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Occlusion of the LAD will lead to infarction of which area - | Occlusion of proximal LAD can result in large anterior wall infarction. If it is distal LAD, then anteroapical or anteroseptal infarction can occur. | 2,500 | medmcqa_train |
The slogan for WHO 2005 – | Year → World Health Day (WHD) Theme
2004 → Road safety is no accident
2005 → Make every mother and child count
2006 → Working together for health
2007 → International health security: Invest in health, build a safer future
2008 → Protecting health from climate change
2009 → Health facilities in emergencies | 2,501 | medmcqa_train |
Investigation of choice for esophageal rupture is? | ANSWER: (D) Water soluble low molecular weight contrast swallowREF: with textUse of non ionic water soluble contrast medium instead of barium is warranted when there is any risk of aspiration or esophageal leak. (Ref: Gastrointestinal Imaging: The Requisites By Giles W. Boland 4th ed page 2)Careful endoscopic assessment at the end of any procedure combined with a chest X-ray will identify many cases of perforation immediately. If not recognised immediately, then early and late suspected perforations should be assessed by a water-soluble contrast swallow. If this is negative, a dilute barium swallow should be considered. A CT scan can be used to replace a contrast swallow or as an adjunct to accurately delineate specific fluid collections. (Bailey 25th ed page 1015)Diagnosis of an esophageal perforation may be made radiographically. A chest roentgenogram may demonstrate a hydropneumothorax. A contrast esophagram is done using barium for a suspected thoracic perforation and Gastrografin for an abdominal perforation. Barium is inert in the chest but causes peritonitis in the abdomen, whereas aspirated Gastrografin can cause life-threatening pneumonitis. A surgical endoscopy needs to be performed if the esophagram is negative or if operative intervention is planned. (Ref: Sabiston 18th ed chapter 41) | 2,502 | medmcqa_train |
The incidence of mental illness is the maximum if the causal factors affect a paicular period - | The incidence of mental illness is the maximum if the causal factors affect a paicular period of first five years of life crucial points in the life cycle of human being which are impoant from the view of mental health are prenatal period, first five years of life, school child , adolescence, old age. ref ;(page no;832)23rd edition of PARK&;s textbook of Preventive and Social medicine | 2,503 | medmcqa_train |
Brain dead individuals have all of the following features EXCEPT (* NIMHANS March-2017 Post-MBBS, NIMHANS - Feb. 2008) | (C) Only pain is preserved# BRAIN-DEAD> individual has no clinical evidence of brain function upon physical examination.> No response to pain and no cranial nerve reflexes.> Reflexes include pupillary response (fixed pupils), oculocephalic reflex, corneal reflex, no response to the caloric reflex test, and no spontaneous respirations.> In comatose patients, once it has been determined that the cervical spine is intact, a test of the vestibulo-ocular reflex (VOR), also known as the oculocephalic reflex or doll's eye reflex can be performed by turning the head to one side.> Positive response occurs when the eyes rotate to the opposite side to the direction of head rotation, thus indicating that the brain- stem (CN3,6,8) is intact.> Vertical oculo-vestibular eye responses can be assessed by irrigating both ears simultaneously.> If the brainstem is intact, cold water causes the eyes to deviate downwards and warm water causes the eyes to deviate upwards. | 2,504 | medmcqa_train |
Miss folded proteins might be produced due to defect of: | Rough endoplasmic reticulum is associated with protein synthesis, protein folding and miss folded protein degradation. Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:10,11,12 | 2,505 | medmcqa_train |
APGAR score include A/E | Apgar score is an objective method of evaluating the newborn&;s condition. It includes Hea rate, Respiratory effo, Muscle tone, Reflex irritability and Color. It is generally performed at 1min and again at 5 min after bih. Reference : page 126 Ghai Essential Pediatrics 8th edition | 2,506 | medmcqa_train |
Bloom Richardson staging is for? | Ans. (b) Breast cancer(Ref Internet source)Bloom and Richardson grading for cancer breast is based on* Tubules formation* Nuclear pleomorphisms* Mitotic counts | 2,507 | medmcqa_train |
Point B in treatment of Ca cervix corresponds to | B i.e. Obturator Lymph node | 2,508 | medmcqa_train |
Which is the MOST appropriate gestational age for performing amniocentesis? | Amniocentesis is ideally performed between 14-16weeks of gestation. Early amniocentesis can be carried out at 12-14 weeks under ultrasonographic guidance. The fetal cells so obtained are subjected for cytogenetic analysis. Fetal fibroblasts and fluid for biochemistry are used for study. Chorionic villus sampling : is carried out transcervically between 10 - 12 weeks and transabdominally from 10 weeks to term. Trophoblast cells are used for study. Cordocentesis: Is done between 18-20 weeks of gestation. Fetal WBCs are used for study. Ref: Textbook of Obstetrics By DC Dutta 6th edn page 107-8. | 2,509 | medmcqa_train |
In a 5 year old child, instead of the physiological splitting of second hea sound, expected only during inspiration, a wide and a fixed split of S2 is heard, both during inspiration, as well as expiration. Condition associated with this is? | WIDE FIXED SPLIT OF S2 IS SEEN IN: ASD Right Bundle Branch Block TAPVC WIDE VARIABLE SPITTING OF S2 IS SEEN IN: Pulmonic stenosis VSD Mitral regurgitation | 2,510 | medmcqa_train |
Deficiency of purine nucleoside phosphorylase causes | A combined T cell and B cell immunodeficiency that is a rare autosomal recessive metabolic disorder that has material basis in mutation in the PNP gene and characterized mainly by decreased T-cell function. Ref-Sathyanarayana 4/e | 2,511 | medmcqa_train |
Cataracta brunescens result due to deposition of | Nuclear senile cataract: The usual degenerative changes are intensification of the age- related nuclear sclerosis associated with dehydration and compaction of the nucleus resulting in a hard cataract. It is accompanied by a significant increase in water insoluble proteins. However, the total protein content and distribution of cations remain normal. There may or may not be associated deposition of pigment urochrome and/or melanin derived from the amino acids in the lens. The nucleus may become diffusely cloudy (greyish) or tinted (yellow to black) due to deposition of pigments. In practice, the commonly observed pigmented nuclear cataracts are either amber, brown (cataracta brunescens) or black (cataracta nigra) and rarely reddish (cataracta rubra) in colour. Ref:- A K Khurana; pg num:- 176,178 | 2,512 | medmcqa_train |
The least extrapyramidal side effects are seen with which of the following phenothiazine? | Side effects of impoant CNS drugs Midazolam Ataxia, Blackouts in elderlyTolcapone Hepatotoxic Phenytoin Hirsuitism , Gingival hyperplasia , Osteomalacia , Teratogen , Megaloblastic anemia , Ataxia, Lymphadenopathy, Hyperglycemia , Arrhythmias, Vitamin K deficiency Valproate Irreversible hepatic necrosis in older children, Acute pancreatitis Zonisamide,, Topiramate Renal stones VigabatrineIrreversible visual field defectsFelbamate Aplastic anemia Thioridazine Male sexual dysfunction, Retinal damage, Least extra pyramidal symptomsClozapine Agranulocytosis , Myocarditis Risperidone Extra pyramidal symptoms HaloperidolExtra pyramidal symptoms , Akathisia Olanzapine Risk of stroke and death Ziprasidone , Pimozide QT prolongation Quetiapine Cataract Iloperidone Ohostatic hypotension Lithium in expectant mothers Ebstein's anomalyFormic acid Retinal damage Opioids Tolerance & addiction (Refer: Rang and Dale's Clinical Pharmacology, 7th edition, pg no: 557-559) | 2,513 | medmcqa_train |
Which is not a variable of MDRD (Modification of Diet in Renal Disease) formula? | TEST : 1. CKD - EPI - cystatin C method (BEST) ; Cystatin - C is produced by nucleated cells 2. Modification of diet in renal disease formula GFR= 186.3 x (serum creatinine level ( mg/dl))-1.154 x age-0.203 x ( 0.742 if female ) x (1.21 if black) 3. Cockroft Gault formula 4. Creatinine clearance 5. Inulin clearance | 2,514 | medmcqa_train |
Feature of post ovulatory endometrium on ultrasound is: | Ans. is d, i.e. Prominent posterior enhancementRef: Transvaginal Ultrasound by Melvin G. Dodson 1st/ed, p86This is a very important QuestionIMPORTANT: The appearances of endometrium on transvaginal ultrasound during different stages of normal menstrual cycle has been summarized here.A. Just after menstruation (days 3-7)Single hyperechoic thin lines (central endometrial echo)B. At the time of ovulationHalo presentRelatively thin anterior posterior endometrial thickness (<6mm)No posterior enhancementQThree line sign.Q/Trilaminar appearanceC. Luteal phaseMaximum endometrial thicknessHyperechoic endometriumLoss of haloQLoss of three line signQProminent posterior enhancementQ | 2,515 | medmcqa_train |
