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A female wanted to have an emergency contraception after an unprotected intercourse. Which of these is NOT useful as an emergency contraceptive? | Post coital or emergency contraceptives are, Ethinyl oestradiol Conjugated estrogen Ethinyl oestradiol + Norgestrel Levonorgestrel Mifepristone Copper IUDs Ref: Textbook of Obstetrics by D.C. Dutta, 6th edition, Page 550. | 1,800 | medmcqa_train |
A characteristic feature of Still's disease - | Stills disease is a variant of rheumatoid commonly occurring in adults in 20's and 30's.
Patients characteristics clinical features are:
High spiking fever often up to 40°C.
Sore throat
Evanescent salmon coloured non pruritic rash, seen on chest & abdomen
Lymphadenopathy
Pericardial effusion
Wrist joint involvement
Chances are that you might confuse it with Felty's syndrome so I am giving the important features of both these conditions together | 1,801 | medmcqa_train |
Which of the following is false regarding endemic bladder stones? | PRIMARY BLADDER CALCULI (ENDEMIC BLADDER CALCULI) Mainly seen in underdeveloped countries (Noh Africa, Thailand, Myanmar, Indonesia), in pediatric age group. Most common in children <10 Years, with a peak incidence at 2 to 4 years of age. Related to chronic dehydration and low protein, low phosphate, exclusive milk & high carbohydrate diet. Low phosphate diet Increases urinary ammonium excretion leading to ammonium urate stones Treatent Small stones: Removed or crushed transurethral electrohydraulic lithotripsy or Cystolithotomy. Primary bladder calculi rarely recur after treatment. | 1,802 | medmcqa_train |
Which of the following is present normally in the urine of a pregnant women in the third trimester and lactation? | Glucosuria during pregnancy is not necessarily abnormal. The appreciable increase in glomerular filtration, together with impaired tubular reabsorptive capacity for filtered glucose, accounts in most cases for glucosuria. Though glucosuria is common during pregnancy, the possibility of diabetes mellitus should not be Ignored when it is identified. | 1,803 | medmcqa_train |
All are major symptoms of sinusitis except ? | Ans. is 'd' i.e., Halitosis The clinical symptoms of acute sinusitis have been classified into major and minor Major Facial pain or pressure Purulent nasal discharge Fever Nasal congestion Nasal obstruction Hyposmia or Anosmia Facial congestion or fullness Minor Headache Cough Fatigue Halitosis Dental pain Ear pain or pressure | 1,804 | medmcqa_train |
Which of the following is the most widespread method of genetic transfer among bacteria? | Option a, b, c, d * There are three mechanisms of horizontal gene transfer in bacteria:- 1.Transformation 2. Transduction 3. Conjugation (Most common mechanism), It was discovered first by Lederberg and Tatum. * Conjugation plays an impoant role in the transfer of plasmids coding for antibacterial drug resistance and bacteriocin production . * R factor (or the resistance factor) is a plasmid which has two components. o Resistance transfer factor (F) is the plasmid responsible for conjugational transfer(similar to F factor) o Resistance determinant (r): Codes for resistance to one drug. An R factor can have several r determinants. | 1,805 | medmcqa_train |
Which of the following is not an inflammatory mediator | steps: (1) migration and proliferation of fibroblasts into the site of injury and (2) deposition of ECM proteins produced by these cells. The recruitment and activation of fibroblasts to syn- thesize connective tissue proteins are driven by many growth factors, including PDGF, FGF-2 (described earlier), and TGF-b. The major source of these factors is inflamma- tory cells, paicularly macrophages, which are present at sites of injury and in granulation tissue. Sites of inflamma- tion are also rich in mast cells, and in the appropriate chemotactic milieu, lymphocytes may be present as well. Each of these cell types can secrete cytokines and growth factors that contribute to fibroblast proliferation and activation. As healing progresses, the number of proliferating fibroblasts and new vessels decreases; however, the fibro- blasts progressively assume a more synthetic phenotype, so there is increased deposition of ECM. Collagen synthe- sis, in paicular, is critical to the development of strength in a healing wound site. As described later, collagen syn- thesis by fibroblasts begins early in wound healing (days 3 to 5) and continues for several weeks, depending on the size of the wound. Net collagen accumulation, however, depends not only on increased synthesis but also on diminished collagen degradation (discussed later). Ulti- mately, the granulation tissue evolves into a scar composed of largely inactive, spindle-shaped fibroblasts, dense collagen, fragments of elastic tissue, and other ECM com- ponents (Fig. 2-30, B). As the scar matures, there is proA A gressive vascular regression, which eventually transforms the highly vascularized granulation tissue into a pale, largely avascular scar. Growth Factors Involved in ECM Deposition and Scar Formation Many growth factors are involved in these processes, including TGF-b, PDGF, and FGF. Because FGF also is involved in angiogenesis, it was described earlier. Here we briefly describe the major propeies of TGF-b and PDGF. * Transforming growth factor-b (TGF-b) belongs to a family of homologous polypeptides (TGF-b1, -b2, and -b3) that includes other cytokines such as bone morphogenetic proteins. The TGF-b1 isoform is widely distributed and is usually referred to as TGF-b. The active factor binds to two cell surface receptors with serine-threonine kinase activity, triggering the phosphorylation of transcription factors called Smads. TGF-b has many and often oppo- site effects, depending on the cell type and the metabolic state of the tissue. In the context of inflammation and repair, TGF-b has two main functions: TGF-b stimulates the production of collagen, fibro- nectin, and proteoglycans, and it inhibits collagen degradation by both decreasing proteinase activity and increasing the activity of tissue inhibitors of pro- teinases known as TIMPs (discussed later on). TGF-b is involved not only in scar formation after ref Robbins 9/e p83 | 1,806 | medmcqa_train |
A drug given for metoclopramide induced dystonic reaction is : | "Acute muscle dystonia caused by antiemetic-antipsychotic drugs is promptly relieved by parenteral promethazine or hydroxyzine." This is based on the central anticholinergic action of the drugs.
