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Phantom limp sensation are best described by
Ans. (d) Law of projection(Ref: Ganong, 25th ed/p.171)Law of projection:This law states that "No matter where a particular sensory pathway is stimulated along its course to the cortex, the conscious sensation produced is referred to the location of the receptor"This law explains phantom pain wherein Some of these patients may complain of pain and proprioceptive sensations in the absent limb following amputation
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Fusion inhibitor is-
Ans. is 'a' i.e., Enfuvirtide New drugs in HIV infection o Etravirine is recently approved NNRTI. This is the second generation NNRTI and is effective against HIV resistant to first generation NNRTI (Efavirenz, Delavirdine. Nevirapine). Fusion inhibitors (Entry inhibitors) o Enfuvirtide binds to Gp41 subunit of HIV envelop protein and inhibits the fusion of viral and host cell membrane. o Maraviroc is a CCR5 Co-receptor antagonist and is only active against "CCR - 5 - tropic virus" which tends to predominate early in infection. Integrase inhibitors o Raltegravir and Elvitegravir act by inhibiting enzyme integrase.
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All of the following are Water Borne Diseases except ?
Public Health Classification of Water Borne Diseases: Water borne diseases - Illnesses caused by micro-organisms, d/t drinking of untreated or contaminated water Typhoid Cholera Hepatitis- A E.coli Salmonella Water washed diseases - Infections that are caused by poor personal hygiene resulting from inadequate water availability. Conjunctivitis Trachoma Shigellosis, Scabies Typhus Water based diseases - Caused by parasites that spend pa of their life cycle in water. Dracunculiasis or Guinea worm disease Water breeding diseases - Insect related diseases which breed in water Malaria Dengue Filariasis (Mansonia) Trypanosomiasis Yellow fever
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ADH is released from: March 2013
Ans. B i.e. Posterior pituitaryArginine vasopressin (AVP)/Vasopressin/Argipressin/Antidiuretic hormone (ADH)It is a neurohypophysial hormone.It is derived from a preprohormone precursor that is synthesized in the hypothalamus and stored in vesicles at theposterior pituitary.Its two primary functions are to retain water in the body and to constrict blood vessels.Vasopressin regulates the body's retention of water by acting to increase water absorption in the collecting ducts of the kidney nephron
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Case control study is-
.<p>case control studies are usually retrospective studies that proceed from an effect to a cause.</p><p>ref:park&;s textbook of preventive and social medicine,22 nd edition ,pg no 131</p>
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Cystitis is most commonly caused by
(E. coli): Ref: 173-S* The organisms found in urine in cystitis are the E. coli, streptococci, staphylococci and B. proteus, the tubercle bacillus, and occasionally pseudomonas pyocyanea, Gonococcal cystitis is relatively rare, and almost invariably follows instrumentation.* The organism which is found most frequently is the E. coli* As the result of antibiotic treatments Pseudomonas, pyocyanea sometimes become the dominant infecting organism because of its resistance to antibiotics relative to the other infecting organisms.
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Inversion & Eversion of foot occurs at which joint?
#NAME?
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The head quaers of UNESCO is located in
The United Nations Educational, Scientific and Cultural Organization (UNESCO is a specialized agency of the United nations (UN) based in Paris , France. Its declared purpose is to contribute to promoting international collaboration in education, sciences, and culture in order to increase universal respect for justice, the rule of law , and human rights .
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A young pregnant mother at 32 weeks gestation presents in preterm labor. Antenatal steroid to induce fetal lung maturity is indicated in all of the following conditions, EXCEPT:
Patient in the clinical scenario is in preterm labour. For patients in 32 weeks of gestation, steroids are given to induce lung maturity. But if the patient is having chorioamnionitis, steroids are contraindicated, as steroids can accelerate the infection. Chorioamnionitis can be diagnosed clinically by the presence of maternal fever, tachycardia and uterine tenderness. When this is diagnosed, fetal and maternal morbidities increase and delivery is indicated, regardless of the fetal gestational age. Ampicillin is the drug of choice to treat group B streptococcal infection. Ref: Williams Obstetrics, 22nd Edition, Pages 864-5 ; Textbook of Obstetrics By DC Dutta, 6th Education, Pages 317-8
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Trochlear nerve all true except
Trochlear nerve is thinnest nerve. It is the only nerve to emerge from dorsum of brain stem has longest intracranial course. It enters orbit through outer part of superior orbital fissure (ie lateral to annulus of Zinn) and supplies superior oblique muscle. Because it's a crossed cranial nerve (with decussation in mid brain), the trochlear nerve nucleus supplied contralateral superior oblique muscle.
