine. Pg. 815
Chronic pancreatitis is a chronic inflammatory disease in which there is irreversible progressive destruction of pancreatic tissue
Its clinical course is characterized by severe pain and in the later stages, exocrine and endocrine pancreatic insufficiency .
High alcohol consumption is the most frequent cause accounting for 60-70% of case, but only 5-10%of people with alcoholism develop chronic pancreatitis . The exact mechanism remains unclear; genetic and metabolic factors may be at play. | 158,560 | medmcqa_train |
Compliance curve of the lung given below. Curve A signifies which of the followings: | Compliance is defined as the change in volume for a unit change in pressure. It measures the distensibility or, stretchability of lung The total compliance of both lungs together in the normal adult human averages about 200 milliliters of air per centimeter of water transpulmonary pressure. The compliance of the combined lungthorax system is almost exactly one half that of the lungs alone-- 110 milliliters of volume per centimeter of water pressure. Types of compliance measurements: Static compliance: This is the measurement made without taking into account the effect of the different phases of respiration. Dynamic compliance: Compliance measurement during the difference phases of respiratory. So it's a measure of static compliance (lungs and chest wall stiffness) plus airway resistance = impedance of lung Specific compliance = Compliance/FRC Reduced compliance is caused by: Increased fibrous tissue in the lung (pulmonary fibrosis) Decreased surfactant or increased surface tension Presence of air (pneumothorax), excess fluid (pleural effusion), or blood (hemothorax) in the intrapleural space Alveolar edema, which prevents the inflation of some alveoli Atelectasis (collapse) Increased pulmonary venous pressure a lung becomes engorged with blood An increased compliance occurs in pulmonary emphysema normal aging lung In both instances, an alteration in the elastic tissue in the lung is probably responsible. Aging cause changes in the structure of lung collagen and elastin rather than changes in the amount or propoion of the two molecules. In emphysema, the alveolar septal tissue that normally opposes lung expansion are destroyed. Increased compliance also occurs during an asthma, but the reason is unclear. | 158,561 | medmcqa_train |
Which of the following nerves carries taste sensation from posterior one-third of the tongue: | The Glossopharyngeal nerve is the nerve for both general sensation and taste sensation for the posterior 1/3rd of the tongue including the circumvallate papillaeNerve supply of tongueMotor supply: All the intrinsic muscles, except the palatoglossus are supplied by the hypoglossal nerve (The palatoglossus is supplied by the cranial pa of accessory nerve through the pharyngeal plexus)Sensory supply :- Anterior 2/3rd of the tongue - Lingual nerve is the nerve of general sensation and the chorda tympani is the nerve of taste for the anterior two-thirds of the tongue.- Posterior 1/3rd of tongue - The glossopharyngeal nerve is the nerve for both general sensation and taste sensation for the posterior 1/3rd of the tongue.The posterior most pa of the tongue is supplied by the vagus nerve through the internal laryngeal branch | 158,562 | medmcqa_train |
All of the following are true about the Right Coronary Aery (RCA) except___ | The right coronary aery arises from the anterior aoic sinus (Right coronary sinus) of the ascending aoa. (Option B) It passes anteriorly and descends veically in the coronary sulcus between the right atrium and the right ventricle. On reaching the inferior margin, it turns posteriorly and continues in the sulcus on to the diaphragmatic surface and the base of the hea. The diameter of the right coronary aery is less than that of the left coronary aery (option A) The right coronal aery is, usually the first branch of the coronary aery. (Option D) The circumflex coronary aery is a branch of the left coronary aery and is the exclusive supplier to the right bundle branch. Ref: Gray's Anatomy 41st edition Pgno: 1016 | 158,563 | medmcqa_train |