Kaposi sarcoma is commonly seen in ? | " It occurs predominantly on the skin and can involve viually any organ, perhaps except the brain. The initially described form, now known as classic KS, predominantly involves the lower extremities of elderly men. KS is now the most common tumor seen in HIV-infected patients Ref : Bailey and love surgery text book 27th Ed. | 2,516 | medmcqa_train |
Tension band wiring is indicated in fracture of which of the following ? | Tension band wiring is indicated in the treatment of two types of olecranon fracture. First type is a clean break with separation of the fragments, and second type is comminuted fracture of the olecranon with displced fragments. A crack in the olecranon without displacement is treated by immobilising the elbow in an above elbow plaster slab in 30 degrees of flexion. | 2,517 | medmcqa_train |
Giant papillary conjunctivitis is seen | It is the inflammation of conjunctiva with formation of very large sized papillae. Etiology :It is a localised allergic response to a physically rough or deposited surface (contact lens, prosthesis, left out nylon sutures). Probably it is a sensitivity reaction to components of the plastic leached out by the action of tears. ref: A K KHURANA OPHTALMOLOGY,E4, Page-77 | 2,518 | medmcqa_train |
Best investigation for pericardial effusion is - | Ans. is 'd' i.e., Echocardiography Investigations o Investiation of choice to identify individual cardiac chamber enlargement - 2D-echocardiography. o Inv estigation of choice for pericardial effusion - 2D-echocardiography. o Investigation of choice for valvular heart disease - 2D-echocardiography. o Investigation of choice for cardiomyopathy -2D-echocardiography. o Investigation of choice for cardiac temponade - 2D-echocardiography. o Investigation of choice for aortic dissection in stable patient - MRl. o Investigation of choice for aortic dissection in unstable patient - TEE. o Investigation of choice for ventricular function and size - Echocardiography o Investigation of choice for congenital heart disease - Echocardiography, o Investigation of choice for pericardial defect - MRI. o Investigation of choice for radiotherapy/chemotherapy induced myocardial damage - Endomyocardial biopsy o Investigation of choice for myocardial perfusion and viability (reversible ischemia) - Nuclear cardiac imaging (thallium scan or Technetium scan) o Most sensitive investigation for air embolism - Trans-esophageal echocardiography. o Second most sensitive investigation for air embolism - PrecordiaJ Doppler o Best x-ray view for right atrial enlargement - Left anterior oblique view, o Best x-ray view for left atrial enlargement - Right anterior oblique view with barium swallow | 2,519 | medmcqa_train |
Histopathology showing large cells with plant like apperance with perinuclear halo is seen in which type of renal cell carcinoma ? | Ans. is 'd' i.e., ChromophobicHistopathological findings of perinuclear halo and plant cell appearance are seen in chromophobe cell carcinoma ofRCC.o Electron microscopic finding consisting of numerous 150-300 nm microvesicles is the single most distinctive and defining feature of chromophobe cell ca. | 2,520 | medmcqa_train |
Selective alpha 2 agoinst used in glaucoma - | Brimonidine (0.2% : 2 times/day). It is a selective alpha-2-adrenergic agonist and lowers IOP by decreasing aqueous production. Because of increased allergic reactions and tachyphylaxis rates it is not considered the drug of first choice in POAG. It is used as second drug of choice and also for combination therapy with other drugs Ref.AK Khurana 4th edition page no 223 | 2,521 | medmcqa_train |
The rate of formation of CSF per day: | 5000 c.c. | 2,522 | medmcqa_train |
Which one of the following surgical procedures is considered to have a clean-contaminated wound ? | Ans. is 'a' i.e., Elective open cholecystectomy for cholelithiasis | 2,523 | medmcqa_train |
A 63-year-old man with insulin-dependent diabetes develops a black, crusting lesion in the nose and left maxillary sinus. Biopsy reveals nonseptate hyphae, which confirms the diagnosis of what? SELECT ONE. | Mucor is an opportunistic mold that causes mucormycosis. At least 50% of reported cases are associated with uncontrolled diabetes, and many of the remaining patients are immuno- suppressed. It appears as black crusting in the nose and sinuses and spreads rapidly to involve the cerebrum. Biopsy reveals nonseptate hyphae, which confirms the diagnosis. Treatment is directed toward control for diabetic ketoacidosis and use of amphotericin B. | 2,524 | medmcqa_train |
Coagulative necrosis is seen in | . | 2,525 | medmcqa_train |
Depigmenting agent of choice in in treatment of dermatological disorders is - | <p>DEPIGMENTING AGENTS:- Include agents like hydroquinone(2%-5%),azelaic acid (10%-20%), glycolic acid (6%-12%) and monobenzene. They act by inhibiting tyrosinase enzyme. Hydroquinone is most commonly used.It can be combined with steroids and retinoids in the treatment of melasma. Kligmans regimen- 5% hydroquinone+0.1% tretinoin +0.1% hydrophilic ointment. Newer agents-Arbutin and kojic acid.They lighten hyperpigmented patches. Used in melasma, freckles. {Reference: IADVL textbook of dermatology, vishalakshi Vishwanath pg no.379}</p> | 2,526 | medmcqa_train |
Which of the following is true regarding Okazaki fragment? | Ans. C. Several Okazaki fragments must be sequentially synthesized for each replication forka. Okazaki fragments are segments of DNA attached to an RNA initiator component.b. They are related to the lagging strand.c. Helicase acts on the lagging strand to unwind dsDNA. | 2,527 | medmcqa_train |
The hyperosmolarity of the renal meduila is due to increased content of - | B i.e. Na + | 2,528 | medmcqa_train |
Paradoxical respiration is seen in | Diaphragmatic palsy Bilateral diaphragmatic paralysisUnilateral diaphragmatic paralysisMost common cause of bilateral diaphragmatic paralysis are:High spinal cord injuryThoracic trauma (cardiac surgery)Multiple sclerosisAnterior horn disease Muscular dystrophyMost patients present with hypercapnic respiratory failure, frequently complicated by cor pulmonale and right ventricular failure, Atelectasis and pneumonia.The degree of diaphragmatic weakness is best quantitated by measuring trans diaphragmatic pressures.Treatment of choice is assisted ventilation for all or pa of each day.If the nerve to the diaphragm is intact, diaphragmatic pacing may be a ble alternativeUnilateral palsy is MC than bilateral, MC cause is nerve invasion from malignancy, usually a bronchogenic carcinoma.Diagnosis is suggested by an elevated hemidiaphragm on the CXR.Confirmation is best established with the "sniff test"(when the patient is observed with fluoroscopy while sniffing, then paralyzed diaphragm will move paradoxically upward due to the negative intrathoracic pressure).Patients with unilateral paralyzed diaphragm are usually asymptomatic, vital capacity and total lung capacity is reduced about 25%.No treatment if CXR is normal and patient is asymptomatic(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 2221) | 2,529 | medmcqa_train |
In this child Which of the following enzymes is likely to be deficient? | Ans. A. HGPRTaseSlide 1 showing nibbling of lips and fingers; slide 2 showing bite marks on hand inflicted by self. Self-mutilation seen in Lesch Nyhan Syndrome; characteristic of the disease in children.Clinical signs and symptoms seen in Lesch Nyhan Syndrome:a. Biochemical: Hyperuricemia, can result ini. Gout (Joint pains)ii. Nephrolithiasis (abdominal pain, may be radiating in nature)iii. Tophib. Neurological:i. Mental Retardation (Poor performance in school)ii. Dystonia, variablec. Neuropsychiatric:i. Aggressive Behaviour (frequent fight, quarreling with siblings)ii. Self-Mutilation Tendency (associated with muscle loss; biting, chewing, etc.)d. Inheritance is XLR, enzyme absent is HGPRTase; in some patient, where the enzyme is not absent, but only diminished, have a less severe condition called Kelley Seegmiller Syndrome, where neurological and neuropsychiatric symptoms are either absent or very mild. | 2,530 | medmcqa_train |
Musculature of first pharyngeal arch is supplied by which cranial nerve? | Musculature of the first pharyngeal arch includes the muscles of mastication (temporalis, masseter, and pterygoids), anterior belly of the digastric, mylohyoid, tensor tympani, and tensor palatini. The nerve supply to the muscles of the first arch is provided by the mandibular branch of the trigeminal nerveRef: Langman's embryology 11th edition Chapter 16. | 2,531 | medmcqa_train |
which of the following antidepressent causes hypeensive crisis | MAOI * IMPOANCE First class of antidepressant drugs that were introduced * MECHANISM There are three monoamines namely dopamine, adrenaline and serotonin. These mon amines are degraded by monoamine oxidase. MAOI inhibit this enzyme and acts increasing monoamines * DRUGS Phenelezine Tranylcipromine * USE ATYPICAL DEPRESSION, depression with reverse vegetative symptoms * SIDE EFFECTS Hypeensive crisis Cheese reaction When a patient on MAOI takes tyramine rich food like tyramine there will be increased release of monoamines. These excess monoamines cannot be degraded by MAO as it is blocked by MAOI. Thus, this may result in hypeensive crisis. Paresthesia's due to pyridoxine deficiency LIKE IPRONIAZID WEIGHT gain SEXUAL dysfunction Ref. Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no, 955 | 2,532 | medmcqa_train |