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Gardener&;s syndrome is a rare hereditary disorder involving the colon. It is characterized by
.GARDNER'S SYNDROME * It is commonly associated with FAP - 10%. * Presents with bone, skin, soft tissue and dental abnormalities. Jaw osteomas are very common. Other features are epidermoid cysts (50%), exostoses, fibromas, lipomas. * Associated with desmoid tumours seen in the scar, abdomen, intraabdominal region and mesenteric fibromatosis. * Congenital hyperophy of pigment layer of retina (seen as pigment spots)--commonly seen. * Often associated with MEN IIb syndrome. ref:SRB&;s manual of surgery,ed 3,pg no 834
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Surgical alteration or suturing of gunshot wounds may create problems in distinguishing entry from exit. This is called as: AIIMS 13
Ans. Kennedy phenomenon
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Treatment of choice for annular pancrease is
Pancreatic ring surrounds the second or third pa of duodenum. The usual treatment is duodenoduodenostomy. Bailey & Love ,26th,1125
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An old lady was brought to the ER in an unconscious state. She has a history of previous such attacks in the past months. An ECG was done and the graph obtained is given below. Which of the following is most probable cause?
Ans. D. 2:1 blockElectrocardiography and Electrophysiology of AV conduction blockAV conduction block typically is diagnosed electrocardiographically, which characterizes the severity of the conduction disturbances and allows one to draw inferences about the location of the block. AV conduction block manifests as slow conduction in its mildest forms and failure to conduct, either intermittent of persistently, in more severe varieties.a. First degree AV block (PR interval >200ms) is a slowing of conduction through the AV junction. The site of delay is typically in the AV node but may be in the atria, bundle of his, or his Purkinje system. A wide QRS is suggestive of delay in the AV node proper or less commonly in the bundle of His. In second degree AV block there is an intermittent failure of electrical impulse conduction from atrium to ventricle.b. Second degree AV block is sub classified as Mobitz type I (Wenckebach) or Mobitz type II. The periodic failure of conduction in Mobitz, type I block is characterized by a progressively lengthening PR interval, shortening of the RR interval, and a pause that is less than the two times the immediately preceding RR interval on the electrocardiogram (ECG). The ECG complex after the pause exhibits a shorter PR interval than that immediately preceding the pause. This ECG pattern most often arises because of decremental conduction of electrical impulses in the AV node.
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Syndrome of apparent mineralocoicoid excess is due to?
Coisol can stimulate mineralocoicoid receptors. But renal inactivation of coisol occurs to form coisone and thereby BP remains normal. SAME (Syndrome of Apparent Mineralocoicoid Excess) leads to lack of this inactivation. The resultant increase in coisol leads to excess activation of mineralocoicoid receptor and results in hypeension.
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First sign of compament syndrome is ?
Ans. is 'a' i.e., Pain Clinical features of compament syndrome Four signs are reliable in diagnosing a compament syndrome :- Paresthesia or hypesthesia in nerves traversing the compament Pain with passive stretching of the involved muscles (stretch pain) Pain with active flexion of the muscles Tenderness over the compament Amongst these, stretch pain is the earliest sign of impending compament syndrome. The ischemic muscles, when stretched, give rise to pain. Passive extension of fingers (streching the fingers) produce pain in flexor compament of forearm. Other features are Pulselessness, paralysis, Pallor and pain out of propoion to physical findings. Peripheral pulses, are present initially and disappear later. Therefore, pulse is not a reliable indicator for compament syndrome.