Most common malignant lesion of the eyelid is | Basal cell carcinoma This is usually a slow-growing, locally-invasive, malignant tumour of pluripotential epithelial cells arising from basal epidermis and hair follicles; hence, it affects the pilo-sebaceous skin. EPIDEMIOLOGY The strongest predisposing factor to BCC is UVR. It occurs in the elderly or the middle-aged after excessive sun exposure, with 95% occurring between the ages of 40 and 80 years. The incidence of BCC rises with proximity to the equator, although 33% arise in pas of the body not usually sunexposed. Other predisposing factors include exposure to arsenical compounds, coal tar, aromatic hydrocarbons, ionising radiation and genetic skin cancer syndromes. White- skinned people are almost exclusively affected. BCC is more common in men than women. PATHOGENESIS BCCs have no apparent precursor lesions and their development is propoional to the initial dose of the carcinogen, but not duration of exposure. The most likely model of pathogenesis for BCCs involves mesodermal factors as intrinsic promoters coupled with an initiation step. BCCs metastasise extremely rarely. MACROSCOPIC BCC can be divided into localised (nodular; nodulocystic; cystic; pigmented and naevoid) and generalised (superficial: multifocal and superficial spreading; or infiltrative: morphoeic, ice pick and cicatrizing). Nodular and nodulocystic variants account for 90% of BCC. MICROSCOPIC Twenty-six histological subtypes have been described. The characteristic finding is of ovoid cells in nests with a single 'palisading' layer. It is only the outer layer of cells that actively divide, explaining why tumour growth rates are slower thantheir cell cycle speed would suggest, and why incompletely excised lesions are more aggressive. Morphoeic BCCs synthesize type 4 collagenase and so spread rapidly Ref: Bailey and love 27th edition Pgno : 604 | 158,564 | medmcqa_train |
ANA seen in SLE is directed against? | “Antibodies to double-stranded DNA and the Smith (Sm) antigen are virtually diagnostic of SLE" ---------- Robbins
Antinuclear antibodies in SLE
1) Generic antinuclear antibodies (ANA)
□ These are most common (93-100% of patients), thus are most sensitive antibodies for SLE (best screening test).
2) Anti-dsDNA and Anti-smith (Sm) antibodies
□ These are the most specific antibodies for SLE.
3) Antihistone antibodies
□ Particularly seen in drug-induced SLE.
4) Anti-RNP SS-A (Ro), SS-B (La)
□ These are seen in neonatal lupus with congenital heart block and in subacute cutaneous lupus. These antibodies are associated with decreased risk of lupus nephritis.
5) Other less common types of ANAs in SLE
□ Anti-U1 RNP
□ Anti-DNA topoisomerase (Scl-70)
□ Anticentromere
□ Anti-histidyl t-RNA synthase | 158,565 | medmcqa_train |
In cellular event of acute inflammation all are seen except - | . PECAM &; Activation of leukocytesExplanation :- PECAM 1 (platelet endothelial adhesion molecule) or CD31 &; involved in migration of leukocytes | 158,566 | medmcqa_train |
A 76 year old male with a history of dyspnoea on exeion was subjected to x-ray chest by the treating physician. The findings on the chest X-ray are given below. There is a history of fever with significant loss of weight and occasional bloody diarrhoea for the past 3 months. What is the most likely diagnosis? | This is an X-ray film showing multiple cannonball metastasis in the lung. The following neoplasms are most likely to spread to the lungs. Given the history it is likely to be a colorectal carcinoma. Melanoma Thyroid cancer Breast cancer Colorectal cancer Head and neck cancer Renal cell cancer Choriocarcinoma Testicular cancer Osteosarcoma Ewing sarcoma Wilms tumor Rhabdomyosarcoma Prostate cancer | 158,567 | medmcqa_train |
A 21 years female of 143 cm height present primary amenorrhea, absent breast, Cubitus valgus. Most probable diagnosis is? | Individuals with Turner's syndrome are phenotypic females with primary amenorrhea, absent secondary sexual characteristics, sho stature, multiple congenital anomalies, and bilateral streak gonads. Characteristic Findings in Women with Turner Syndrome: Height 142-147cm Micrognathia Epicanthal folds Low-set ears Sensorineural hearing loss Otitis media leading to conductive loss High-arched palate Webbing of the neck Chest square and shield-like Lack of breast development Areolae widely spaced Coarctation of the aoa Sho fouh metacarpal Cubitus valgus Renal abnormalities Autoimmune disorders Autoimmune thyroiditis Diabetes mellitus Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 18. Anatomic Disorders. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e. | 158,568 | medmcqa_train |