All the following polyps are premalignant except:March 2011 | Ans. C: Hyperplastic polypsIt is now appreciated that hyperplastic polyps are without malignant potentialJuvenile polyps that are single and have been completely excised carry no significant increased risk of malignancy. Multiple juvenile polyps can be a sign of the familial juvenile polyposis syndrome. This has a significant risk (approximately 10 per cent) of subsequent colon cancer and also a possible increased risk of cancers of the stomach and duodenum (first pa of the small intestine).Juvenile polyposis (JP)Autosomal dominant.Multiple hamaomatous polyps of the colorectum (98%), stomach (13%), small bowel (6%)Juvenile polyps are usually pedunculated, smooth, lobulated with a vulnerable surface.Diagnostic criteria:- 5 or more juvenile polyps in the colon or rectum; OR- One juvenile polyp and positive family history of JP; OR- Juvenile polyps outside the colon or rectum, i.e. stomach/small bowel.Family history positive in 20-50%, suggesting high incidence of spontaneous mutations or low penetrance.Children/ adolescents often presents with iron deficiency anemia, hypoproteinemia and retarded growth. Also rectal prolapse or other congenital abnormalities (15%) in CVS, Urogenital tract and CNS.Cancer risk:- Increased risk, lifetime risk of 20-60% for colorectal cancer.- Median age at diagnosis is 35-40 years.- Increased risk for gastric and duodenal cancersGenetic testing- Germline mutations of the SMAD4 and BMPR1A are detected in 11-25% and 18-30% of patients of JPC.- Gastric polyposis seems to be more frequent and severe in patients with SMAD4 mutations.Treatment- Colectomy and gastric surgery in severe polyposis.Familial adenomatous polyposis (FAP)<1% of all colorectal cancers.Autosomal dominant inherited disease, > 100 colorectal adenomas, caused by germline mutations of the tumor suppressor gene APC (detectable in 80-90% of patients with typical FAP) Prevalence 1:10000 with penetrance close to 100%.25% of patients with FAP do not have positive family history. These are de novo germline mutations.Polyp development stas in distal colorectum at an average age of 15Majority of patients become symptomatic with bloody diarrhea by the age of 25Extracolonic manifestation:- Up to 90% of patients with FAP develop polyps in upper GIT- 30-40% gastric fundic gland polyposis and 5-10% gastric adenomas- Risk for gastric cancer not increased.Major causes of death in colectomized FAP patients are duodenal and ampullary cancer.Spigelman classification for polyposis in upper GIT to allow adequate follow up.Extra-intestinal manifestation of FAP include:- Desmoid tumours (10-20%)- Epidermoid cysts (30-50%)- Fibromas- Osteomas (often in the mandibula)Congenital hyperophy of the retinal pigment epithelium (70%)- Dental abnormalities. Gardner's syndrome:- Polyposis, epidermoid cysts, osteomaTurcot's syndrome in FAP- Polyposis, CNS tumours (medulloblastoma)Increased risk observed for:- Hepatoblastoma, follicular thyroid cancer, brain tumours (usually medulloblastoma).Treatment:- Procedure: Proctocolectomy with ileal-pouch-anal anastomosis (IPAA): Gold standard.Peutz Jeghers syndrome (PJS)Autosomal dominant.Special type of hamaomatous GI polyp (PJ polyp) and mucocutaneous melanin pigmentations.PJ polyps occur throughout alimentary tract with predilection for the small bowel.Mostly jejunal. Esophagus is spared. Rarely nose, gallbladder and ureter.Polyps characterized by extensive smooth muscle aborization throughout polyp.Pigment lesions in 95% of patients but may disappear with age. Mostly lips, peri-oral and intra-oral mucosa.Diagnostic criteria:2 or more PJ polyps- One PJ polyp and mucocutaneous pigment lesion- One PJ polyp and positive family history of PJS.Endoscopic or surgical excision of large or symptomatic polyps is recommended.Family history is negative in up to 45% of index cases indicating de novo germline mutations.Recurrent colicky abdominal pain due to intussusception in adolescence or young adulthood. Also occult bleeding with iron-deficiency anemia. Pigmentation not always present in childhood and may fade later in life.Intra-epithelial neoplasia predisposes to cancer - hamaoma-adenoma-carcinoma sequenceCancer risk:- 85% by age 70 years- 57% GI cancer.- Colorectal cancer most common with lifetime risk of 39%. Lifetime pancreatic cancer risk is 11%.Extraintestinal cancers include breast risk (31-50%), endometrium and ovary.Cancer uncommon before age 30 years.Almost all female patients with PJS develop potentially malignant ovarian tumour, the sex cord tumour with annular tubules (SCTAT). Malignant transformation in 20% of all cases. Seoli cell tumours considered as male equivalent of SCTAT with gynaecomastia.Genetic testing- PJS is caused by germline mutation of the STKII tumour suppressor gene. | 2,533 | medmcqa_train |
In an elective lap cholecystectomy with no gross spillage, antibiotics required are | Elective lap cholecystectomy is a clean-contaminated surgery, single preoperative IV antibiotic during decisive period is sufficientThere is no evidence that fuher doses of antibiotics after surgery are of any value in prophylaxis against infectionWhen wounds are heavily contaminated or when an incision is made into an abscess, a 5-day course of therapeutic antibiotics may be justifiedRef: Bailey and Love 27e pg: 53 | 2,534 | medmcqa_train |
All of the following may be used to treat Acute Hypercalcemia Except: | Answer is D (Gallium Nitrate) Gallium Nitrate exes s hypocalcemic effect by inhibiting calcium resorption from bone. Maximum hypocakemic effect of gallium nitrate may take 3-4 days to appear and it is not often used now because of availability of superior alternatives. Gallium nitrate is the single best answer of exclusion. Treatment of Hypercalcemia Onset of Action Hydration with Saline Hours Forced diuresis (saline + loop diuretic) Hours Calcitonin Hours Intravenous phosphate Hours Pheomycin / Mithromycin Hours Dialysis Hours Biphosphonates Days (1 to 2 days) Glucocoicoids Days Gallium Nitrate Days (3-4 days) | 2,535 | medmcqa_train |
Hampton's line is feature of | 'Hampton's line' :- - is thin radiolucent line seen at the neck of a gastric ulcer in barium studies - it is seen in benign gastric ulcer - it's caused by thin line of mucosa overhaning ulcer's crater Hampton's line Carman Meniscus sign - (in Malignant gastric ulcer) Duodenal ulcer: - is associated with increased acid secretion caused by higher incidence of H.Pylori infection - duodenum is often deformed along its inferior margin - chronic gastric ulcer gives Trifoliate appearance | 2,536 | medmcqa_train |
A patient developed breathlessness and chest pain, on second postoperative day after a total hip replacement. Echo-cardiography showed right ventricular dilatation and tricuspid regurgitation. What is the most likely diagnosis? | The clinical history corresponding to the diagnosis of pulmonary embolism. For a patient presenting with acute breathlessness and chest pain and in whom right ventricular dilatation with tricuspid regurgitation and mild elevation of pulmonary aery pressure is noted, a pulmonary embolus should be the initial diagnosis to be considered. Ref: Deep Vein Thrombosis and Pulmonary Embolism, Page 253, 254; Feigenbaum's Echocardiography, 7th Edition, Page 762. | 2,537 | medmcqa_train |
Dimorphic with subcutaneous Mycosis is | Sporotrichosis:
Dimorphic fungi
Causes subcutaneous infections. | 2,538 | medmcqa_train |
The phenomenon of conception of a woman due to deposition of semen on vulva without vaginal penetration is called as | FECUNDATION AB EXTRA: The conception of the female due to deposition of semen on the vulva, without penetration of the vagina - The insemination occurs due to the passage of spermatozoa from external genitalia to the uterus. Ref - Krishnan Vij 5th edition pg 395 , 404 | 2,539 | medmcqa_train |
Pilocarpine reduce the intraocular pressure in person with closed angle glaucoma by | Refer kDT 7/e p 156 It has also been used in the treatment of chronic open-angle glaucoma and acute angle-closure glaucoma It acts on a subtype of muscarinic receptor (M3) found on the iris sphincter muscle, causing the muscle to contract -resulting in pupil constriction (miosis). Pilocarpine also acts on the ciliary muscleand causes it to contract. When the ciliary muscle contracts, it opens the trabecular meshwork through increased tension on the scleral spur. This action facilitates the rate that aqueous humor leaves the eye to decrease intraocular pressure | 2,540 | medmcqa_train |
A variety of basic assays are used to detect autoantibodies. Nephelometry is based on the principle of: | Nephelometry measures the interaction of antibodies and antigens in solution, detecting immune complex formation by monitoring changes in the scattering of an incident light. Ref: Imboden J.B. (2007). Chapter 3. Laboratory Diagnosis. In J.B. Imboden, D.B. Hellmann, J.H. Stone (Eds), CURRENT Rheumatology Diagnosis & Treatment, 2e. | 2,541 | medmcqa_train |