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Apa from T & B lymphocytes, the other class of lymphocytes is -
Lymphocytes include natural killer cells (NK cells) (which function in cell-mediated, cytotoxic innate immunity), T cells (for cell-mediated, cytotoxic adaptive immunity), and B cells (for humoral, antibody-driven adaptive immunity). Reff: Ananthanarayanan & panikers textbook of microbiology 9th edition pg:132
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Damage to median nerv e produces -
Ans. is 'c' i.e., Ape thumbDeformity' or disorderNerve involvedo Wrist dropo Radial nerveo Foot dropo Common peroneal nerve (Lateral popliteal)o Claw hand (complete)o Ulnar + Median nerveo Ulnar claw hando Ulnar nerveo Ape thumb deformityo Median nerveo Pointing indexo Median nerveo Policeman tip deformity'o Erb's Palsy (Brachial plexus)o Winging of scapulao Long thoracic nerve (nerve to SA)o Meralgia parestheticao Lateral cutaneous nerve of thigh
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A 31-year-old patient complains of sensory loss over the anterior and posterior surfaces of the medial third of the hand and the medial one and one-half fingers. He is diagnosed by a physician as having "funny bone" symptoms. Which of the following nerves is injured?
Ulnar nerve supplies sensory fibers to the skin over the palmar and dorsal surfaces of the medial third of the hand and the medial one and one-half fingers. Funny bone sensation is irritation of a nerve at the elbow that causes numbness and tingling of the inner elbow, forearm as well as little and ring fingers Median nerve innervates the skin of the lateral side of the palm; the palmar side of the lateral three and one-half fingers; and the dorsal side of the index finger, the middle finger, and one-half of the ring finger. Radial nerve innervates the skin of the radial side of the hand and the radial two and one-half digits over the proximal phalanx.
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A 6 year old female patient complains of pain due to a decayed lower right 2nd molar. She has a history of unpleasant dental extraction with the lower left second molar. On seeing the dentist, the child immediately cries and withdraws. Which theory of child psychology best explains the reaction of the patient?
Classical conditioning (1927) occurs readily with young children and can have a considerable impact on a young child's behavior on the first visit to a dental office. By the time a child is brought for the first visit to a dentist, even if that visit is at an early age, it is highly likely that he or she will have had many experiences with pediatricians and medical personnel. When a child experiences pain, the reflex reaction is crying and withdrawal. In Pavlovian terms, the infliction of pain is an unconditioned stimulus, but a number of aspects of the setting in which the pain occurs can come to be associated with this unconditioned stimulus. For instance, it is unusual for a child to encounter people who are dressed entirely in white uniforms or long white coats. If the unconditioned stimulus of painful treatment comes to be associated with the conditioned stimulus of white coats, a child may cry and withdraw immediately at the first sight of a white-coated dentist or dental assistant. In this case, the child has learned to associate the conditioned stimulus of pain and the unconditioned stimulus of a white-coated adult, and the mere sight of the white coat is enough to produce the reflex behavior initially associated with pain Note: A) Acquisition – learning a new experience (fear of dentist/whitecoat/needles)            B) Generalization – generalizing all similar stimuli (all those wearing white coat cause pain)            C) Discrimination – differentiating individual stimuli ( not everyone who wears white coat causes pain)            D) Extinction - disappearance of the acquired experience ( loss of fear of dental procedures)            E) Spontaneous recovery – reappearance of extinct response ( fear of dental procedure reappears due to poor management behaviour strategies).
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Mirena (LNG IUCD) has to be replaced after :
Mirena (LNG IUD) contains a total of 52 mg levonorgestrel (LNG) LNG is released into the uterine cavity at a rate of approximately 20 microgram/day. Act mainly by local progestogenic effects Effective for up to 5 years.