WHO ORS contains - | Ans. is 'b' i.e., Potassium chloride-1.5 gm Because of the improved effectiveness of reduced osmolarity ORS solution, WHO and UNICEF are recommending that countries manufacture and use the following formulation in place of the previously recommended ORS solution. | 158,569 | medmcqa_train |
DNA replication and transcription occurs in which direction - | Ans. is 'a' i.e., 51 - 31 Elongation in DNA synthesiso Once the RNA primer has been synthesized at each of the replicating forks, a DNA polymerase III initiates the synthesis of new DNA strand by adding deoxyribonucleotides to the 31 end of RNA primer. Thus, both new strands are synthesized always in 51- 31 direction. Both the DNA strands are synthesized simultaneously, but in opposite direction.o During synthesis of RNA primer and synthesis of DNA strands, the nucleotides are added according to the sequence of base in the template strand, i.e. 'base pairing rule'. For example, an adenine nucleotide would enter at a thymine nucleotide.Elongation in transcriptiono The process of elongation proceeds after the formation of the first phosphodiester bond. After formation of approximately 10 phosphadiester bonds of new RNA, sigma (a) factor dissociates from the core enzyme. RNA polymerase utilize ribnucleotide triphosphate (ATP, GTP, CTP and UTP) for the formation of RNA.o RNA synthesis occurs in 51-3' direction (similar to DNA synthesis), i.e. genetic information is read in 31-51direction on template DNA and complementary base sequence is synthesized in 51-31 direction for RNA strand.o The selection of nucleotide is according to base-pairing rule, (e.g. U opposite to A and G opposite to C)o The process of elongation continues until a termiantion point is reached. | 158,570 | medmcqa_train |
Sympathetic ophthalmitis is due to | Sympathetic Ophthalmitis* Bilateral granulomatous panuveitis after penetrating trauma with prolapsed of uvea* Injured eye - exciting eye; normal fellow- sympathizing eye* Causes: penetrating injury, intraocular surgeries, cyclophotocoagulation, cyclocryotherapy* Site of injury: involving CB, iris and lens capsule* Pathogenesis: Autoimmunity against uveal pigments * Dalen Fuchs Nodules - granulomas between Bruchs and RPE* Earliest Symptom: Loss of accommodation* Earliest Sign: Retrolental flare and cells, KPs at the back of cornea* Enucleation of the injured eye within 10 days only in eyes with a hopeless visual prognosis* Treatment: Topical and systemic steroids | 158,571 | medmcqa_train |
Best test to quantify' feto-maternal haemorrhage in Rh isoimmunisation is - | Ans. is 'c' i.e., Kleinhauser test Kleiheaur betke testo It is quantitative test which is used to calculate the approx volume of the fetal blood entering into the maternal circulation. Based on the principle of acid elution technique and is done by using citric acid phosphate buffer. Fetal red cells (dark refractile bodies) are calculated as per 50 low power fields. If there are 80fetal erythrocytes in 50 low power fields in maternal peripheral blood films, it is estimated as transplacental haemorrhage to the extent of 4 ml of fetal blood.o Though more accurate tests are flow cytometry and immunofluorescence.o Apt test (Singer alkali denaturation test) is another test by which is used to detect the presence of fetal blood in maternal blood. But it is qualitative test. It uses KOH as reagent and is based on alkali denaturation.o Bubble test (shake test) is a bedside test to detect the fetal lung maturity. | 158,572 | medmcqa_train |
Collagen found in hyaline cailage is | Collagen present in cailage are chemically distinct from those in most other tissues.They are described as type 2 collagen Inderbir Singh&;s textbook of human Histology Seventh edition Pg no 82 | 158,573 | medmcqa_train |
A 60 year old male patient complains of food lodgment in upper right back teeth region. Patient gives h/o RCT with 16 and extraction with 15. Ceramic crown and bridge was planned. Which of the following is not a method for strengthening this restoration? | -DEVELOPMENT OF RESIDUAL COMPRESSIVE STRESSES
The fabrication of metal-ceramic and all-ceramic prostheses usually involves sintering the ceramic at high temperature or hot-pressing a veneering ceramic onto the metal or core ceramic. The process of cooling to room temperature offers the opportunity to take advantage of mismatches in coefficients of thermal contraction of adjacent materials in the ceramic structure.