Stocker&;s line is seen in | Pterygium It presents as a triangular fold of conjunctiva encroaching the cornea in the area of the palpebral apeure, usually on the nasal side, but may also occur on the temporal side. Deposition of iron seen sometimes in corneal epithelium anterior to advancing head of the pterygium called as stocker's line. Pas. A fully developed pterygium consists of three pas: i. Head (apical pa present on the cornea), ii. Neck (limbal pa), and iii. Body (scleral pa) extending between limbus and the canthus. Stocker's line in pterygium. Pterygium is a fibrovascular proliferative disorder in which conjunctival tissue grows medially to cover the clear cornea. On slit-lamp examination showed marked pterygium that extend from the nasal side of bulbar conjunctiva onto the cornea in the left eye Ref: Khurana; 4th ed; Pg 80 | 2,542 | medmcqa_train |
Which one of the following congenital hea diseases has cyanosis without cardiomeglay and/ or congestive hea failure - | Ans. is 'b' i.e., Fallot's Tetralogy Cardiomegaly and CHF do not occur in Fallot's tetrology. No Cardiomegaly o First you should know the following facts : ? i) Pressure overload to ventricles causes concentric hyperophy without dilatation. ii) Volume overload to ventricles causes hyperophy with dilatation --> Eccentric hyperophy. o Due to pulmonary stenosis, there is pressure overload to right ventricle --> Concentric hyperophy of right ventricle without dilatation - No Cardiomegaly. No CHF o The VSD of TOF is always large enough to allow free exit to the right to left shunt. Since the right ventricle is effectively decompressed by the VSD, CHF never occurs in TOF. | 2,543 | medmcqa_train |
True about stomach carcinoma - | Answer 'a' i.e. Weightloss is commonest feature Symptoms of gastric cancer Earliest symptom is usually vague postprandial abdominal heaviness Most common symptom is weight loss Other symptoms are: - anorexia - abdominal pain (usually not severe) vomiting may be present and becomes a major feature if pyloric obstruction occurs. It may have coffee-ground colour due to bleeding by the tumor. - dysphagia may be the presenting symptom if the lesion is at the cardia. Paraneoplastic symptoms such as - Trousseau's syndrome (thrombophlebitis) - Acanthosis nigricans (hyperpigmentation of the axilla and groin) - Peripheral neuropathy Option b & c Spread of gastric carcinoma - intramural spread within the submucosa - direct spread through the gastric walls - lymphatic spread hematogenous - transperitoneal through peritoneal seedlings about option 'b' - I am not very sure, but it appears to be uncorrect. Most common secondaries are noted in intrabdominal and supraclavicular lymphnodes. Liver is the most common site for hematogenous spread of tumor (Harrison 16/e, p 525) Option 'd' - Barium meal is -75% sensitive for gastric cancer and is the simplest study to perform but it is not confirmatory. Endoscopy with biopsy is always needed if gastric Ca is suspected, to confirm the diagnosis. Harrison 16/e, p 526 writes - "Gastric adenocarcinoma is a relatively radioresistant tumor and adequate control of the primary tumor requires doses of external beam irradiation that exceeds the tolerance of surrounding structures, such as the bowel mucosa and the spinal cord. As a result, the major role of radiation therapy in patients has been palliation of pain." | 2,544 | medmcqa_train |
Which of the following organism is most commonly considered responsible for SIDS especially after giving honey to the neonate or infant? | Ans. A. Clostridium botulinum.(Ref. Nelson Textbook of Pediatrics, 19th ed. Chapter 367)Sudden infant death syndrome# Sudden infant death syndrome (SIDS) is the unexpected, sudden death of a child under age 1 in which an autopsy does not show an explainable cause of death.# SIDS is most likely to occur between 2 and 4 months of age. SIDS affects boys more often than girls. Most SIDS deaths occur in the winter.# The following have been linked to a baby's increased risk of SIDS:# Sleeping on the stomach# Being around cigarette smoke while in the womb or after being bom# Sleeping in the same bed as their parents (co-sleeping)# Soft bedding in the crib# Multiple birth babies (being a twin, triplet, etc.)# Premature birth# Having a brother or sister who had SIDS# Mothers who smoke or use illegal drugs# Being bom to a teen mother# Short time period between pregnancies# Late or no prenatal care# Living in poverty situations# Honey is the one identified, avoidable source of C botulinum spores for susceptible infants.# Because botulinal toxin is the most potent poison known (about 10-9 mg per kg of body weight given intravenously being a lethal amount for man), it appeared possible that rapid in vivo production of botulinal toxin might in some infants lead to sudden death if upper airway obstruction or apnea resulted from flaccidity of airway and respiratory muscles.# In a British study released May 29, 2008, researchers discovered that the common bacterial infections Staphylococcus aureus and Escherichia coli appear to be risk factors in some cases of SIDS. | 2,545 | medmcqa_train |
A patient consults a dermatologist about a skin lesion on her neck. Examination reveals a 1-cm diameter,red, scaly plaque with a rough texture and irregular margins. Biopsy demonstrates epidermal and dermal cells with large, pleomorphic, hyperchromatic nuclei. Which of the following conditions would most likely predispose this patient to the development of this lesion? | The lesion is a squamous cell carcinoma of the skin. Actinic keratosis, which is a hyperplastic lesion of sun-damaged skin, predisposes for squamous cell carcinoma. Another predisposing condition to remember is xeroderma pigmentosum, which predisposes for both squamous cell and basal cell carcinomas of skin. A nevus is a mole, containing characteristic cells called nevocellular cells. If the nevocellular cells are located at the dermal-epidermal junction (junctional nevus), in the dermis (dermal nevus), or both (compound nevus) they do not predispose for squamous cell carcinomas of the skin. Ref: Vujevich J.J., Goldberg L.H. (2012). Chapter 246. Cryosurgery and Electrosurgery. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick's Dermatology in General Medicine, 8e. | 2,546 | medmcqa_train |
In Osteomalacia | Rickets / Osteomalacia Pathophysiology - Failure of calcification & mineralization of cailage and osteoid tissue Clinical featuresRadiological featuresGeneralized muscle weakness, lethargy, irritability and listlessness Protuberant abdomen Large head, open fontanelles and craniotabesThickening of knees, ankle & wrists due to physeal overgrowth Rachitic rosary Harrison's groove Pectus carinatumSho stature & bowing of long bones with genu valgum, coxa vara, kyphoscoliosis Elongation of physis & hazy appearance of provisional zone of calcification Widened growth plate Cupping of metaphysis Splaying and flaring of epiphysis Bowing of diaphysis with thinning of coices OsteopeniaLooser's zone Biconcave codfish veebra Thoracolumbar kyphosis Trefoil & Champagne glass pelvis (Refer: Tachdijian'spaediatric Ohopedics, 5th edition, pg no: 1685-1696) | 2,547 | medmcqa_train |
Frotteurism: | Ans. (c) Pleasure in touching opposite sexRef: The Essentials ofFSM by K.S. Narayan Reddy 31st ed. / 404* FROTTEURISM: rubbing the genitalia with the body of the person of other sex for sexual satisfaction.* Paraphilias: Abnormal 8c unorthodox sex play by using unusual objects or parts are know as paraphilia eg. Sadomasochism, Transvestism, Bestiality, Frotteurism, Homosexuality etc.* Bisexuality means hermaphrodite; an individual with both ovary 8c testis 8c external genitals of both sexes.Different Paraphilias/PerversionSexual perversionMode of sexual pleasureSadismPleasure in giving pain to sexual partnerMasochismPleasure on receiving painful stimulus from sexual partnerBondageSadism + masochism are found togetherFetischismSexual gratification by article of opposite sexFrotteurismSexual gratification by contact. Ex: rubbing genitalia on another personExhibitionismSatisfaction in exhibition of genitals with or without mastutbationTransvestism/ EonismPleasure in wearing clothes of opposite sexUranismSexual gratification by fingering, fellatio, cunnilingus etc.Buccal coitus or Sin of GomorrahFellatio is oral stimulation of penis by male or femaleCunnilingus is oral stimulation of female genitalsVoyeurism/ ScotophiliaAlso known as Peeping tomDesire to watch sexual intercourse or toobserve genitals of othersTrolismExtreme degree of voyeurism. Ex: A perverted husband enjoy watching his wife having sexual intercourse with another man.Urolangia/ CoprophiliaSexual excitement by sight or odor of urine or faeces.Tribadism/ LesbianismGratification of sexual desire of a women by another womenSodomy or Buggery of Greek Love* Anal sex* Gerantophilia -when passive agent is adult* Paederasty - when the passive agent is young boy (catamite)IncestSexual intercourse with close relativeBestialitySexual intercourse by a human being with a lower animal | 2,548 | medmcqa_train |