Promethazine is a first-generation anti-histaminic which has a maximum penetration of blood-brain barrier and maximum anticholinergic activity. | 1,807 | medmcqa_train |
Compared with cow's milk, mother's milk has more? | Mother's milk has more lactose as compared to cow's milk. | 1,808 | medmcqa_train |
A man presented with persistent ear pain and discharge, retro-orbital pain and modified radical mastoidectomy was done to him. Patient comes back with persistent discharge, what is your diagnosis? | In a patient with CSOM, persistent ear discharge with or without deep seated pain in spite of an adequate coical or modified mastoidectomy points towards petrositis. Spread of infection from middle ear and mastoid to the petrous pa of temporal bone is petrositis it can also involve adjacent 5th cranial nerve and 6" cranial nerve when it produces classical triad of symptoms - 6th nerve palsy, retro orbital pain (5th nerve) and persistent discharge from the ear, known as Gradenigo's syndrome Treatment Adequate drainage is the mainstay of treatment along with specific antibiotic therapy. Modified radical or radical mastoidectomy is often required if not done already. The fistulous tract should be identified, curetted and enlarged to provide free drainage. | 1,809 | medmcqa_train |
Child presents with linear verrucous plaques on the trunk with vacuolisation of keratinocytes in S.Spinosum and S.Granulosum. Diagnosis is ? | Verrucuous epidermal nevus Linear verrucuous lesions, with characteristic histopathological feature of granular degeneration of the epidermis ours the diagnosis of verrucous epidermal nevus. Epidermal nevus Epidermal nevi are hamaomas that are characterized by hyperplasia of the epidermis and adnexal structures. These nevi may be classified into a number of distinct variants which are based on clinical morphology, extent of involvement and the predominant epidermal structure in the lesion. Variants of the epidermal nevi are ? - Verrucuous epidermal nevus - Nevus sebaceous - Nevus comedonicus - Eccrine nevus - Apocrine nevus - Becker's nevus - White sponge nevus Verrucuous epidermal nevus Verrucuous epidermal ,nevus consists of hyperplasia of the surface epidermis and typically appears as verrucuous papules that coalasce to form well demarcated, skin colored to brown, papillomatous plaque. Most lesions are present at bih and develop during infancy. They enlarge slowly during childhood and generally reach a stable size at adolescence. Lesions may be localized or diffuse. Linear configurations are common especially on the limbs and may follow skin tension lines or Blaschko's lines. The salient histological features are ? Perinuclear vacuolization of the cells in the stratum spinosum and stratum granulosum. Irregular cellular boundaries peripheral to the vacuolization and increased number of irregularly :,aped large keratohyaline granules. Compact hyperkeratosis in stratum corneum. Darner white disease Autosomal dominant disease. Males and females are equally affected. Daffier white disease is not present at bih and usually begins in the first or second decade. Characteristic sites of prediliction are the face, forehead, scalp, chest and the hack (seborrhic sites). Clinical features consists of way papules and plaques in (seborrhic sites). Histology shows suprabasal acantholysis in epidermis with dyskeratotic cells. Incontinentia pigmentii X linked disease (so only seen in females) Lesions are present along the Blaschko lines, which are initially vesicular, that later on turns into verrucuous lesions and hyperpigmented stages. Common histological features are : - Hverkeratosis - Eosinophilic spongiosis of epidermis - Basal cell degeneration - Pigment incontinenti | 1,810 | medmcqa_train |
Best test to detect pneumoperitoneum is: | X-ray abdomen in lateral decubitus | 1,811 | medmcqa_train |
In the intraepthielial region of the mucosa of intestine the predominant cell population is that of | IEL are6 a distinctive population of T cells dispersed among the luminal epithelial cells. paicularly in the small intestine there is a predominantly of CD8+T cells | 1,812 | medmcqa_train |
Terry Thomas sign is seen in | scapholunate dislocation : * Most common ligamentous instability of the wrist * Patients may have high degree of pain despite apparently normal radiographs * Physicians should suspect this injury if patient has wrist effusion and pain seemingly out of propoion to the injury * If improperly diagnosed can lead to chronic pain * Located proximal axial line from 3rd metacarpal Scapholunate Dissociation-Diagnosis * Exam -- Watson&;s test -- Scaphoid shuck test -- Pain/swelling over dorsal wrist, proximal row * Imaging -- Plain films: >3mm difference on clenched fist view -- Scaphoid ring sign Scapholunate Dissociation Treatment * If discovered within 4 weeks, surgery * After 4 weeks, conservative treatment reas -- Bracing -- NSAIDS -- Consider evaluation by hand surgery to confirm no surgery needed ref : maheswari 9th ed | 1,813 | medmcqa_train |
The basic reason for "reperfusion injury" to the myocardium is: | After MI, there is failure of Na+-K+ pump resulting in NCX failure Thus intracellular Ca+2 increases Now when perfusion is established (nutrients are available), because of increased ICF Ca+2, cardiac fibers contract very strongly Already muscle fibers are fragile due to M.I, now this contraction results in fuher damage. This is basic reason for "reperfusion injury". | 1,814 | medmcqa_train |
A 5-year-old girl is brought to the physician after her parents noticed red blood in her stool. Physical examination reveals mucocutaneous pigmentation. Small bowel radiography discloses multiple, small- to medium-sized polyps that are diagnosed pathologically as hamartomas. Which of the following is the most likely diagnosis? | Peutz-Jeghers syndrome is an autosomal dominant, hereditary disorder characterized by intestinal hamartomatous polyps and mucocutaneous melanin pigmentation, which is particularly evident on the face, buccal mucosa, hands, feet, and perianal and genital regions. The polyps seen in Peutz-Jeghers syndrome are hamartomatous, characterized by a branching network of smooth muscle fibers continuous with the muscularis mucosa that support the glandular epithelium of the polyp. Congenital teratoma (choice A) does not involve the intestine. The other choices are principally colonic polyps that derive from the luminal epithelium.Diagnosis: Gastrointestinal polyp, Peutz-Jeghers polyp | 1,815 | medmcqa_train |
First indices to change in iron deficiency anemia is - | The single most sensitive tool for evaluating the iron status is by measurement of serum ferritin. Hemoglobin concentration is relatively insensitive. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 623 | 1,816 | medmcqa_train |
Which of the following is associated with the disease pathology seen in this child? | Child with right sided po-wine stain- seen in sturge weber syndrome. Features of sturge weber syndrome: S- Seizure T- Trigeminal distribution of po wine stain U- Unilateral weakness R- Retardation( mental retardation) G-Glaucoma E- Buphthalamos here, glaucoma is associated with surface ocular vascular malformations . | 1,817 | medmcqa_train |
Patient came with hydrops and scarring of cornea. What would be the treatment modality you would opt for him: | Penetrating keratoplasty has to be done in cases of deep corneal scar or hydrops. SURGICAL MODALITIES FOR KERATOCONUS Keratoplasty for Keratoconus DALK (deep anterior Lamellar keratoplasty): when > 1/2 of stroma is involved. ALTK (Anterior lamellar therapeutic keratoplasty) : When less than 1/2 of stroma is involved. Penetrating Keratoplasty: When full thickness of cornea is involved as in hydrops with scar. INTRASTROMAL CORNEAL RING SEGMENTS Reduce corneal steepening Made of PMMA. Femtolaser is used to make tunnel in cornea. Used in Pellucid Marginal Degeneration, post LASIK ectasia and keratoconus. | 1,818 | medmcqa_train |
Incubation period of Mumps - | Incubation period of mumps varies from 2 to 4 weks, usually 14- 18 days Reference : Park&;s Textbook of preventive and social medicine, 24th edition.Pg no.162 | 1,819 | medmcqa_train |
Drainage of venous blood from testes following division of testicular vein for treatment of varicocele is by: March 2009 | Ans. A: Cremasteric veinVaricocelectomy, the surgical correction of a varicocele, is performed on an outpatient basis.The three most common approaches are inguinal (groin), retroperitoneal (abdominal), and infrainguinal/subinguinal (below the groin).Possible complications of this procedure include hematoma (bleeding into tissues), infection, or injury to the scrotal tissue or structures.In addition, injury to the aery that supplies the testicle may occur.An alternative to surgery is embolization, a non-invasive treatment for varicocele.Embolization is an effective treatment for post-surgical varicoceles. | 1,820 | medmcqa_train |
In Moore's classification of omphalocole (examphalos), type I umbilical defect is less than ________ cm. | Moore suggested a classification of omphalocele into types 1, 2 and 3 with the diameters of < 2.5 cm, 2.5 to 5 cm and > 5 cm respectively. | 1,821 | medmcqa_train |
Lyme disease is transmitted by - | Hard ticks transmit the following disease Tick typhus Viral encephalitis Viral fever Viral hemorrhagic fever Tularemia KFD Tick paralysis Human babesiosis Soft tick transmits Q fever Relapsing fever KFD(outside India) Park's Textbook of Preventive and Social Medicine, 25th edition, Page No. 840 | 1,822 | medmcqa_train |
A 35-year-old woman, on hemodialysis for chronic renal disease, complains of pain in the hands. On examination, the joints are normal with no inflammation or tenderness on palpation. Lab values reveal a low calcium, high phosphate, and high PTH level. What is the most likely diagnosis? (See Figure below.) | The diagnosis is secondary hyperparathyroidism as a consequence of the chronic renal disease. Calcium deposits are seen in the periarticular areas of the fourth and fifth metacarpophalangeal, third proximal interphalangeal, and fourth distal interphalangeal joints. There is slight soft tissue swelling, especially, of the fourth and fifth metacarpophalangeal joints. Calcification in scleroderma is subcutaneous in location. In gout if monosodium urate is deposited it could appear as a soft tissue mass. | 1,823 | medmcqa_train |