-MINIMIZING THE NUMBER OF FIRING CYCLES
The purpose of porcelain firing procedures is to densely sinter the particles of powder together and produce a relatively smooth, glassy layer (glaze) on the surface. In some cases a stain layer is applied for shade adjustment or for characterization, such as stain lines or fine cracks.
-ION EXCHANGE
The technique of ion exchange is an effective method of introducing residual compressive stresses into the surface of a ceramic.
-THERMAL TEMPERING
Perhaps the most common method for strengthening glasses is by thermal tempering, which creates residual surface compressive stresses by rapidly cooling the surface of the object while it is hot and in the softened (molten) state. This rapid cooling produces a skin of rigid glass surrounding a soft (molten) core. As the molten core solidifies, it tends to shrink, but the outer skin remains rigid. The pull of the solidifying molten core, as it shrinks, creates residual tensile stresses in the core and residual compressive stresses within the outer surface.
Philips’ Dental Material, pg- 440, 441 | 158,574 | medmcqa_train |
A 23-year-old female presents with an itchy, linear rash on her foot. She returned from a camping trip 4 days ago and denies using any new makeup, clothing, or jewelry. True about this skin pathology: | Diagnosis - Contact dermatitis. Foot lesions are erythematous papules and vesicles with serous weeping. Lesions localized to areas of contact with the offending agent (the foot ware in this case). Treatment: Topical or systemic coicosteroids & cool, wet compresses | 158,575 | medmcqa_train |
Treatment of choice of Kawasaki disease ? | Kawasaki disease is a vasculitis that mostly involves the coronary vessels. It presents as an acute systemic disorder, usually affecting children under 5 years.Kawasaki's disease is an acute, febrile, multisystem disease of children. Some 80% of cases occur prior to the age of 5, with the peak incidence occurring at <=2 years. It is characterized by nonsuppurative cervical adenitis and changes in the skin and mucous membranes such as edema; congested conjunctivae; erythema of the oral cavity, lips, and palms; and desquamation of the skin of the fingeips. Although the disease is generally benign and self-limited, it is associated with coronary aery aneurysms in ~25% of cases, with an overall case fatality rate of 0.5-2.8%.Presentation is with fever, generalised rash, including palms and soles, inflamed oral mucosa and conjunctival congestion resembling a viral exanthema. The cause is unknown but it is thought to be an abnormal immune response to an infectious trigger These complications usually occur between the third and fouh weeks of illness during the convalescent stage. Vasculitis of the coronary aeries is seen in almost all the fatal cases that have been autopsied. There is typical intimal proliferation and infiltration of the vessel wall with mononuclear cells. Beadlike aneurysms and thromboses may be seenalong the aery. Other manifestations include pericarditis, myocarditis,myocardial ischemia and infarction, and cardiomegaly . It occurs mainly in Japan and other Asian countries, such as China and Korea, but other ethnic groups may also be affected. Treatment is with aspirin (5 mg/kg daily for 14 days) and IV Ig (400 mg/kg daily for 4 days) . Ref Davidsons 23e p1041 ,Harrisons 20e p2588 | 158,576 | medmcqa_train |
A 35 year old female, hospitalized after a motor vehicle accident, develops acute gastric stress ulcers. Increases in which of the following normal physiological parameters may have contributed to this condition? | Pepsin production is a normal physiologic activity of the stomach that, in conditions of stress, may overwhelm the stomach's weakened defenses and result in gastric ulceration. Gastric acid production is another condition that may increase and cause acute ulceration. Fuhermore, these two factors may remain unchanged and still result in gastric ulcers if the gastric defenses are weakened by stress. All of the other choices represent normal defensive forces in the stomach. Increased bicarbonate transpo would protect the gastric epithelium from the potentially harmful acidity of the gastric contents. The adherent mucus is relatively alkaline, providing local protection to the superficial mucosa. Gastric epithelial cells can normally replicate rapidly, allowing mucosal defects to be rapidly repaired. Increasing the regenerative capacity of the epithelium would have a protective effect against ulceration. The gastric mucosa is richly supplied with blood, providing the epithelial cells with an ample supply of nutrients, oxygen, and bicarbonate to contend with the harsh gastric microenvironment. Stress ulcers are associated with compromised gastric blood flow, not increased flow. Ref: Mills J.C., Stappenbeck T.S., Bunnett N. (2010). Chapter 13. Gastrointestinal Disease. In S.J. McPhee, G.D. Hammer (Eds), Pathophysiology of Disease, 6e. | 158,577 | medmcqa_train |