A 23-year-old woman is noticed to have irregular pupils on routine examination. She has 1 large pupil, which has minimal response to light stimulation, but it does respond to accommodation. The eye movements are normal and she experiences no double vision.For the above patient with a pupillary abnormality, select the most likely diagnosis. | The tonic pupil (Holmes-Adie syndrome) is caused by a parasympathetic lesion at or distal to the ciliary ganglion. The pupil is large and usually unilateral, with absent response to light. A bright room, by causing constriction of the normal pupil, accentuates the anisocoria. The tonic pupil can be associated with Shy-Drager syndrome, amyloidosis, or diabetes. However, it is most commonly seen in otherwise healthy young women. | 2,549 | medmcqa_train |
Which of the following is secreted by TRH stimulation? | TRH is derived from a pro-TRH peptide. Like other hypothalamic-releasing hormones, TRH reaches the anterior pituitary the hypothalamic-pituitary poal circulation. It interacts with specific receptors on pituitary thyrotrophs to release TSH and on mammotrophs to release prolactin. Ref: Textbook of Endocrine Physiology edited by William J. Kovacs, Sergio R. Ojeda, 2011, Page 324; Guyton's physiology, 22nd edition, Table 74-1 Page 907 | 2,550 | medmcqa_train |
All of the following are components of withdrawl reflex except | Inverse stretch reflex is not component of withdrawl reflex. | 2,551 | medmcqa_train |
Nutrient and oxygen reach the chondrocytes across perichondrium by | an impoant fact about cailage matrix is that it is avascular, i.e. not supplied by capillariestherefore, chondrocytes within the matrix must receive nutrients and oxygen by diffusion from vessels that lie outside the cailagethis long-distance diffusion is possible because of the large volume of water trapped within the matrix(Refer: Manish Kumar Varshney's Essential Ohopedics Principles & Practice, 1st edition, pg no. 7, 347) | 2,552 | medmcqa_train |
A 20 year old boy c/o hearing of voices, aggressive behavior since 2 days. He has fever since 2 days. When asked to his family, they say that he has been muttering to self and gesticulating. There is no of psychiatric illness. Likely diagnosis is: | B i.e. Acute psychosis- Delusions or hallucinations (suchas hearing voices in this case) with grossly disorganized speech and behavior (such as muttering to self, gesticulation, aggressiveness in this case) of acute onset with normal cognition & consciousness indicate the diagnosis of acute psychosis (i.e. psychosis of acute onset). This acute psychosis may be d/t psychotic disorder d/t general medical condition (such as high fever as in this case) or d/t brief psychotic disorder (DSMIVTR), or d/t acute and transient psychotic disorder (ICD-10). So here the term acute psychosis is used to depict the clinical picture not the cause of that clinical picture.Delirium can also present acute onset disorganized behavior (agitation) and speech (incoherent) with delusions or hallucinations but the delusions are poorly elaborated & transient, the course of disease is fluctuant (eg sun downing). And characteristically there is clouding of (disturbance in) consciousnesss (i.e. reduced clarity of awareness of the environment) and disorientation (change in cognition) in delirium. Just like psychosis clinical picture of delirium may also be d/t various reasons such as general medical condition / substance intoxication/ withdrawal.- Dementia is a chronic slow/insiduous process presenting with decrement in intellectual abilities (such as sho & long term memory, judgement, abstract thinking, impulse control, personal care and personality)Q.- Delusional disorder presents with nonbizarre delusions (involving situations that occur in real life) of at least 1 months durationQ. Apa from the impact of delusion (s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre (i.e. criteria. A of schizophrenia has never been met). However, tactile or olfactory hallucinations may be present if they are related to delusional theme. | 2,553 | medmcqa_train |
Spuriously high BP is seen in A/E : | A i.e. Auscultatory gap | 2,554 | medmcqa_train |
All are Glucogenic hormones except? | Ans. A ADHRef: Ganong, 25th ed. pg. 442Glucagon, thyroxine, cortisol and growth hormone increase blood sugar levels and are glucogenic. ADH regulates water re-absorption via the collecting duct. | 2,555 | medmcqa_train |
Which type of Human papilloma virus is most commonly associated with Cervical cancer ? | Genital HPV infection is extremely common and most often cause no symptoms. A propoion of individuals infected with low-risk HPV types such as HPV-6 or HPV-11 will develop genital was, whereas a subset of women with high-risk HPVs such as HPV-16 or HPV-18 will develop preneoplastic lesions of cervical intraepithelial neoplasia (CIN). Low-grade cervical dysplasias are common and most regress spontaneously. In contrast, the minority of lesions that progress to high-grade dysplasias tend to persist and/or progress to carcinomas in situ before becoming invasive cancers. The majority of adenocarcinomas of the cervix and of squamous cell cancers (SCC) of the vulva, vagina, penis and anus are caused by HPV-16 and HPV-18 (together accounting for about 70% of cases globally), the remaining 30% being due to other high-risk HPV types (such as HPV-31, -33, -35, -39, -45,-51, -66). HPV is also associated with other cancers of the anus, head and neck, and rarely, recurrent respiratory papillomatosis in children. | 2,556 | medmcqa_train |
Ashley's rule is used to : | Ashley's rule States that male sternum lenth will be more than 149mm and female sternum lenth will be less than 149mm. | 2,557 | medmcqa_train |
Statins act on which enzyme - | Ans. is 'd' i.e., HMG CoA reductase Hypolipidemic drugsHMG-CoA reductase inhibitors (statins) - Lovastatin. Simvastatin, Pravastatin, Atorvastatin, Rosuvastatin.Bile acid sequestrants (Resins) - cholestyramine, colestipol.Activate lipoprotein lipase (fibric acid derivatives) - clofibrate, gemfibrozil, bezafibrate, fenofibrate.4.Inhibit lipoly sis and triglyceride synthesis - Nicotinic acid.5,Other - Probueol, Gugulipid, Ezetimibe, Avasimibe, Torcetrapib.o Ezetimibe inhibits intestinal cholesterole absorption.o Avasimibe inhibits enzyme acyl Coenzyme A ; cholesterol acyl transferase-1 (ACAT-1) which causes esterification of cholesterol.o Torcetrapib inhibits cholesterol ester triglyceride transport protein -| HDL cholesterol. | 2,558 | medmcqa_train |
Antiendomysial antibody is used in screening of ? | Ans. is 'a' i.e., Coeliac diseases Coeliac disea.se (CD) is a permanent intolerance of the small intestine to gluten, characterized by gluten-dependent changes in villous morphology and/or signs of immunological activation detectable in the lamina propria of intestinal mucosa. The presence of serum anti-endomysial antibodies (EMA) is generally considered to be highly suggestive for CD because of their high values of sensitivity and specificity. Other antibodies used for diagnosis Tissue transglutaminase, Antigliadin antibodies Treatment is Gluten-free diet | 2,559 | medmcqa_train |
Primary level of prevention is? | Modes Primordial Before the emergence of risk factor Health education Primary Risk factor but no disease yet Health promotion, specific protection Secondary Disease possible staed in the body Early diagnosis, Treatment Teiary Disease is already in progression Disability limitation , Rehabilitation | 2,560 | medmcqa_train |
Allen test detects insufficiency of which aery | Allen's Test Tests the adequacy of the blood supply to the hand from the radial and ulnar aeries and the arcade between them Allen's test is used to know the integrity of palmar arcg (patency of radial and ulnar aeries). If these are patent, AVF can be safely ligated Method of Allen's test Elevate the hand and apply digital pressure on the radial and ulnar aeries to occlude them Ask the patient to make a fist several times The tips of the finger should go pale. Release each aery in turn and observe the return of colour Ref : Sabiston 20th edition Pgno :1979 | 2,561 | medmcqa_train |
Which of the following features is not shared between 'T cells' and 'B cells' - | Option 1 During development T cells undergo both positive selection and negative selection, while B cells undergo only negative selection (by apoptosis of self-reacting immature B-cells in spleen). Death of cells with TCRs that do not react with self MHC proteins - negative selectionSurvival of cells with TCRs that react with self MHC preoteins- positive selection Option 2 MHC class I Present on All nucleated cells (except sperms) and platelets. Option 3 Both cells have Antigen Specific Receptors. FIGURE 01:Development of T cells. Note the positive and negative selection that occurs in the thymus. Maturation of B cells- Cells arise from stem cells and differentiate into pre-B cells expressing m heavy chains in the cytoplasm and then into B cells expressing monomer IgM on the surface. This occurs independent of antigen. Activation of B cells and differentiation into plasma cells is dependent on antigen. Cells to the left of the veical dotted line do not have IgM on their surface, whereas B cells, to the right of the veical line, do have IgM. m, mu heavy chains in cytoplasm; Y, IgM. | 2,562 | medmcqa_train |