Emphysema aquosum is associated with? | Emphysema aquosum is a sign of wet drowning. Drowning fluid actually penetrates alveolar walls to enter the tissues and the blood vessels. This has been described as emphysema aquosum. Cause of death in wet drowning: Disruption of pulmonary surfactant Dry drowning: Water does not enter the lungs, but death results from: Immediate sustained laryngeal spasm Cardiac arrest due to vagal inhibition | 1,824 | medmcqa_train |
Fosphenytoin different from phenytoin in which of the following- | Ans. is 'b' i.e., Can be mixed with saline o While phenytoin cannot be injected in a drip of glucose solution, fosphenytoin can be injected with saline and glucose. | 1,825 | medmcqa_train |
Macrocytic anemia is seen in all EXCEPT - | Robbins basic pathology 8th edition, page no 423, Answer is option3, post hemorrhagic anemia Post Hemorrhagic anemia is normocytic and normochromic. With chronic blood loss, iron stores are gradually depleted. Iron is essential for hemoglobin synthesis and effective eeythropoiesis, and it's deficiency thus leads to chronic anemia of underproduction. | 1,826 | medmcqa_train |
Chyluria is due to- | The most common presentations of the lymphatic filariases are asymptomatic (or subclinical) microfilaremia, hydrocele , acute adenolymphangitis (ADL), and chronic lymphatic disease. If there is obstruction of the retroperitoneal lymphatics, increased renal lymphatic pressure leads to rupture of the renal lymphatics and the development of chyluria, which is usually intermittent and most prominent in the morning. (Harrison's Principles of internal medicine, 20th edition, page 1747) | 1,827 | medmcqa_train |
Which of the following is true about pathophysiology of skeletal fluorosis? | Fluorosis: Excessive deposition of fluorine occurs in bone and soft tissues. Fluorine stimulates osteoblastic activityand fluoroappatite crystals are laid down in bone which are resistant to osteoclastic resorption. This leads to calcium retention, impaired mineralization and secondary hyperparathyroidism. Interosseousmembrane ossification is a diagnostic radiological finding in skeletal fluorosis The characteristic pathology involves Sub-periosteal new bone formation, Osteosclerosis(Most commonly seen veebrae, ribs and pelvis) Hyperostosis at the bony attachments of ligaments, tendons and fascia. | 1,828 | medmcqa_train |
Patient is on Autocoids for 1 year now complains of severe pain Epigastrium relieved by antacid drugs. He complaints of Right Iliac fossa pain and loss of liver dullness. Diagnosis is: | Ans. (a) Perforation of duodenum* This is a clear-cut case of drug induced ulcer and perforation - Duodenal ulcer perforation* Features are diffuse abdominal pain with right iliac fossa pain due to tracking of pus in right colic gutter - Valentino Syndrome* Obliteration of liver dullness* Board like rigidity | 1,829 | medmcqa_train |
Upon contact between the sperm head and the zona pellucida, penetration of the sperm into the egg is allowed because of | . | 1,830 | medmcqa_train |
A person switches from high fat diet to low fat diet with compensatory increase in carbohydrates to maintain the same calories. Which of the following fat component will be increased ? | As excess of carbohydrates are conveed to fat in the body (liver) which eventually gets packed into VLDL so, VLDL represents the amount of fat production in the body, or in other words, it also represent excess dietary carbohydrate intake. While Chylomicrons represents the externally taken fats. Function Lipoproteins Lipoprotein rich in triglyceride Lipoprotein with least electrophoretic mobility Transpoer of dietary (exogenous) triglycerides & Cholesterol Chylomicrons Transpoer of endogenous triglycerides VLDL Transpos endogenous Cholesterol from Liver to Peripheral tissue. LDL Lipoprotein rich in apolipoproteins Transpos excess Cholesterol from Peripheral tissue to Liver called as reverse cholesterol transpo HDL has the highest electrophoretic mobility and least lipid content. HDL paicles are the densest. On electrophoresis, HDL moves fahest on electrophoretic plate towards the anode. HDL Lipoprotein resembling plasminogen Lp(a) | 1,831 | medmcqa_train |
G-cells are present mostly in- G-cells are present mostly in- | Ans. is 'c' i.e., Pyloric antrum | 1,832 | medmcqa_train |
Which type of cells are prominently infiltrated in Rheumatoid arthritis? | (B) T-cells[?]Role of T cells in RAoProminent T-cell infiltrate in RA synoviumoGenetic similarities between RA patients-Specific human leukocyte antigen (HLA)-DR genes - HLA DR4, DR14 and DR1oShared Epitope: The third hypervariable region of DR b chains, especially amino acids 70 through 74.oCD4+ T helper (Th) cells may initiate the autoimmune response in RA by reacting with an arthritogenic agent, perhaps microbial or a self-antigenoSynovial lining or intimal layer: Normally, this layer is only 1-3 cells thick. In RA, this lining is greatly hypertrophied (8-10 cells thick).oPrimary cell populations in this layer are fibroblasts and macrophages. | 1,833 | medmcqa_train |
Most common cause of isolated splenic metastasis is: | Causes of isolated splenic metastasis: Carcinoma Ovary (27%) > Colorectal carcinoma (26%) > Uterine cancer (17%) MC primary for metastasis of spleen: Malignant melanoma (30-50%) > Ca Breast (21%) > Ca lung (18%) | 1,834 | medmcqa_train |
Cellular oxidation is inhibited by : | A i.e. Cyanide | 1,835 | medmcqa_train |
Which of the following includes the contents of the orbit | Content of Orbit:
Eyeball - Eyeball occupies anterior 1/3rd of orbit.
Fascia - Orbital and bulbar fascia.
Muscles - Extraocular and intraocular muscles.
Vessels - Ophthalmic artery, superior and inferior ophthalmic veins and lymphatics.
Nerves - Optic, oculomotor, trochlear and abducent, branches of ophthalmic and maxillary nerves and sympathetic nerves.
Lacrimal gland.
Orbital fat. | 1,836 | medmcqa_train |
Pulse pressure in severe aoic regurgitation is equal to- | Therefore, a defining characteristic of aoic regurgitation is an increase in aoic pulse pressure (systolic minus diastolic pressure). ... Early in the course of regurgitant aoic valve disease, there is a large increase in left ventricular end-diastolic pressure and left atrial pressure.pulse pressure usually between 75-90 mm/hg Ref Davidson 23rd edition pg 450 | 1,837 | medmcqa_train |
Transplacental exchanges that take place are essential to the well being of the fetus. Which of those listed below is NOT a method? | Placental exchanges that take place occur according to different mechanisms. Simple diffusion is the movement of molecules of gas and water from a high concentration to a low concentration. Iodine readily crosses the placental barrier. Active transpo is another method. This method transpos specific molecules across a membrane or against a concentration gradient which requires energy (ATP) (i. e. Ca++, Na +, and K+). Endocytosis is the method by which the macromolecules are captured by cell microvilli. Leakage is difficult to understand, but it has to do with the connections or like connections between fetal and maternal blood. Ref: Molina P.E. (2013). Chapter 9. Female Reproductive System. In P.E. Molina (Ed), Endocrine Physiology, 4e. | 1,838 | medmcqa_train |
Superficial inguinal lymph nodes drain from all of the following except: | Superficial Inguinal Lymph NodesThe horizontal groupThe medial members of the group receive superficial lymph vessels from the anterior abdominal wall below the level of the umbilicus and from the perineum. The lymph vessels from the urethra, the external genitalia of both sexes (but not the testes), and the lower half of the anal canal are drained by this route.The lateral members of the group receive superficial lymph vessels from the back below the level of the iliac crests.The veical group lies along the terminal pa of the great saphenous vein and receives most of the superficial lymph vessels of the lower limb.The efferent lymph vessels from the superficial inguinal nodes pass through the saphenous opening in the deep fascia and join the deep inguinal nodes.Deep Inguinal Lymph NodesThe deep nodes are located beneath the deep fascia and lie along the medial side of the femoral vein; the efferent vessels from these nodes enter the abdomen by passing through the femoral canal to lymph nodes along the external iliac aery Lymphatic Drainage of the PenisFrom most of the penis, lymph drains into the superficial inguinal lymph nodes.Vessels from the glans penis drain into the deep inguinal lymph nodes. | 1,839 | medmcqa_train |
Which of the following anticancer drug can cause flagellated dermatitis? | FLAGELLATED DERMATITIS: It is characterised by pruritic, erythematous, linear streaks that resemble whiplash marks, hence the name flagellated. Bleomycin is metabolized by an enzyme hydrolase. This enzyme is deficient in skin and lungs. Therefore, the major adverse effects of bleomycin is related to skin (flagellated dermatitis) and lungs (pulmonary fibrosis) OTHER CAUSES OF FLAGELLATED DERMATITIS: DRUGS: BLEOMYCIN, DOCETAXEL, BENDAMUSTINE RHEUMATOLOGICAL CAUSES: DERMATOMYOSITIS, ADULT ONSET STILL'S DISEASE TOXINS: SHIITAKE MUSHROOMS | 1,840 | medmcqa_train |
The commonest cranial nerve involved in acoustic neuroma is: | As the eighth nerve schwannoma grows, it extends into the posterior fossa to occupy the angle between the cerebellum and pons (cerebellopontine angle). In this lateral position, it is so situated as to compress the seventh, fifth, and less often the ninth and tenth cranial nerves, which are implicated in various combinations. Later it displaces and compresses the pons and lateral medulla and obstructs the CSF circulation. | 1,841 | medmcqa_train |