Which of these is characteristic of amyloidosis- | Robbins and Cotran pathologic basis of disease South Asia edition. *by electron microscopy all types amyloid consist of continuous non branching fibrills.X Ray crystallography and infrared spectroscopy demonstrate a characteristic cross-beta-pleated shear conformation .this conformation is responsible for distinctive Congo red staining and birefringence of amyloid. | 158,578 | medmcqa_train |
What is the intermediate host of the organism shown here? | organism-Guinea worm/medina worm/serpent worm habitat- subcutaneous nodules DH-humans IH- cyclops(lobsters, crabs shrimps) MOI-ingestion of drinking water containing cyclops infested with L3Larvae | 158,579 | medmcqa_train |
Following is true about longitudinal studies | Longitudinal studies are useful in: To study the natural history of disease and it's future outcome For identifying risk factors of disease For finding out incidence rate or rate of occurrence of new cases of disease in the community Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 78 | 158,580 | medmcqa_train |
What is the indication for therapeutic thoracocentesis? | Therapeutic thoracocentesis- Indication - Free fluid separates the lung from chest wall by 10 mm Measured radiographically Preferred site of thoracocentesis -7th ICS Scapular line. For Recurrent pleural effusion - pleurodesis. In pleurodesis we inject a sclerosing agent in pleural space which causes obliteration of pleural cavity | 158,581 | medmcqa_train |
The major difference between X-Rays and Light is: | The main difference between an X-ray photon and a visible light photon lies in the energy of each photon. Xray photon has approximately 5000 times the energy of an ordinary light photon, allowing the Xray photon to pass through materials more readily than a regular light photon. Ref: Techniques in Microscopy for Biomedical Applications By Terje Dokland, Page 289 | 158,582 | medmcqa_train |
Structure NOT passing through esophageal opening | At T8 - IVC hiatus in central tendon through which IVC and few branches of Rt. phrenic nerve passes At T10 - Oesophageal opening is present through which passes: Esophagus Esophageal branch of left gastric aery Anterior and posterior vagal trunk At T12 - Aoic hiatus posterior to diaphragm formed by median arcuate ligament through which passes: Aoa Thoracic duct Azygous vein | 158,583 | medmcqa_train |
Notching of the ribs is seen in man | Coarctation of aoa | 158,584 | medmcqa_train |
Baezomib is - | Ans. is 'a' i.e., Proteosome inhibitor Proteosome inhibitors o Transcription factor NFKB is associated by an inhibitor IKB. o IKB is degraded by proteosomes. o Inhibition of proteosome prevents degradation of IKB which inhibits the overactivity of NFKB. o Proteosome inhibitor (Baezomib) is used in multiple myeloma. | 158,585 | medmcqa_train |
Superior rib notching is/are caused by: | A, B, C, i.e. Hyperparathyroidism, Poliomyelitis, Marfan syndome | 158,586 | medmcqa_train |
Destruction of fat in acute pancreatitis is due to - | An enzyme activated by trypsin is phospholipase A2. This enzyme splits a fatty acid off lecithin, forming lysolecithin. Lysolecithin damages cell membrane. It has been hypothesized that in acute pancreatitis phospholipase A2 is activated in the pancreatic ducts, with the formation of lysolecithin from lecithin that is a normal constituent of bile. This cause disruption of pancreatic tissue and necrosis of surrounding fat. | 158,587 | medmcqa_train |