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5 year old Boy with something coming out of the anus with pedicle attached to rectal/ anal wall and bright red bleeding- most common diagnosis -
Ans. is 'a' i.e., Juvenile rectal Polyp * Juvenile polyps are the most common type of childhood polyp, occurring in up to 1% of preschool children. They are usually solitary polyps found in the rectum which most commonly present with rectal bleeding.* These are hamartomatous polyps, which are usually pedunculated but can be sessile.* "The typical child with a juvenile polyp is 4 to 6 years of age, presents with intermittent painless rectal bleeding with bowel movements."- Rudolph's Pediatrics* Juvenile polyps are usually are not premalignant.* Because the gross appearance of these polyps is identical to adenomatous polyps, these lesions should also be treated by polypectomy.
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Glutathione requires which vitamin to act as antioxidant -
Ans. is 'b' i.e., Niacin o Option a, c & d are themselves antioxidants, but glutatbion requires niacin as NADPH.o NADPH is necessary tor the maintenance of a reducing environment in the cell.o NADPH plays a key role in antioxidant defences by converting the oxidized glutathione into the reduced glutathione, which is protective.
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Oral contraceptive pills decrease incidence of all of the following conditions except :
Hepatic adenoma
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A 14 year old boy with difficulty in walking and behavioural disturbance, recovered from prolonged jaundice recently, has bluish pigmentation over lunula. The next investigation to be done:
Neurological involvement + Jaundice + Azure Nails (Bluish discoloration of nails) = Wilson's disease Dx: Slit lamp examination and 24 hrs urinary copper Rx: for Neurological feature - Tetrathiomolybdate
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Intra-aerial calcium gluconate infusion is used in the management of burns caused by
Hydrofluoric acid causes Hypocalcemia. Calcium based therapies are main stay of treating Hydrofluoric acid burns. Topical application of calcium gluconate onto wounds and IV administration of calcium gluconate for systemic symptoms. Intra-aerial calcium gluconate infusion provides effective treatment of progressive tissue injury and intense pain.
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A 2-year-old female child was brought to a PHC with a history of cough and fever for 4 days with inability to drink for last 12 hours. On examination, the child was having weight of 5 kg, and respiratory rate of 45/minute with fever. The child will be classified as suffering from:
The child is unable to drink water for 12hrs & weight of the child is 5kg which is less than expected (12kg), which shows severe malnutrition. Inability to drink constitutes a danger sign amongst the clinical manifestations and classifies the pneumonia as very severe disease. Ref: Park's Textbook Of Preventive And Social Medicine By K. Park, 19th Edition, Page 146; Park's Textbook Of Preventive And Social Medicine By K. Park, 18th Edition, Page 142, 143
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Familial amylodotic polyneuropathy is due to amyloidosis of nerves caused by deposition of
Ref Robbins 9/e p259 Familial (Hereditary) Amyloidosis A variety of familial forms of amyloidosis have been described; most are rare and occur in limited geographic areas. The best-characterized is an autosomal recessive condition called familial Mediterranean fever. This is a febrile disorder characterized by attacks of fever ccompanied by inflammation of serosal surfaces, includ- ing peritoneum, pleura, and synol membrane. This dis- order is encountered largely in persons of Armenian, Sephardic Jewish, and Arabic origins. It is associated with widespread tissue involvement indistinguishable from reactive systemic amyloidosis. The amyloid fibril proteins are made up of AA proteins, suggesting that this form of amyloidosis is related to the recurrent bouts of inflamma- tion that characterize this disease. The gene for familial Mediterranean fever is called pyrin and encodes a protein that is a component of the inflammasome (Chapter 2). Patients have gain-of-function mutations in pyrin that result in constitutive overproduction of the pro- inflammatory cytokine IL-1 and persistent inflammation. In contrast with familial Mediterranean fever, a group of autosomal dominant familial disorders is characterized by deposition of amyloid predominantly in the peripheral and autonomic nerves. These familial amyloidotic poly- neuropathies have been described in kindreds in different pas of the world--for example, in Pougal, Japan, Sweden, and the United States. As mentioned previously, the fibrils in these familial polyneuropathies are made up of mutant forms of transthyretin (ATTRs).