The first case introduced into the population group to be studied is called: | Ans: b (Primary case) Ref: Park, 19th ed, p. 90The term primary case refers to the first case of a communicable disease introduced into the population unit being studied.The term index case refers to the first case to come to the attention of the investigator; it is not always the primary case. Secondary cases are those developing from contact with primary case. | 1,842 | medmcqa_train |
Long thyroid stimulating agent is | Answer is option 2, antibody to thyroid receptors. Thyrotropin receptor (TSHR) antibodies that stimulate the thyroid (TSAb) cause Graves' hypehyroidism and TSHR antibodies which block thyrotropin action (TBAb) are occasionally responsible for hypothyroidism. Unusual patients switch from TSAb to TBAb (or vice versa) with concomitant thyroid function changes. We have examined case repos to obtain insight into the basis for "switching." | 1,843 | medmcqa_train |
Pungent volatile anesthetic agents are: | B i.e. Isoflurane | 1,844 | medmcqa_train |
What are the minimum and maximum possible values of Glasgow Coma Score? | Ans. a. Minimum = 3. Maximum = 15 (Ref: Harrison 19/e p1730, 18/e p3381-3382; Sabiston 19/e p1894; Schwartz 9/e p1522; Bailey 26/e p312. 25/e p301. 302)In Glasgow Coma Scale (GCS). maximum score is 15 and minimum score is 3.Glasgow Coma Scale (GCS)Eye OpeningVerbal responseBest Motor responseSpontaneous4Oriented5Obeys commands6To loud voice3Confused, disoriented4Localizes pain5To pain2Inappropriate words3Flexion (withdrawal) to pain)4No response1Incomprehensible sounds2Abnormal flexion posturing3 No response1Extension posturing2 No response1Maximum score-15Q. minimum score-3Q.Best predictor of outcome: Motor responseQPatients scoring 3 or 4 have an 85% chance of dying or remaining vegetative, while scores above 11 indicate only a 5-10% likelihood of deathQ | 1,845 | medmcqa_train |
Iron is absorbed in: March 2012 | Ans: B i.e. DuodenumSite of absorptionStomach is the site of absorption of water and alcoholDuodenum is the site of absorption of iron and calciumIleum is the site of absorption of vitamin B12 and bile salt | 1,846 | medmcqa_train |
Falanga is - | Ans. is 'b' i.e., Beating of feet * Beating may be of following types -i) Falanga (Falolka/Baatinada) : Beating of soles of feet with blunt object.ii) Telefono : Simultaneous beating of both ears with palms.iii) Quirofana : Beating on abdomen while upper half of body lying unsupported on table. | 1,847 | medmcqa_train |
Cognitive model of depression is given by ? | Beck Cognitive therapy is a psychotherapy developed by American pyschiatrist Aaron T. Beck. Cognitive therapy is one of the therapeutic approaches within the larger group of cognitive behavioural therapies. Cognitive therapy seeks to help the client overcome difficulties by identifying and changing dysfunctional thinking, behaviour and emotional responses. This involves helping clients develop skills for modifying beliefs, identifying distoed thinkings, relative to others in different ways and changing behaviours. Treatment is based on collaboration between client and therapist and on testing beliefs. Therapy may consist of testing the assumptions which one makes and identifying how some of one's usually unquestioned thoughts are distoed, unrealistic and unhelpful. Once, those thoughts have been challenged, ones feelings about the subject matter of those thoughts are more easily subject to change. Beck initially focussed on depression and developed a list of errors in thought that he proposed could maintain depression, including arbitrary inference, selective abstraction, over generalization and magnification (of negatives) and minimization (of positives). According to Beck's theorey of the etiology of depression, depressed people acquire a negative view of the world in childhood and adolescence. Children and adolescent who suffer from depression acquire this negative view earlier. Depressed people acquire such view through a loss of a parent, rejection by peers, (criticism from teachers or parents, the depressive attitude and other negative events). When the person with such view encounters a situation that resembles the original conditions of the learned view in some way, even remotely, the negative views of the persons are activated. A simple example may illustrate the principle of how cognitive therapy works Having made a mistake at work, a person may believe "I am useless and can't do anything right at work". Strongly believing this then tends to worsen his mood. The problem may be worsened fuher if the individual reacts by avoiding activities and then behaviourally confirming the negative belief to himself. As a result, any adaptive response and fuher constructive consequences become unlikely, which reinforces the original belief of being useless. In therapy, the latter example could be identified as a self fulfilling prophecy or "problem cycle" and the effos of the therapist and client would be directed at working together to change it. | 1,848 | medmcqa_train |
A 22 years old man presents with a solitary 2 cm space occupying lesion of mixed echogenecity in the right lobe of the liver on USG. The rest of the liver is normal. Which of the following test should be done next? | MRI as the diagnostic test of choice for hepatic hemangioma at most centers. Nuclear medicine studies may be used to confirm the diagnosis when a probable hemangioma is detected on ultra-sonography. Nuclear medicine studies may also help to clarify the nature of a lesion when the diagnosis is equivocal on CT or MRI. Percutaneous biopsy of a hepatic hemangioma carries an increased risk of hemorrhage. Liver biopsy is contraindicated in most circumstances where a hemangioma is high in the differential diagnosis of a hepatic mass. Hepatic angiography: The diagnostic accuracy of noninvasive tests has obted the need for hepatic aeriography in most cases. | 1,849 | medmcqa_train |
Dye used for myelography | contrast agents used for myelography are : Iohexol Iopamidol Metrizamide Myodil | 1,850 | medmcqa_train |
Which is NOT pyrogenic Interleukin | (C) IL-4 # Pyrogenic cytokines: Known pyrogenic cytokines include IL-1, IL-6, TNF, ciliary neurotropic factor (CNTF), and interferon (INF)a. Others probably exist; although IL-18 - a membrane of the IL-1 family - does not appear to be pyrogenic cytokine. Each cytokine is encoded by a separate gene, and each pyrogenic cytokine has been shown to cause fever in laboratory animals and in humans. When injected into humans, IL-1, IL-6 and TNF produce fever at low doses (10 to 100 ng/kg).> Fever, characterized by an elevation of body temperature, usually by 1deg to 4degC, is one of the most prominent manifestations of the acute-phase response, especially when inflammation is caused by infection. Fever is produced in response to substances called pyrogens that act by stimulating prostaglandin (PG) synthesis in the vascular and perivascular cells of the hypothalamus. Bacterial products, such as lipopolysaccharide (LPS; called exogenous pyrogens), stimulate leukocytes to release cytokines such as IL-1 & TNF (called endogenous pyrogens) that increase the levels of cyclooxygenases that convert AA into prostaglandins. In the hypothalamus the PGs, especially PGE2, stimulate the production of neurotransmitters, which function to reset the temperature set point at a higher level. IL-4 is involved in immediate hypersensitivity reactions. | 1,851 | medmcqa_train |
A 45-year old male presented with severe respiratory distress. O/E he had pedal edema, bilateral crepitation on auscultation. He was admitted to emergency department and expired 2 days of admission. Lung biopsy done suggested the following. What is your diagnosis? | Ans. (d) Heart failure cellsThe lung biopsy shows intra-alveolar transudate granular pale pink material along with alveolar micro-hemorrhages & hemosiderin-laden macrophages ("heart failure" cells) seen in left-sided congestive heart failure. | 1,852 | medmcqa_train |
Murder is.............. offence. | Ans: (a) Cognizable, non-compoundable and non-bailableRef: The First Schedule, Classification of Offences, Indian Penal CodeCognizable offencesCognizable offences are more serious crimes wherein police can arrest the suspect without any warrant.Ex. rape, murder, ragging, dowry death etc.Compoundable offencesCompoundable offences are those offences where, the complainant (one who has filed the case, i.e., the victim), enter into a compromise and agrees to have the charges dropped against the accused.Bailable offencesBailable offences are less serious crimes wherein the suspect can be released from custody by furnishing a bond on bail. | 1,853 | medmcqa_train |
In stage III ovarian cancer patient with upper abdominal disease < 5cm, management of choice is | Management of Advanced stage diseaseIncludes stage III and IVDebulking surgery versus neoadjuvant chemotherapy followed by Postoperative chemotherapyPrimary cytoreduction surgery is the preferred in1. Retroperitoneal only disease preoperatively 2. Patients with stage IIIC or IV disease with good performance status who have < 5cm upper abdominal disease 3. Patients who are considered ideal for intraperitoneal chemotherapy if optimally reducedNeoadjuvant chemotherapy and interval debulking surgery is preferred in1. Patients with bulky upper abdominal peritoneal disease >5cm in diameter2. Medically unfit for surgeryPostoperative chemotherapySystemic chemotherapy with 6 cycles of carboplatin and paclitaxelPostoperative radiotherapy1. Not effective compared to chemotherapy2. Used clear cell or mucinous carcinomasMAINTENANCE THERAPY1. No role after the complete clinical response 2. Drugs used: 3month or 12month paclitaxel every 28days | 1,854 | medmcqa_train |
Which of the following diseases of the skin is the most
likely to be associated with partial anodontia? | Ectodermal dysplasia is characterized by congenital dysplasia of ectodermaL structures, manifested as hypohidrosis (partial or complete absence of sweat glands) hypotrichosis and hypodontia or partial anodontia.