The very first step in investigation of Epidemic | INVESTIGATION OF AN EPIDEMIC The occurrence of an epidemic always signals some significant shift in the existing balance between the agent, host and environment. It calls for a prompt and thorough investigation of the cases to uncover the factor(s) responsible and to guide in advocating control measures to prevent fuher spread. Emergencies caused by epidemics remain one of the most impoant challenges to national health administrations. Epidemiology has an impoant role to play in the investigation of epidemics. The objectives of an epidemic investigation are a. to define the magnitude of the epidemic outbreak or involvement in terms of time, place and person. b. to determine the paicular conditions and factors responsible for the occurrence of the epidemic. c. to identify the cause, source(s) of infection, and modes of transmission to determine measures necessary to control the epidemic; and d. to make recommendations to prevent recurrence. Steps of investigations of epidemic Verification of diagnosis Confirmation of existence of epidemic Defining population at risk Rapid search for all cases and their characteristics Data analysis Formulation of hypothesis Testing of hypothesis Evaluation of ecological factors Fuher investigation of population at risk Writing the repo Ref : Park 23rd edition Pgno : 132 | 158,588 | medmcqa_train |
Orally administered anti kala-azar drug is | Ans. is 'b' i.e., Miltefosine o Drugs used for kala-azar :- o Parentral : Amphotericin-B (iv), Paromomycin (im), sodium stibogluconate (iv or im). Oral : Miltefosine | 158,589 | medmcqa_train |
Which DNA segments in the lactose operon of E. coli is a trans-acting regulatory element? | Regulatory sequences in DNA are classified as cis- or trans-acting elements, depending on the mechanism of action. Cis-acting elements function only when located on the strand of DNA being regulated, relatively close to the regulated gene. The operator (0), the promoter (P), and the CAP binding site all are located just upstream from the regulated structural genes of the operon, and do not function if placed at other locations. The -galactosidase gene is one of the regulated structural genes of this operon. Trans-acting elements can function from long distances, and can even be on a different DNA molecule in the cell. The gene, which encodes the repressor protein, is an example of a trans-acting regulatory element. Because the gene encodes a diffusible product, it doesn't matter where it is placed relative to the regulated genes. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 567 | 158,590 | medmcqa_train |
Comment on the diagnosis for an individual serum alkaline phosphatase normal, PTH normal, Vitamin D3 normal with elevated serum Calcium values? | Multiple myeloma is a plasma cell neoplasm commonly associated with lytic bone lesions, hypercalcemia, renal failure, and acquired immune abnormalities. Clinical Features. The clinical features of multiple myeloma stem from (1) the effects of plasma cell growth in tissues, paicularly the bones (2) the production of excessive Igs, which often have abnormal physicochemical propeies; and (3)The suppression of normal humoral immunity. Bone resorption often leads to pathologic fractures and chronic pain. The attendant hypercalcemia can give rise to neurologic manifestations, such as confusion, weakness, lethargy, constipation, and polyuria, and contributes to renal dysfunction. Decreased production of normal Igs sets the stage for recurrent bacterial infections. Cellular immunity is relatively unaffected. Of great significance is renal insufficiency, which trails only infections as a cause of death. The pathogenesis of renal failure (Chapter 20), which occurs in up to 50% of patients, is multifactorial. However, the single most impoant factor seems to be Bence-Jones proteinuria, as the excreted light chains are toxic to renal tubular epithelial cells. Ceain light chains (paicularly those of the l6 and l3 families) are prone to cause amyloidosis of the AL type, which can exacerbate renal dysfunction and deposit in other tissues as well. | 158,591 | medmcqa_train |
"Gold standard" study for diagnosis of pulmonary embolic episode is: | Ans. B. Pulmonary angiographyAlthough pulmonary angiography is supposed to be the definitive and gold standard means of diagnosing PULMONARY EMBOLISM with the decreasing availability of pulmonary arteriography and increasing use of other non-invasive tests like spiral CT, the exact role of pulmonary arteriography is now less clear and there are only few indications for it, especially in absence of spiral CT or MRI. | 158,592 | medmcqa_train |
Tryptophan is | During metabolism Tryptophan, pa of carbon skeleton enters ketogenic pathway and rest glucogenic pathway. Alanine is glucogenic and Acetoacetyl CoA is ketogenic. | 158,593 | medmcqa_train |
A 3–month old male child with normal genitalia presents to the emergency department with severe dehydration, hyperkalemia and hyponatremia. The measurement blood levels of which of the following will be helpful? | This is a case of congenital adrenal hyperplasia due to deficiency of 21 - hydroxylase deficiency.