Which of the following statements is true regarding the relation of bile duct | Bile duct : Anatomy It lies in front of the poal vein and to the right of the hepatic aery Common hepatic duct is 1-4cm in length and has a diameter of approx. 4mm CBD is about 7-11 cm in length and 5-10 mm in diameter A fibroareolar tissue containing scant smooth muscle surround the mucosa (a distinct muscle layer is absent) Most impoant aeries to the Supra duodenal bile duct run parallel to the duct at the 3 & 9'o clock position Approximately 60% of the blood supply to the Supra duodenal bile duct originates inferiorly from the pancreaticoduodenal and retro duodenal aeries Whereas 38% of blood supply originate superiorly from the right hepatic atmeru and cystic duct aery Ref: Sabiston 20th edition Pgno : 1482-1484 | 2,563 | medmcqa_train |
Which of the following is a manifestation of magnesium deficiency? | Magnesium deficiency causes irritability, hyper reflexion and sometimes hyporeflexia, tetany and seizures. Ref: Park 22nd edition, page 577. | 2,564 | medmcqa_train |
The most important function of epithelioid cells in tuberculosis is: | Ans. (b) Secretory(Ref: Immunology, 8th edition, by David Male; pg 427)Epithelioid cells are transformed macrophages that have lost their phagocytic function but retained their secretory activity.Epithelioid cells contain numerous endoplasmic reticulum & golgi bodies.They secrete IL10, TNF alpha, TGF beta; | 2,565 | medmcqa_train |
Smoke stake pattern is characteristic of? | Ans. is 'd' i.e., Central serous retinopathy * Smoke stack pattern (small hyper fluorescent spot which ascends vertically like a smoke-stack), which gradually spreads laterally to take a mushroom or umbrella configuration, is a Fundus Fluorescein Angiography (FFA) finding of Central Serous Retinopathy.* Another important FFA finding of CSR is Ink-blot or enlarging dot pattern (small hyperfluorescent spot which gradually increases in size.* Among these the most common FFA finding is ink-blot pattern. | 2,566 | medmcqa_train |
Surgical scissors left in abdomen is covered under which doctrine - | Res ipsa loquitur: means the thing or fact speaks for itself. Here the patient has to merely state the act of negligence. It must satisfy the conditions that in the absence of negligence, the injury would not have occurred ordinarily, the doctor had exclusive control over the injury-producing treatment or instrument and the patient was not guilty of contributory negligence. The case can be proved without medical evidence. Medical maloccurrence: in spite of good medical attention and care, an individual fails to respond properly or may suffer from adverse reactions of the drug. Therapeutic misadventure: is a case in which an individual has been injured or had died due to some unintentional act by a doctor or agent of the doctor or the hospital. eg: hypersensitivity reaction caused by penicillin, aspirin, etc. Novus actus interveniens: if the doctor is negligent, which results in a detion from the logical sequence of events, then the responsibility for the subsequent disability or death may pass from the original incident to the later negligent action of the doctor. eg: leaving of a swab or surgical instrument in the abdomen after the repair of an internal injury. Ref: Dr.K.S.Narayana Reddy, The Essentials of Synopsis of Forensic Medicine & Toxicology, 34th edition Pg.37,38,44. | 2,567 | medmcqa_train |
Patient presenting with abdominal pain, diarrhea taking clindamycin for 5 days. Treated with metronidazole symptoms subsided. What is the causative agent - | Ans. is 'a' i.e., Clostridium difficile | 2,568 | medmcqa_train |
Indication for intramuscular iron therapy? | Ans. d (Oral iron intolerance). (Ref. KDT, Pharmacology, 6th/pg.584)IRON THERAPY# Some iron preparations come with other compounds designed to enhance iron absorption, such as ascorbic acid,# Typically, for iron replacement therapy, up to 300 mg of elemental iron per day is given, usually as three or four iron tablets (each containing 50-65 mg elemental iron) given over the course of the day.# Ideally, oral iron preparations should be taken on an empty stomach, since foods may inhibit iron absorption.# A dose of 200-300 mg of elemental iron per day should result in the absorption of iron up to 50 mg/d.# The goal of therapy in individuals with iron-deficiency anemia is not only to repair the anemia, but also to provide stores of at least 0.5-1.0 g of iron.# Sustained treatment for a period of 6-12 months after correction of the anemia will be necessary to achieve this.# Of the complications of oral iron therapy, gastrointestinal distress is the most prominent and is seen in 15-20% of patients.# Typically, the reticulocyte count should begin to increase within 4-7 days after initiation of therapy and peak at 1 1/2 weeks.# The amount of iron needed by an individual patient is calculated by the following formula:Iron requirement (mg) =4.4 X bidt wt (kg) X Hb defucut (g/dL)Indications of parenteral Iron therapy# Oral iron intolerance# Failure to absorb oral iron# Non-compliance to oral therapy# In presence of severe anemia with bleeding.Oral Iron preparationsIron contentFerrous sulfate Hydrated salt20%Dried salt32-35%Ferrous gluconate12%Ferrous fumarate, succinate33%Colloidal ferric hydroxide50%Iron-calcium complex5% Iron therapy:Dosage ------200mg elemental iron per dayRise of Hb --------0.5-lgm% per week1st sign of response --------| Apetite, | fatigue within 12-24 hrs Reticulocytosis 3-4th DayIndication of Blood transfusion------Hb < 7gm% or CCFDuration of iron tablets ------At least 100 days after correction of Hb | 2,569 | medmcqa_train |
Edrophonium binds to which site of Acetylcholinesterase | Edrophonium is ultra sho-acting acetylcholinesterase drug which binds only to anionic site Ref: KDT 6th ed pg 104 | 2,570 | medmcqa_train |
Indications for exchange transfusion are all except? | Ans. is 'c' i.e., Cord bilirubin < 5 mg/100 ml Cord bilirubin 5 or more is an indication. | 2,571 | medmcqa_train |
A 26-year-old recently married woman presents with tender nodules on her shin. Initial history taking should include questions about | Red tender nodules on her shin could be erythema nodosum; Erythema nodosum is a type of panniculitis, i.e. an inflammatory disorder affecting subcutaneous fat.Oral contraceptives which this newly married woman would take is likely hereOther causes are Neutrophilic dermatoses (Behcet's disease, Sweet's syndrome), iodides, bromides, sulfonamides, Sarcoidosis, Ulcerative colitis(also Crohn&;s), Streptococcus, Pregnancy, and Malignancy | 2,572 | medmcqa_train |
Fatty acid found exclusively in breast milk is:- | - Fatty acid found exclusively in breast milk: DHA (Docosa hexanoic acid) - It aids in development of brain by promoting myelination of neurons. OTHER ESSENTIAL FATTY ACIDS & THEIR RICH SOURCES: Linoleic acid, Arachidonic acid - Safflower oil Linolenic acid - flaxseed oil, soyabean oil Eichosa pentanoic acid - fish oils. | 2,573 | medmcqa_train |
Severity of mitral stenosis is determined by: March 2005 | Ans. B: Diastolic murmur duration Mitral Stenosis Severity assessment on auscultation - Time interval between A2 and opening snap is inversely propoional to the severity of MS. - Duration (of low pitched, rumbling, diatolic murmur, heard at the apex) of murmur correlates with the severity of stenosis in patients with preserved CO. Echocardiography: Mitral Stenosis Severity Scales - Pressure half-time Normal : 30 to 60 milliseconds Abnormal : 90 to 400 ms Gray area : 60 to 90 ms Mild MS : 90 to 150 ms Moderate MS : 150 to 219 ms Severe MS : > 220 ms Mitral valve area Normal : 4 to 6 cm2 Mild MS : 1.5 to 2.5 cm2 Moderate MS : 1.0 to 1.5 cm2 Severe MS : End-diastolic pressure gradient Normal : 0 to 2 mm Hg Mild MS : 2 to 6mmHg Moderate MS : 6 to 10 mm Hg Severe MS : >10 mm Hg Mean pressure gradient Mild MS : < 5 mmHg Moderate MS : 6 to 12 mm Hg Severe MS : > 12 mm Hg | 2,574 | medmcqa_train |
30 year old patient with pain in right hypochondrium for 5 days with soft and tender liver and intercostal tenderness. He complains of catch in breath on inspiration and has a non productive cough. On examination the lung fields are clear, patient looks pale and emaciated. Probable diagnosis is | Ans. (a) Ameobic liver abscessRef:Manipal Manual of surgery, 4th ed./521Refer to the above explanationHydatid cystUsually clinically silentEnlarged liver with smooth surface and is non tender.Pyogenic liver abscessMultiple abscess leading to spiky fever and enlarged liver.Hepatic adenomaPresents in young women on OCP and is solitary. Liver enlargement may or may not be seen. | 2,575 | medmcqa_train |
In post-hepatic jaundice, the concentration of conjugated bilirubin in the blood is higher than that of unconjugated bilirubin because - | Jaundice
Jaundice is not a disease but rather a sign that can occur in many different diseases.