Two types
Hypohidrotic (Christ-Siemens-Touraine syndrome) most common type and includes dental manifestations.
Hidrotic (Clouston syndrome)- no specific dental defects are seen. | 1,855 | medmcqa_train |
Early neonatal sepsis occurs within (hours) - | Ans. is 'd' i.e., 72 hours | 1,856 | medmcqa_train |
All the following are features of Tropical pulmonary eosinophilia except | In TPE Microfilaria are rapidly cleared from blood stream by the lungs . Thus, Microfilaria are sequestrated in the lungs . Ref Harrison 19th edition pg 1686-87 | 1,857 | medmcqa_train |
Feilization occurs in which pa of the fallopian tube | REF : DUTTA OBG 9TH ED | 1,858 | medmcqa_train |
Naturally occurring LA – | Cocaine is the only naturally occuring local anaesthetic, obtained from leaves of Erythroxylon coca. | 1,859 | medmcqa_train |
The dangerous paicle size causing pneumoconiosis varies from ? | Ans. is 'd' i.e., 1-5 m Pneumoconiosis o Pneumoconiosis is an occupational lung disease caused by the inhalation of dust. o The development of pneumoconiosis depends on - (i) The amount of dust retained in the lungs and airways. (ii) The size, shape of the paicles --> The most dangerous paicle ranges from Ito 5 m in diameter because they may reach the terminal small airway and air sacs and settle in their linings. (iii) Paicle solubility and physiochemical reactivity. (iv) Additional effects of other irritants (e.g. concomitant smoking). Impoant pneumoconiosis o Cool worker's pneumoconiosis (CWP) --> Coal dust o Silicosis (grinder's disease) --> Silica dust o Asbestosis --> Asbestos dust o Beryliosis --> Berylium dust o Siderosis --> Iron dust o Byssinosis --> Cotton dust | 1,860 | medmcqa_train |
An 6 cm simple ovarian cyst was identified in late pregnancy, what would be the best management ?: | Treatment of ovarian tumour in pregnancy depending on time of pregnancy: During pregnancy In an uncomplicated case, the best time of elective operation is b/w 14-18wks as chances of aboion are less and access to the pedicle is easy. But if the tumour is diagnosed beyond 36 weeks, tumour is removed early in puerperium. During labour If the tumour is above the presenting pa watchful expectancy is followed but if its impacted in pelvis, caesarian section should be done followed by removal of tumour in same setting. During puerperium The tumour should be removed as early in puerperium as possible because the longer is the wait for the surgery, there is more chance of having the tumor undergo a torsion | 1,861 | medmcqa_train |
Neovascularisation is seen in | A i.e. Central vein obstruction | 1,862 | medmcqa_train |
A person present with cribriform plate fracture with CSF rhinorrhea. What will be immediate treatment? | TREATMENT OF CSF RHINORRHEA Early cases of post-traumatic CSF rhinorrhoea can be managed by conservative measures such as bed rest, elevating the head of the bed, stool softeners, and avoidance of nose blowing, sneezing and straining. Prophylactic antibiotics can be used to prevent meningitis. Acetazolamide decreases CSF formation. These measures can be combined with lumbar drain if indicated. Surgical repair can be done by the following: 1. Neurosurgical intracranial approach. 2. Extradural approaches such as external ethmoidectomy for cribriform plate and ethmoid area, trans-septal sphenoidal approach for sphenoid and osteoplastic flap approach for frontal sinus leak. 3. Transnasal endoscopic approach. With the advent of endoscopic surgery for nose and sinuses, most of the leaks from the anterior cranial fossa and sphenoid sinus can be managed endoscopically with a success rate of 90% with first attempt. Principles of repair include: (a) Defining the sites of bony areas . It can be (i) Cribriform plate (ii) Lateral lamina close to anterior ethmoid aery (iii) Roof of ethmoid (iv) Frontal sinus leak (v) Sphenoid sinus (b) Preparation of graft site. (c) Underlay grafting of the fascia extradurally followed by placement of mucosa (as a free graft or pedicled flap) (d) If bony defect is larger than 2 cm, it is repaired with cailage (from nasal septum or auricular concha) followed by placement of mucosa. (e) Placement of surgicel and gelfoam fuher strengthens the area. This is followed by a high antibiotic smeared nasal pack. Sometimes fat from the thigh or abdomen is used to plug the defect in place of fascia graft. (f) Lumbar drain if CSF pressure is high. (g) Antibiotics CSF leak from frontal sinus often requires osteoplastic flap, operation and obliteration of the sinus with fat. Ref : ENT textbook by Dhingra 6th edition Pgno : 163-165 | 1,863 | medmcqa_train |
A 60 yr old female with I-1/0 8 blood transfusion in 2 years. Her Hb- 60g/L, TLC-5800, platelet-3.4 lakhs, MCV 60, RBC-2.1 lakhs/mm3. He is having hypochromic microcytic anemia. Which investigation is not needed aEUR' | Evaluation for pulmonary hemosiderosis Anemia with low RBC count, microcytotosis and hypochromia point towards iron deficiency anemia. - "Bone marrow biopsy" in iron deficiency anemia demonstrates erythroid hyperplasia and micronormoblasts reaction. - Prussian blue staining of the bone marrow aspirate and smear and biopsy demonstrate absent of iron stores. The patient continue to have iron deficiency anemia despite the blood transfusions. - This suggests chronic blood loss leading to iron deficiency anemia. - Chronic blood loss can result .from GIT (melena hematemesis) pathology. - G.I. Endoscopy is done in these cases to rule out GIT pathway. Chronic blood loss may also result from hemolytic anemias. - "Hemosiderin in urine" is found in patients with intravascular hemolysis. - Most of the autoimmune hemolytic anemias cause extravascular hemolysis (urine hemosiderin is absent). - Intravascular hemolysis occurs in paroxysmal nocturnal hemoglobinuria. This leads to chronic iron deficiency anemia. - Hemosiderin is present in urine due to intravascular hemolysis. Urinary hemosiderin can differentiate b/w PNH and other autoimmune hemolytic anemias. Idiopathic pulmonary hemosiderosis - Idiopathic pulmonary hemosiderosis is a rare condition chaeracterized by repeated episodes of intraalveolar bleeding that lead to abnormal accumulation of iron as hemosiderin in alveolar macrophage and subsequent development of pulmonary fibrosis and anemia. - The clinical features are characterized by a triad of - Hemoptysis - Moderate to severe iron deficiency anemia. - Diffuse radiological abnormality Diagnosis in these cases is confirmed by - Iron stains of sputum aspiration of and biopsy. The patient in the question does not give any features that are suggestive of idiopathic pulmonary hemosiderosis. He does not require evaluation for pulmonary hemosiderosis. | 1,864 | medmcqa_train |
Nitrates are not used in - | Ans. is 'c' i.e., Renal colic Uses of nitrates Angina pectoris MI CHF and acute LVF --> nitroglycerine i.v. can be used Act by decreasing preload (LV filling pressure). Biliary colic and esophageal spasm (achalasia cardia) Acute coronary syndrome (unstable angina and non-ST segment elevation Ml). Cyanide poisoning | 1,865 | medmcqa_train |
Natural uncoupler is- | Ans. is 'a' i.e., Thermogenin o Amongst the given options, a, b and c are uncouplers. o However, only thermogenin, among these three is a natural (physiological) uncoupler. Uncouples o As the name suggests, these compounds block the coupling of oxidation with phosphorylation. These compounds allow the transfer or reducing equivalents in respirators chain but prevent the phosphorylation of ADP to ATPy by uncoupling the linkage between ETC and phosphorylation. Thus the energy instead of being trapped by phosphorylation is dissipated as heat. Uncouplers may be NaturalThermogenin, thyroxine Synthetic 2, 4-dinitrophenol (2, 4-DNP), 2, 4-dinitrocresol (2, 4-DNC), and CCCP (chlorocarbonylcyanidephenyl hydrazone). | 1,866 | medmcqa_train |
All of the following statements about hairy cell leukemia are true except: | Hairy cell leukemia is a type of B-cell leukemia. Clinical feature: Massive splenomegaly Increase chances of infections DIAGNOSIS 1. BLOOD Pancytopenia Phase contrast microscopy- Hairy projections Staining- TRAP 2. Immunophenotyping CD11 + CD25+ CD103 + Annexin A1 + ( Best marker) 3.BM examination BM aspiration - Dry tap BM biopsy- Honey comb appearance - Fried egg appearance | 1,867 | medmcqa_train |