Because of the enzyme block ,there is increased formation of 17- hydroxyprogesterone, which is then shunted into the production of testosterone.
Levels of cortisol and aldosterone are reduced. | 158,594 | medmcqa_train |
Refeeding Syndrome - Lab values to be monitored are all except | Ans. (d) AmmoniumRef: Bailey and Love 27th edition Page 288, Surgery Sixer 3rd Edition Page 6Refeeding Syndrome* Characterized by severe fluid and electrolyte shifts in malnourished patients undergoing refeeding.* It can occur with Enteral and Parenteral nutrition (MC with TPN)* Lab values: Hypophosphatemia, Hypocalcemia, Hypomagnesemia(Mneumonic-CPM Low)* Risk factors: Alcohol, Severe malnutrition, Anorexia, Prolonged fasting* Treatment: Avoid Overfeeding* Deliver calories slowly* Electrolyte imbalance needs to corrected | 158,595 | medmcqa_train |
Mucormycosis of paranasal sinus is most common in | MUCORMYCOSIS: Caused by - rhizopus , rhizomucor , cunninghamella Moulds with non septate hyphae The higher prevalence of mucormycosis in India turned out to be statistically significant (p < 0.0001) in comparison with all other countries Predisposing factors - Organ transplant recipients - Long term desferroxamine therapy - Immunosuppression due to steroids or cytotoxic drugs Hematological malignancy - Diabetics - Chronic renal failure Five forms Rhinocerebral (most common site) Pulmonary mucormycosis (2' most common) Cutaneous Gastrointestinal Disseminated Diagnosis: Microscopy and biopsy show organisms that appears as broad ribbon like usually non septate hyphae which branch at right angles | 158,596 | medmcqa_train |
Which of the following supplies the pineal gland? | Pineal gland is present posterior to midbrain so if tumor is in pineal gland ,it may l/t dorsal mid brain syndrome as it would press on the midbrain from behind. * MCA(Middle Cerebral Aery) not a pa of Circle of Willis * PCA (Posterior Cerebral Aery) P1,P2 and 10-11 Post choroidal aeries P1 supplies- Midbrain P2 supplies -PCA Post choroidal aeries supplies -Pineal gland | 158,597 | medmcqa_train |
A 54-year-old man is admitted to the hospital due to severe headaches. A CT examination reveals an internal carotid artery aneurysm inside the cavernous sinus. Which of the following nerves would be typically affected first? | The abducens nerve would be affected first due to aneurysmal dilation of the internal carotid artery (ICA) because the nerve runs in closest proximity to the artery within the cavernous sinus. The other nerves running in the wall of the cavernous sinus are the oculomotor nerve, trochlear nerve, and both the maxillary and ophthalmic branches of the trigeminal nerve. Each of these nerves, however, courses along, or within, the lateral walls of the cavernous sinus and may not be immediately affected by an aneurysm of the ICA. | 158,598 | medmcqa_train |
Coenzyme required for tissue respiration is | Coenzyme Q (CoQ) is a quinone derivative with a long, hydrophobic isoprenoid tail. It is also called ubiquinone because it is ubiquitous in biologic systems. CoQ is a mobile carrier and can accept hydrogen atoms both from FMNH2, produced on NADH dehydrogenase (Complex I) and from FADH2, produced on succinate dehydrogenase (Complex II).Ref: Harpers Biochemistry; 30th edition | 158,599 | medmcqa_train |
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