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Which of the following is not a presumptive sign of pregnancy -
Ans. is 'b' i.e., Dalrymple's sign o The following are presumptive signs for diagnosis of pregnancy:# Breast changes: Enlargement with vascular changes with delicate veins visible under the skin.# Jacquemier's sign/Chadwick's sign: Dusky hue of the vestibule and anterior vaginal wall, due to local congestion.# Osiander's sign: Increased pulsation felt through the lateral fomices at 8th week.# GoodelVs sign : Cervix becomes soft as early as 6th week.# Piskacek's sign : Assymetrical enlargement of the uterus if there is lateral implantation.# Hegar's sign: Approximationo of fingers placed on the abdomen and in the anterior fornix.# Palmer's sign: Regular, rhythmic uterine contraction during bimanual examination
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False about Hyperophic gastropathy is
It is seen in menetriers disease&ZES &it associated with malignancies & it form cribriform rugacitu on stomach. The condition needs to be differentiated from other forms of hyperophic gastropathy such as Zollinger-Ellison syndrome, hyperophic hypersecretory gastropathy, lymphocytic gastritis, or gastric carcinoma MALTomas are the tumors referred to as lymphomas of mucosa- associated lymphoid tissue. REFERANCE. menetrier's disease
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Body temperature regulation centre is located at
Anterior hypothalamus, responds to heat;Posterior hypothalamus, responds to cold. Ref: Ganongs Review of medical physiology;25 th edition ; pg :309; table 17-1.
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High Air velocity is measured by -
Ans. is 'b' i.e.. Anemometer
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A destitute woman is admitted to the hospital with altered sensorium and dehydration; urine analysis shows mild proteinuria and no sugar; what other test would be desirable:
Women in the question stem with altered sensorium and dehydration is suffering from ketoacidosis. Absence of sugar exclude the diagnosis of diabetic ketoacidosis. So ketosis could be due to starvation which can be detected by Rotheras test. During starvation acetylCoA takes alternate fate to form ketone bodies. Ref: Textbook of Biochemistry By DM Vasudevan, 3rd Edition, Pages 131, 440 ; Textbook of Medical Biochemistry By Chatterjee, 4th Edition, Pages 677- 679
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A sixteen year old boy receives a superficial cut on the thumb side of his forearm. The superficial vein most likely affected is the?
There are two large cutaneous veins running up the arm. Both veins take origin from the dorsal venous arch of the hand and run up the lateral and medial sides of the arm. On the medial side (near the 5th digit) there is the basilic vein. On the lateral side (by the thumb), there is the cephalic vein. Since the infection is on the thumb side of the forearm, the correct answer is the cephalic vein. The median antebrachial vein runs down the center of the anterior forearm. The median cubital vein connects the cephalic vein to the basilic vein in the cubital fossa.
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Defect in Snurps causes-
Ans. is 'b' i.e., Thalassemiao Defective splicing (defect in snurps) is the most common mutation causing thalassemia,o Molecular defect in pathogens is of thalassemia:-b-Thalassemiao Most common type of genetic abnormality in b-thalassemia is point mutation i.e., nonsense.o Some may also occur due to deletion or insertion i.e., frame shift mutations,o Defect may occur at different steps of b-chain synthesis:i) Splicing mutationso Mutations leading to aberrant splicing are the most common cause of b-thalassemia.ii) Chain terminator mutationso This cause premature termination of mRNA translation.iii) Promoter region mutationso This results in transcription defect.a-Thalassemiao The most common cause of reduced a-chain synthesis is deletion of a-globin genes,o Rarely nonsense mutation may also cause a-thalassemia.
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Not true about Red degeneration of myomas is-
Ans. is 'b' ie immediate surgical intervention needed Red degenerationis the most frequent* complication of myomas during pregnancy.The tumour assumes a peculiar purple red colour.It usually occurs due to thrombosis of large veins in the tumour.it has a peculiar fishy odour*Clinical featuresAcute onset of pain over the tumour*Malaise or even rise of temperature*Tenderness or rigidity over the tumourBlood count shows Leucocytosis*Rapid pulseConstipationTreatmentMainly conservative*Analgesics & sedativesAmpicillinThe symptoms usually clear off within 10 days.Surgery is not required even when laparotomy is done with mistaken diagnosis, abdomen is to be closed without doing anything.