A decrease in which of the following parameters will shift the O2 dissociation curve to the right? | Left shift (high affinity for O2) Right shift (low affinity for O2) Temperature decrease increase 2.3-DPG decrease increase p(CO2) decrease increase p(CO) increase decrease pH (Bohr effect) increase (alkalosis) decrease (acidosis) Type of haemoglobin Fetal haemoglobin Adult haemoglobin | 1,868 | medmcqa_train |
Kussumauls breathing | Rapid,deep(Kussmaul) breathing usually implies metabolic acidosis but may also occur with pontomesencephalic lesions. Ref:Harrison's medicine -18th edition,page no:2251. | 1,869 | medmcqa_train |
Dislocation of lens is seen in: | C i.e. Homocystinuria | 1,870 | medmcqa_train |
Which of the following is not a prodrug- | Ans. is 'd' i.e., Diazepam Prodrug o Few drugs are inactive as such and need conversion in the body to one or more active metabolites. Such a drug is called a prodrug. Prodrug Levodopa Enalapril - Methyldopa Chloralhydrate Dipivefrine Oxcarbazepine Prednisone Bacampicillin Sulfasalazine Cyclophosphamide Mercaptopurine Fluorouracil Sulindac Azathioprine Coisone Benorilate Proguanil Zidovudin Terfenadine Prontosil | 1,871 | medmcqa_train |
Cause of "bloody" vomitus in a neonate | Meckel&;s dieiculum may cause severe hemorrhage due to peptic ulceration. The blood is usually passed per rectum and is maroon in colour. it may cause bloody vomitus. Ref : BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,24 TH EDITION PG NO:1159 | 1,872 | medmcqa_train |
Lancinating pain around the tonsils during eating is indicative of | (B) Glossopharyngeal neuralgia # Nerve Supply of Tonsils:* Lesser palatine branches of sphenopalatine ganglion (CN V) and glossopharyngeal nerve provide sensory nerve supply. | 1,873 | medmcqa_train |
Bird of Prey" sign is seen in the radiographic barium examination of: | Sigmoid volvulus | 1,874 | medmcqa_train |
A 30-year-old woman sustained a traumatic blow to her right breast. Initially, there was a 3-cm contusion beneath the skin that resolved within 3 weeks, but she then felt a firm, painless lump that persisted below the site of the bruise 1 month later. What is the most likely diagnosis for this lump? | Fat necrosis is typically caused by trauma to the breast. The damaged, necrotic fat is phagocytosed by macrophages, which become lipid-laden. The lesion resolves as a collagenous scar within weeks to months. The firm scar can mammographically and grossly resemble a carcinoma. An abscess may form a palpable but painful mass lesion, and often from Staphylococcus aureus infection when localized. A fibroadenoma is a neoplasm, and tumors are not induced by trauma. Inflammatory carcinoma refers to dermal lymphatic invasion by an underlying breast carcinoma, giving a rough red-to-orange appearance to the skin. Sclerosing adenosis is a feature of fibrocystic changes, a common cause of nontraumatic breast lumps. | 1,875 | medmcqa_train |
The basis of Korotkoff sound is | The sounds of Korotkoff are produced by turbulent flow in the brachial aery. When the aery is narrowed by the cuff, the velocity of flow through the constriction exceeds the critical velocity and turbulent flow results. | 1,876 | medmcqa_train |
Aganglionic segment is encountered in which part of colon in case of Hirchsprung's disease - | Ans. is 'a' i.e., Distal to dilated segment "The major feature of Hirschsprung ds is an absence of ganglion cells in the neural plexus of the intestinal wall, together with hypertrophy of nerve trunks. The absence of ganglion cells gives rise to a contracted non-peristaltic segment with a dilated hypertrophied segment of normal colon above it ___ Bailey 24/e | 1,877 | medmcqa_train |
Estimation of the following hormones is useful while investigating a case of gynecomastia except- | Gynecomastia refers to enlargement of the male breast. It is caused by excess estrogen action and is usually the result of an increased estrogen-to-androgen ratio. True gynecomastia is associated with glandular breast tissue that is >4 cm in diameter and often tender. Evaluation of a case of gynecomastia should include a careful drug history, measurement and examination of the testes, assessment of virilization, evaluation of liver function, and hormonal measurements including testosterone, estradiol, and androstenedione, LH, and hCG. Reference : page 2366 Harrison's Principles of Internal Medicine 19th edition . | 1,878 | medmcqa_train |
Light requirement in watch manufacturing company is - | The recommended illumination (IES Code)in watch manufacturing company is 2000-3000 lux Rule of thumb is that the illumination must be 30 times higher the level at which ask can be just done. Parks textbook of preventive and social medicine.K Park. Edition 23.page no:741.table2. | 1,879 | medmcqa_train |
Drug with membrane stabilizing activity is? | ANSWER: (D) OxprenololREF: KDT 6 th edition page 140Membrane stabilizing activity (in propanolol, oxprenolol, acebutolol). This activity is claimed to contribute to the antiarrhythmic action, but appears to be significant only at high doses | 1,880 | medmcqa_train |
Which of the following statement is/are true of all paramyxoviruses -a) They contain a single standed RNA genome of negative polarityb) Envelope is derived from the host cells plasma membranec) They have a cytoplasmic site of replicationd) They enter the body by the respiratory route | Paramyxoviruses are negative sense single stranded Enveloped RNA viruses
Site of riboncleoprotein synthesis is cytoplasm and envelop is derived from host cell plasma membrane
They are important pathogens of infants and children and responsible for major part of acute respiratory infections and Infection is acquired by respiratory route | 1,881 | medmcqa_train |
Venous congestion of liver affects ? | Ans. is 'c' i.e., Centrilobular zoneNutmeg liver or chronic passive congestion or Congestive hepatopathy :?Chronic passive congestion is liver dysfunction due to venous congestion, usually right sided cardiac dysfunction (right sided cardiac decompenstion).When there is right sided cardiac decompensation, the blood being dammed back in the IVC and hepatic veins. o This results in increase venous pressure and passive congestion of centrilobular region and hemorrhagic necrosis of centrilobular region.The liver takes on a variegated mottled appearance, reflecting hemorrhage and necrosis in the centrilobular region, known as 'nutmeg liver'. | 1,882 | medmcqa_train |
In alcohol withdrawal which is not seen - | Blackout occurs during acute intoxication (not during withdrawal). All the other options can occur in alcohol withdrawal. | 1,883 | medmcqa_train |
A triphasic withdrawal syndrome follows an abrupt discontinuation of ______ use. | Cocaine use produces a mild physical, but a strong psychic dependence. A triphasic withdrawal syndrome follows an abrupt discontinuation of chronic cocaine use. Signs and symptoms : In the early phase (crash phase, 9 h to 4 days), there is anorexia, depression, agitation, excessive craving, hypersomnia, fatigue and exhaustion which is followed by normal mood, anxiety and anhedonia (next 4-7 days). In third phase (extinction phase, after 7-10 days), there are no withdrawal symptoms, but increased vulnerability to relapse. Treatment : Bromocriptine and amantadine are useful in reducing cocaine craving. Gabapentin is being used in adult addicts. | 1,884 | medmcqa_train |