Jaundice is the yellowish staining of skin and sclerae which is caused by the high level of blood bilirubin.
On the basis of etiology, jaundice can be divided into 3 types : -
1. Prehepatic jaundice
Prehepatic jaundice is due to increased production of bilirubin which results in an increased bilirubin load presented to the liver.
The liver is normal and is able to conjugate the bilirubin at a normal rate; However, due to overproduction of bilirubin, conjugation capacity of the liver is overwhelmed and unconjugated bilirubin is increased → Unconjugated hyperbilirubinemia.
Prehepatic jaundice is caused by hemolysis, i.e., hemolytic anemia due to any cause, e.g., hereditary spherocytosis, Thalassemia, SCA, Malaria, Drugs (methyldopa, quinine) etc.
2. Hepatic jaundice
Here the cause lies within the hepatocytes which have either a defect in the conjugation process or in the excretion of conjugated bilirubin into the bile.
This type of jaundice is caused by all causes of hepatitis (infection, alcohol, drugs, toxin or autoimmune); in congenital hyperbilirubenemias; and in cirrhosis.
3. Post hepatic (extrahepatic) jaundice
Post hepatic jaundice is due to obstruction of the excretion into the bile, e.g., in stone in CBD, carcinoma pancreas, CBD carcinoma etc.
Conjugation capacity of hepatocytes are normal and they continue their conjugation process without any interference leading to conjugated hyperbilirubinemia. | 2,576 | medmcqa_train |
The causative organism can be best isolated in which of the following conditions. | Staphylococcus aureus can be isolated from a tampon of a patient with toxic shock syndrome. S.aureus strains isolated from patients with toxic shock syndrome produce a toxin called toxic shock syndrome toxin-1 (TSST-1), which can be found in the vagina, on tampons, in wounds or other localized infections, or in the throat but viually never in the bloodstream. Streptococcal antigens cross-reactive with human tissues ; streptococcal antigen Human antigen Disease Hyaluronic acid Synol fluid Reactive ahritis Cell wall M protein Myocardium Acute rheumatic fever Cell wall C carbohydrate Cardiac Valves Acute rheumatic fever peptidiglycan skin antigens Guttate psoriasis Cytoplasmic membrane Glomerular capsular intima Acute glomerulonephritis Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg:204 | 2,577 | medmcqa_train |
A 63-year-old woman fell while crossing the street after her Thursday afternoon bridge game. Attempts at resuscitation for cardiac arrest by the emergency medical service (EMS) team were unsuccessful. The woman had previously been diagnosed as having aortic stenosis and left ventricular hypertrophy. In addition to these factors, which of the following predisposes to sudden cardiac death? | Sudden cardiac death is defined as an unexpected death occurring within 1 hour after the beginning of symptoms in a patient who was previously hemodynamically stable. In asymptomatic patients presenting initially with cardiac disease, 20% will die within the first hour of symptoms. Electrolyte imbalance, hypoxia, and conduction system defect are additional factors that increase the risk of sudden death syndrome. Split first heart sound accentuated on inspiration occurs in normal individuals. In CHF, the CVP changes more than 1 cm when pressure is applied below the right costal margin to the liver (hepatojugular reflex) for a 30-second period.New York Classification of Functional changes in Heart DiseaseClassLimitation of Physical ActivityINoneIISlightIIIMarkedIVComplete (even at rest) | 2,578 | medmcqa_train |
Transitional cell carcinoma of bladder is associated with- | Ans. is 'a' i.e., Schistosomiasis; 'b' i.e., Naphthylamine & 'c' i.e., SmokingRisk factors for transitional cell carcinoma (TCC) of bladder ?I. Smoking ---> Major etiological factor.Occupational exposure to chemicals Nephthylamine benzidine, aniline dyes, acrolein.Schistosoma haematobium (Bilharziasis) ---> It is a risk factor for both TCC & SCC.Drugs --> PhenacetinCyclophosphamide therapyPelvic irradiations | 2,579 | medmcqa_train |
Which of the following regulates lipolysis in adipocytes? | Ans. B. Activation of triglyceride lipase as a result of hormone-stimulated increases in cyclic AMP levelsa. Lipolysis is directly regulated by hormones in adipocytes. Epinephrine stimulates adenylate cyclase to produce cyclic AMP, which in turn stimulates a protein kinase.b. The kinase activates triglyceride lipase by phosphorylating it. Lipolysis then proceeds and results in the release of free fatty acids and glycerol.c. A futile re esterification of free fatty acids is prevented, since adipocytes contain little glycerol kinase to phosphorylate the liberated glycerol, which must be processed in the liver. Inhibition of lipolysis occurs in the presence of insulin, which lowers cyclic AMP levels. Lipoprotein lipase is not an adipocyte enzyme. | 2,580 | medmcqa_train |
What is the expected mixed venous oxygen tension, in mm Hg, in a normal adult after breathing 100% oxygen for 10 minutes? | Ans. (c) 45Ref: American Board of Anesthesiology American Society of Anesthesiologists, Book A 1996 q-67Breathing 100% oxygen will not change the oxygen saturation much. In arterial blood it is around 97% saturation which corresponds to a PO2 of 100 mm HgIn venous blood it is 75% saturation which corresponds to a mixed venous oxygen tension of around 40-45 mm Hg | 2,581 | medmcqa_train |
Muscle attached to medial border of scapula is- | Ans. is 'a' i.e., Rhomboidus Major * Lateral border of scapula (posteriorly) : Origins of teres minor and teres major.* Medial border of scapula : (i) Anteriorly : Insertion of serratus anterior; (ii) Posteriorly : Insertions of levator scapulae, rhomboideus major and minor. | 2,582 | medmcqa_train |
Seminal stain can be detected by | Test for seminal stains
Creatine phosphokinase test
Acid phosphatase test
Florence test (Choline iodide crystals)
Barberio's test (Crystals of spesmin picrate). | 2,583 | medmcqa_train |
Oligohydramnios is seen in: | Oligohydramnios can be caused by - Renal anomalies Uteroplacental insufficiency: IUGR ACE inhibitors Premature rupture of membranes Amniocentesis (leak) Pre-ecclampsia Amnion nodosum NSAIDs Post term pregnancy over estimated gestational age The sonographic diagnosis of oligohydramnios is usually based on an AFI < 5 cm or a single deepest pocket of amnionic fluid of < 2 cm | 2,584 | medmcqa_train |
The normal P wave is inveed in lead : | Answer is D (aVR) The normal P wave is negative (inveed) in lead aVR. Characteristics of a Normal P Wave P wave results from spread of electrical activity through the atria (Atrial Depolarization) A normal p wave indicates that the electrical impulse responsible for the p wave originated in the sinus node and the normal depolarization of the right and left atria has occurred Normal P Wave is rounded, neither peaked nor notched. Width or duration of the P wave in time is 0.10 seconds or 2.5 small squares Height of the P wave is 2.5 mm (2.5 small squares) Sinus P waves are best seen in Lead II and V1 P wave is upright in most leads, mainly L1 L11 and aVF P Wave is inveed in aVR (and occasionally in aVL) P wave in VI may be biphasic with equal upward and downward deflection, notched and wide. Activation of right atrium produces positive component and activation of left atrium produces negative component. There should be one p wave preceding each QRS complex. More than one p wave before a QRS complex indicates a conduction disturbance. | 2,585 | medmcqa_train |
Physiological uncoupler is | Uncouplers will allow oxidation to proceed, but the energy instead of being trapped by phosphorylation Fig. 19.18. Impoant mitochondrial membrane transpoers. 1 = PYT (pyruvate transpoer); 2 = TCT (tricarboxylate transpoer); 3 = ANT (adenine nucleotide transpoer) is dissipated as heat. This is achieved by removal of the proton gradient. (Table 19.5; Fig. 19.17). The uncoupling of oxidative phosphorylation is useful biologically. In hibernating animals and in newborn human infants, the liberation of heat energy is required to maintain body temperature. In Brown adipose tissue, thermogenesis is achieved by this process. Thermogenin, a protein present in the inner mitochondrial membrane of adipocytes, provides an alternate pathway for protons. It is one of the uncoupling proteins (UCP). Thyroxine is also known to act as a physiological uncoupler.Ref: DM Vasudevan Textbook of Medical Biochemistry, 6th edition, page no: 234 | 2,586 | medmcqa_train |