Lamivudine is given when? | Lamivudine belongs to the set of antiviral agents effective against hepatitis B virus infection. Given case repos on liver injuries after ceain antiviral agent treatments, this study examined the effects of lamivudine on alanine aminotransferase (ALT) and total bilirubin (TB) using a medical system database Ref Harrison20th edition pg 2675 Lamivudine has been used for treatment of chronic hepatitis B at a lower dose than for treatment of HIV/AIDS. It improves the seroconversion of e-antigen positive hepatitis B and also improves histology staging of the liver. Long-term use of lamivudine leads to emergence of a resistant hepatitis B virus (YMDD) mutant. Despite this, lamivudine is still used widely as it is well tolerated Lamivudine, commonly called 3TC, is an antiretroviral medication used to prevent and treat HIV/AIDS. It is also used to treat chronic hepatitis B when other options are not possible.It is effective against both HIV-1 and HIV-2.It is typically used in combination with other antiretrovirals such as zidovudine and abacavir. Lamivudine may be included as pa of post-exposure prevention in those who have been potentially exposed to HIV. Lamivudine is taken by mouth as a liquid or tablet HIV, high level resistance is associated with the M184V/I mutation in the reverse transcriptase gene as repoed by Raymond Schinazi's group at Emory University. GlaxoSmithKline claimed that the M184V mutation reduces "viral fitness", because of the finding that continued lamivudine treatment causes the HIV viral load to rebound but at a much lower level, and that withdrawal of lamivudine results in a higher viral load rebound with rapid loss of the M184V mutation; GSK therefore argued that there may be benefit in continuing lamivudine treatment even in the presence of high level resistance, because the resistant virus is "less fit". The COLATE study has suggested that there is no benefit to continuing lamivudine treatment in patients with lamivudine resistance. A better explanation of the data is that lamivudine continues to have a paial anti-viral effect even in the presence of the M184V mutation. In hepatitis B, lamivudine resistance was first described in the YMDD (tyrosine-methionine-aspaate-aspaate) locus of the HBV reverse transcriptase gene. The HBV reverse transcriptase gene is 344 amino acids long and occupies codons 349 to 692 on the viral genome. The most commonly encountered resistance mutations are M204V/I/S. The change in amino acid sequence from YMDD to YIDD results in a 3.2 fold reduction in the error rate of the reverse transcriptase, which correlates with a significant growth disadvantage of the virus. Other resistance mutations are L80V/I, V173L and L180M Ref Davidson 23rd edition pg 768 | 1,885 | medmcqa_train |
In PML, all of the following are seen except : | Answer is C (CD15 / 34 both seen in same cell) Acute promyelocytic Leukaemia (PML : FAB M3) * This is a type of Acute Myeloid Leukaemia (AML) and has been classified as the M3 category according to the FAB morphological classification.9 * It constitutes 5 - 10% of all AML (Robbin's / Ghai) Pathological characteristic of PML * It is characterized by the chromosomal translocation 1(15;17)Q - CMDT * t(1 5;17) translocation produces a fusion gene ( PML-RAR }involving the Retinoic Acid Receptor gene and Promyelocytic Leukemia (PML) gene. This PML - RaR fusion protein tends to suppress gene transcription and blocks differentiation of cells. This block can be overcome with pharmacological doses of retinoic acid (Harrrison). * Most cells are hypergranularQ promyelocytes often with many Auer rods per cell. Presentation characteristic / Specific features of PML * Patients of PML are younger (median age 35 - 40 years) - Robbin's * Incidence of Disseminated Intravascular Coagulation (DIVC) is high in patient with PML. -Robbin's DIC may occur with any subgroup of AML but is especially common in acute PML (M3)-Ghai Treatment specific to PML subject All-Trans Retinoic Acid (ATRA/Tretinoin) * The treatment of patient with PML has been dramatically improved by the use of All - Trans - Retinoic acid. This agent is an analog of vitamin A that leads to terminal differentiation of occult promyelocytic leukemia cells. - CMDT * Remission in PML is induced by All - Trans-Retinoic acid as a single agent -Ghai Arsenic Trioxide Arsenic Trioxide produces meaningful response in upto 85% of patients refractory to tretinoin | 1,886 | medmcqa_train |
All the following are true of Paget disease Except | Paget disease is a disorder of unknown origin, which occurs in older people and involves either a single bone or several bones. It is not associated with systemic metabolic disturbances, and some pas of the skeleton are always spared. The bones show marked thickening, owing to excessive osteoblastic and reduced osteoclastic activity. Although only a few persons suffering from Paget disease develop sarcoma of bone, in adults the disease remains an impoant predisposing condition for this tumor in long bones. The skull and veebrae are viually never the sites of secondary osteogenic sarcomas. Ref: Maheshwari 6e pg 317. | 1,887 | medmcqa_train |
True about keratoconus are all of the following except: September 2005 | Ans. B: It manifests just after bih Keratoconus is frequently due to a congenital weakness of the cornea, though it manifests itself after pubey. However it can occur secondarily following trauma or Down's syndrome. Keratoconus is divided into mild, moderate, and advanced. Mild keratoconus - External and corneal signs are often absent or minimal. - A history of multiple inadequate spectacle corrections of one or both eyes may be noted and may include oblique astigmatism on refraction as well as moderate-to-high myopia. - Irregularly astigmatic keratometry values (egg-shaped), not necessarily on the steep side of normal (approximately 45 diopters (D)), are consistent with diagnosis. Diagnosis can be confirmed with computer-assisted videokeratography, which may reveal corneal inferior steepening (approximately 80% of keratoconus cases), central corneal astigmatic steepening (approximately 15% of keratoconus cases), or even bilateral temporal steepening (extremely rare). Diagnosis may also be aided by applying a diagnostic rigid contact lens with its base curve equal to the flat keratometry value. One observes a typical nipple pattern by use of sodium fluorescein dye in the underlying tear film. Moderate keratoconus One or more corneal signs of keratoconus are often present. Enhanced appearance of the corneal nerves is noted. Approximately 40% of eyes in patients with moderate keratoconus develop Vogt striae (fine-stress lines) in the deep stroma. Approximately 50% develop the deposition of iron in the basal epithelial cells in a (often paial) ring shape at the base of the conical protrusion called the Fleischer ring. Approximately 20% develop corneal scarring. Superficial corneal scarring can be fibular, nebular, or nodular. Deep stromal scarring may occur, perhaps representing resolved mini-hydrops events. Some patients show scarring at the level of the Descemet membrane (posterior limiting lamina), consistent in appearance with posterior polymorphous corneal dystrophy. Paraxial (usually inferior to the pupil) stromal thinning may be appreciated. Keratometry values typically increase to 45-52 D. Distoion of the retinoscopy and direct ophthalmoscope red pupillary reflex may allow observation of "scissoring" or an inferior distoion termed the oil drop sign. The Munson sign is noted when, upon downgaze, a "V" shape is noted in the cornea's profile against the lower lid margin, an accentuation of the conical shape of the modest to advanced keratoconus cornea. Advanced keratoconus This often results in keratometry values greater than 52 D and enhancement of all corneal signs, symptoms, and visual loss/distoion. Vogt striae are seen in approximately 60% of eyes, and Fleischer ring and/or scarring are seen in approximately 70% of eyes. Acute corneal hydrops can occur. Treatment: In the early stages, vision may be improved with spectacles but contact lens are more beneficial as they eliminate the irregular corneal curvature. If the disease progresses and the cone hydrated, the most satisfactory treatment is corneal transplantation. | 1,888 | medmcqa_train |
Vaccines prepared by embryonated hen's egg are: | Ans. (b) Rabies Vaccine that grows in embryonated eggs: Influenza Yellow fever (17 D strain) Rabies (Flury strain) Mumps Varicella vaccine growns in chick embryo fibroblast culture. Rubella - RA 27/3 vaccine produced in human diploid fibroblast. No eggs culture vaccine of measles are produced. All are tissue culture vaccine, either chick embryo or human diploid cell line. | 1,889 | medmcqa_train |
How does the distal nephron differ functionally from the proximal tubule? | Proximal and distal convoluted tubule The site of action of acetazolamide is the proximal convoluted tubule and the site of action of the thiazides is the distal convoluted tubule. The distal nephron has a negative luminal potential because it is poorly permeable to negatively charged ions. Therefore, when Na+ is reabsorbed, negatively charged ions, primarily Cl-, lag behind, producing a negative intraluminal potential. Although a similar situation occurs in the proximal tubule, the proximal tubule has a higher permeability to Cl- and, therefore, does not develop as large a negative intraluminal potential. The distal nephron is less permeable to hydrogen than the proximal tubule. Aldosterone increases Na+ reabsorption from the distal nephron but has no effect on the proximal tubule. K+ is reabsorbed from the proximal tubule and secreted by the distal nephron. Although the amount of H+ excreted each day is determined by the amount of H+ secreted into the distal nephron, Proximal tubule secretes much more H+ than the distal nephron. However, almost all of the H+ secreted in the proximal tubule is reabsorbed in association with the reabsorption of HCO3- | 1,890 | medmcqa_train |
Which is the commonest abdominal mass in neonate - | Ans. is 'c' i.e., Neuroblastoma The commonest intra-abdominal tumor in first two years of life Neuroblastoma The commonest intra-abdominal tumor between 2"d to 5th year of life - Wihn's tumor The commonest intra-abdominal tumor in children (no age specification) Neuroblastoma (Wilm's tumor is the second most common abdominal tumor in children) Remember: The commonest cause of abdominal mass in Newborn is : Multiple dysplastic kidneys (if neoplasm or tumor has not been mentioned when asking for the commonest intra-abdominal mass, the answer will be multiple dysplastic kidneys) | 1,891 | medmcqa_train |
A patient gets tingling when his bed light is flashed suddenly. Which type of hallucination is this : | "Example of reflex hallucination : when the light flashes the patient gets tingling sensation". | 1,892 | medmcqa_train |
Which of the following amino acids is most responsible for the buffering capacity of hemoglobin and other proteins? | Remember that a buffer is most effective when its pKa is within the pH range of the surrounding medium. Histidine is the only amino acid with good buffering capacity at physiologic pH. The imidazole side chain of histidine has a pKa around 6.0 and can reversibly donate and accept protons at physiologic pH. Arginine and lysine are basic amino acids with pKa's of 12.5 and 10.5, respectively; at physiologic pH both will behave as bases and accept protons. Aspaic acid and glutamic acid are acidic amino acids with pKa's of approximately 4; at physiologic pH they will behave as acids and donate protons. Ref: Rodwell V.W. (2011). Chapter 30. Conversion of Amino Acids to Specialized Products. 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. | 1,893 | medmcqa_train |
Which of the following is NOT associated with elevation Right hemi-diaphragm: | Ans. (c) CholecystitisCholecystitis is inflammation of gall bladder wall.Radiological evaluation does not show elevation of right hemidiaphragm in these cases.AMOEBIC LIVER ABSCESS* Chest radiographs are abnormal in the majority of patients with amebic hepatic abscesses. Findings include elevation of the right hemi-diaphragm, right pleural effusion, atelectasis in the region of the base of the right lung, and a right pleural effusion.PYOGENIC LIVER ABSCESS* Chest radiographs are abnormal in half of patients with pyogenic liver abscesses, reflecting an underlying inflammatory process. The most frequent findings include a right pleural effusion, elevation of the right hemi-diaphragm, and atelectasisIn case of subdiaphragmatic abscess also, there is elevation of right hemi-diaphragm. | 1,894 | medmcqa_train |
Mydriasis is/are caused by: | D i.e. Atropine Pinpoint pupils are seen in - 'Car Chlor Or Mor' i.e. Carbolic acid, Chloral hydrate, Organophosphorus, Morphine (opiate)Q and 'New Horn' i.e. neurosyphilis/tabes dorsalis (spinal miosis or small, irregular Argyll Robeson pupil) and Horner's syndrome. Atropine and cocaine cause mydriasisQ Barbiturate poisoning 1/t constricted & reacting pupils which dilate during terminal asphyxiaQ | 1,895 | medmcqa_train |
Which of the following techniques use piezoelectric crystals - | Ans. is 'a' i.e., Ultrasonography o Ultrasonography is based on piezoelectric effect.o MRI is based on gyeromagneticproperty of proton (H+).Ultrasonography (USG) / Ultrasoundo USG is performed with the pulse-echo technique. By the virtue of piezoelectric effect in the ultrasound probe (or transducer), electric energy is converted to sound energy that is transmitted into patient's tissues. The US transducer (probe) then becomes a receiver, detecting echo of sound energy reflected from tissue.o The US transducer (probe) then becomes a receiver, detecting echo of sound energy reflected from tissue.o The ultrasound transducer uses the principle or property of piezoelectricity.o Quartz is a naturally occuring peizoelectric material.o Currently, Lead Zirconate titanate (PZT) is the most widely used material in the ultrasound tranducer/probes | 1,896 | medmcqa_train |
A patient with hypeension is also having aoic dissection. Anti-hypeensive agent of choice is: September 2008 | Ans. A: Sodium Nitroprusside Antihypeensive therapy in acute aoic dissection aims specifically to lessen pulsatile load or aoic stress, in order to retard the propagation of the dissection and prevent aoic rupture. The goals of treatment are to prevent myocardial ischemia, decrease left ventricular afterload, decrease myocardial oxygen consumption, and prevent rupture and bleeding from suture lines Nitroprusside is a potent direct aerial and venous dilator, acting through release of nitric oxide. It has a rapid onset of action, and a shoer half-life and thus is given in the form of continuous infusion. The hypotensive effects of nitroprusside can be unpredictable because it simultaneously causes potent venodilatation and peripheral aerial vasodilatation. This is especially the case for patients with severe left ventricular hyperophy and preload-dependent diastolic dysfunction. It has been shown to cause coronary steal; it can cause a significant reflex tachycardia, and it can decrease oxygen circulation. It is photosensitive, so it requires special handling. Its most serious adverse effect is in the form of cyanide toxicity, which occurs due to accumulation of its metabolites thiocyanate/ cyanide and its clinical presentation may vary leading to difficulty in diagnosis. Thus, it is recommended that this drug be used only when other intravenous antihypeensive agents are not available | 1,897 | medmcqa_train |
The parietal peritoneum covering the inferior surface of the diaphragm transits its sensory information via the phrenic nerve. In the case of peritonitis in the parietal peritoneum on the inferior surface of the diaphragm, pain may be referred through which of the following nerves? | Ans. D. Supraclavicular nervesThe phrenic nerve consists of contributions from spinal nerve levels C3 to 5.Therefore, when sensory information comes from the parietal peritoneum on the inferior diaphragmatic surface, it may refer through spinal nerves at the same levels.a. Supraclavicular nerve shares levels with the C3 and C4 levels.b. The greater and lesser occipital nerves both originate at the C2 level.c. Great auricular nerve root value is C2, C3 | 1,898 | medmcqa_train |
Operation of choice in GERD is | Operations for GORD are based on the creation of an intra-abdominal segment of oesophagus, crural repair and some form of wrap of the upper stomach (fundoplication) around the intra-abdominal oesophagus.Nissen fundoplication is one of the commoner procedures done.Ref: Bailey and Love 27e pg: 1078 | 1,899 | medmcqa_train |
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