A 55 year old diabetic man is brought to the emergency room in an unresponsive state. The following laboratory values are obtained: PCO2 19 mm Hg, HCO3 11 mEq/L, and pH 6.9. The most appropriate immediate treatment of this patient is ? | This patient is in a diabetic ketoacidotic coma. The goals in treating such a patient are to increase the rate of glucose utilization by insulin-dependent tissues, to reverse ketonemia and acidosis, and to replenish fluid imbalances. Oral hypoglycemic agents are commonly prescribed for the maintenance of NIDDM patients and would not be appropriate in an acute setting. Treatment with bicarbonate would result in only a transient elevation of pH. Since this is a life-threatening condition, monitoring the patient without treatment is unacceptable. Ref: D'Alessio D. (2011). Chapter 43. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycemia. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. | 2,587 | medmcqa_train |
Which of the following antibacterial drug is polar? | Ans. is 'a' i.e., Ampicillin Ampicillin: It is an ionized highly polar drug. In the duodenum it exes a zwitter ion effect and thus has a lower bioavailabilty. Though the oral absorption is incomplete it is adequate. It is an antibacterial drug acting both on gram positive and gram negative organisms. Main mode of excretion is by kidneys. It is paly excreted in bile and shows enterohepatic circulation. | 2,588 | medmcqa_train |
The main action of muscle "Gamellius" is? | Gemellus muscle laterally rotates the femur at the hip joint. Superior gemellus muscle: Attaches proximally at the ischial spine; distally, the muscle attaches on the greater trochanter of the femur. The nerve to the obturator internus and superior gemellus muscles (L5, S1, S2) innervates this muscle.Inferior gemellus muscle: Attaches proximally on the ischial spine; distally, the muscle attaches at the greater trochanter of the femur. The nerve to the inferior gemellus and quadratus femoris muscles (L4, L5, S1) innervates this muscle. | 2,589 | medmcqa_train |
A patient with pheochromocytoma would secrete which of the following in a higher concentration? | Ans. is 'a' i.e., Norepinephrine o Most pheochromocytomas contain and secrete both nor epinephrine and epinephrine and the percentage of norepine phrine is usually greater than in normal adrenal.Pheoch rornocvtom||AdrenalCan't suppress ACTHo Most of them secrete norepinephrineo Exclusively secrete nor epinephrine | 2,590 | medmcqa_train |
The structural abnormality of chromosome in which one arm is lost and remaining arm is duplicated is called: | b. Isochromosome(Ref: Nelson's 20/e p 590', Ghai 8/e p 637)Iso-chromosome results when 1 arm of a chromosome is lost and the remaining arm is duplicated or when the axis of division occurs perpendicular to the normal axis of division. | 2,591 | medmcqa_train |
Columella effect is seen in | Columella effect is seen in type 3 tympanoplasty (myringostapediopexy) where single ossicle remains just like that of bird&;s ear. In Type III tympanoplasty Malleus and incus are absent. Graft is placed directly on the stapes head. It is also called myringostapediopexy or columella tympanoplasty. Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition, page 30. | 2,592 | medmcqa_train |
A Patient with increased BP and decreased hea rate is likely to have | Cushing's reflex , is a physiological nervous system response to increased intra cranial pressure.Results in cushings triad - increased BP, irregular breathing and bradycardia. Usually seen in terminal stages of head injury . It can also be seen after iv administration of epinephrine. In head injury- CPP=MAP-ICP. CPP- cerebral perfusion pressure. MAP- Mean aerial pressure. ICP- intra cranial pressure Head injury causes increased ICP thus lowering CPP causing ischemia. When ICP approaches the level of mean systemic pressure , cerebral perfusion falls . Bodys response to fall in cerebral perfusion is raise systemic blood pressure and dialate cerebral vessels which increases cerebral blood volume and increases ICP followed by lowering CPP.And causes a vicious cycle. When aerial pressure lowers , a reflex called CNS ischaemic response is initiated by the hypothalamus . Hypothalamus activates sympathetic nervous system causing peripheral vasoconstriction and increased cardiac output. This increases aerial pressure and cerebral blood flow is restored. This response stimulates the baroreceptors in the carotid bodies thus slowing the hea rate drastically- bradycardia(baroreceptor reflex -refer image) 2) Marey's law- Explained by barereceptor reflex States that' hea rate is inversely propoional to blood pressue '(but not the vice versa) . Bainbridge reflex- infusion of saline or blood --- increased venous filling of atria--- stimulation of tachycardia producing atrial receptor(TPAR)---tachycardia | 2,593 | medmcqa_train |
Chloroquine is given as 600 mg loading dose because: | Oral absorption of CQ is excellent. About 50% gets bound in the plasma. It has high affinity for melanin and nuclear chromatin: gets tightly bound to these tissue constituents and is concentrated in liver, spleen, kidney, lungs (several hundred-fold), skin, leucocytes and some other tissues. Its selective accumulation in retina is responsible for the ocular toxicity seen with prolonged use. ESSENTIALS OF PHARMAXOLOGY page no.822 | 2,594 | medmcqa_train |
Treatment of acute lymphangitis requires: | Treatment of acute lymphangitis requires antibiotic and rest. | 2,595 | medmcqa_train |
Lisch nodules (Pigmented Iris hamartomas) are seen in | Ans. b (Neurofibromatosis) (Ref. Harrison's Internal Medicine 17th ed., Chapter 374; RRM 7th ed., p.316)# Lisch nodules (iris hamartoma) and Optic gliomas = NF-1.# Glaucoma = Sturge Weber syndome.# Retinal angiomas = VHL# GlaucomaNEUROFIBROMATOSIS# Autosomal dominant inherited disorder- pure neurofibromas (= tumor of nerve sheath with involvement of nerve, nerve fibers run through mass)- neurilemmomas (= nerve fibers diverge and course over the surface of the tumor mass)(a) localized neurofibroma (most common, 90%)(b) diffuse neurofibroma (mostly solitary + not associated with NF1)(c) plexiform neurofibroma (PATHOGNOMONIC of NF1)Peripheral Neurofibromatosis (90%) = NEUROFIBROMATOSIS TYPE 1 = von Recklinghausen disease# autosomal dominant with abnormalities localized to the pericentromeric region of chromosome 17.- CLASSIC TRIAD:- Cutaneous lesions- Skeletal deformity- CNS manifestations# CNS and ocular MANIFESTATIONS- Lisch nodules= melanocytic iris hamartomas <2 mm in size- Optic pathway glioma- Hydrocephalus (Aqueductal stenosis)- Vascular dysplasia= occlusion / stenosis of distal ICA, proximal MCA/ACA- Plexiform neurofibromas are PATHOGNOMONIC for NF1- Erosion of bony elements with marked posterior scalloping# SKELETAL MANIFESTATIONS (in 25-40%)- Harlequin appearance to orbit (empty orbit) = partial absence of greater and lesser wing of sphenoid + orbital plate of frontal bone- Sharply angled focal kyphoscoliosis (50%) in lower thoracic + lumbar spine- Pseudarthrosis after bowing fracture (particularly in tibia) in 1st year of life# Others:- Cafe-au-lait spots= pigmented cutaneous macules >6 in number, >5 mm in greatest diameter; Coast of California.; Freckling.- Progressive pulmonary interstitial fibrosis with lower lung field predominance (up to 20%)- Pheochromocytoma- Renal artery stenosis: very proximal- Malignant peripheral nerve sheath tumor - most common malignant abdominal tumor in NF1 | 2,596 | medmcqa_train |
All of the features of Wilson's disease, EXCEPT: | Ans. is 'b' Testicular atrophy Basic defect in Wilson's disease is|Reduced biliary exception of copper*|Cu accumulates in hepatocytes resulting in liver damage (Manifest almost all types of hepatitis* including fulminant hepatitis)|Liver cells get saturated with Cu|Cu spilled in plasma|Gets deposited in following organsBasal ganglia - Spasticity, Rigidity, Chorea (dysphagia, dysarthria, positive Babinski, abdominal reflex absent).Eye - Kayser Fleischer ring* present in descemet's membrane* of cornea.Some frequently asked facts about Wilson's diseaseAssociated with Coombs (-ve) hemolytic anemia*Sensory symptoms are characteristically absent*Testis never involved*Ceruloplasmin deficiency is important marker of disease* | 2,597 | medmcqa_train |
Valley fever or dese rheumatism is caused by? | Coccidioidomycosis (also called dese rheumatism or San Joaquin Valley fever or California fever) - A systemic fungal disease caused by a dimorphic soil dwelling fungus - Coccidioides Sporotrichosis or Rose Gardner's disease is chronic subcutaneous pyogranulomatous disease caused by a thermally dimorphic fungus Sporothrix schenckii. Chromoblastomycosis is a slowly progressing granulomatous infection caused by several soil fungi. These are Fonsecaea pedrosoi, Fonsecaea compactum, Cladosporium carrionii, and Phialophora verrucosa. Histoplasmosis or Darling's disease is caused by dimorphic fungus-Histoplasma capsulatum. | 2,598 | medmcqa_train |
Which one of the following is not an amide – | Esters (aminoesters) :- Procaine, chlorprocaine, tetracaine (amethocaine), Benzocaine, Cocaine.
Amides (aminoamides) Lignocaine, Mepivacaine, Prilocaine, Bupivacaine, Etidocaine, Ropivacaine , Dibucaine. | 2,599 | medmcqa_train |
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