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Which of the following is not supplied by C8 T1 -
Small muscles of hand include- Thenar, Hypothenar, interossei and lumbricals. They are supplied by C8-T1. Extensor indicis is supplied by C7, C8
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All the following enzymes activity is increased in fasting state except
MetabolismRegulatory enzymesLipid metabolism Fatty acid oxidation Carnitine acyltransferase 1KetogenesisHMG CoA synthaseLipolysis Hormone-sensitive lipaseCarbohydrate metabolism Glycogenolysis Glycogen phosphorylase Gluconeogenesis Pyruvate carboxylase Phosphoenol pyruvate carboxykinase (PEPCK)Fructose1,6 bisphosphataseGlucose-6-phosphatase(Refer: DM Vasudevan, Textbook of Biochemistry, 7th edition, pg no: 102-103)
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Anaesthetic agent not metabolized by body is?
Ans. (a) N20Ref: Miller's 7thedch: 24
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Which of the following is not true about hydroquinone?
Ans. is'd'i.e., It should not be used for melasma or chloasma of pregnancy .Ref: KDT Vhle p. 8921Hydroquinone:It is a weak hypopigmentation agent.Inhibits tyrosinase and other melanin forming enzymes, decreases formation of and increases degradation of melanosomes.Regular application (as 2-6% lotion or cream) for months is required in melasma, chloasma of pregnancy, etc.
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A pelvis characterized by an anteroposterior diameter of the inlet greater than the transverse diameter is classified as:
Ans. C. AnthropoidBy tradition, pelvis are classified as belonging to one of four major groups. The gynecoid pelvis is the classic female pelvis with a posterior sagittal diameter of the inlet only slightly shorter than the anterior sagittal diameter. In the android pelvis, the posterior sagittal diameter at the inlet is much shorter than the anterior sagittal diameter, limiting the use of the posterior space by the fetal head. In the anthropoid pelvis, the anteroposterior (AP) diameter of the inlet is greater than the transverse diameter, resulting in an oval with large sacrosciatic notches and convergent side walls. Ischial spines are likely to be prominent. The platypelloid pelvis is flattened with a short AP and wide transverse diameter. Wide sacrosciatic notches are common. The pelves of most women do not fall into a pure type and are blends of one or more of the above types.
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Celiac plexus block all the following is true except ?
Ans. is 'd' i.e., Can be given only by retrocrural (classic) approach Celiac plexus block can be done by following three approaches : Retrocrural (classic) approach, anterocrural approach and splanchnic nerve block. See explanation- 4 of session- 8 of Anaesthesia of All India 2014-15 pattern of this book.
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All of the following are the disadvantages of anesthetic ether, except
Ether has high blood solubility (high blood : gas partition coefficient) → induction is slow. It is irritant in nature and increases salivary & respiratory secretions. Blood pressure is maintained because of reflex stimulation and high sympathetic tone. It does not sensitizes the heart to arrhythmogenic action of adrenaline It is highly inflammable, cautery should not be used.
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Minimum fluid collection required for radiological detection of pleural effusion in lateral decubitus view is: September 2009
Ans. Amount of pleural fluid required to cause a blunted costophrenic angle discernible on chest radiography is more than 300 ml. A chest computerized tomography scan is more sensitive than a simple chest x-ray and is often used for assessment of loculated effusions because, in some instances, up to 500 cc of loculated fluid can be obscured behind the dome of the diaphragm
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Pseudopolyps are features of –
Ulcerative colitis Ulcerative colitis is an inflammatory bowel disease characterized by - Inflammation involving only the mucosa and submucosa Formation of pseudopolyps Involvement is in a continuous fashion (absent of skip lesions which are characteristic of CD) Ulcerative colitis involves the rectum and extends proximally in a retrograde fashion to involve the entire colon (pancolitis) in more severe cases.
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Coracoid process of the scapula is:
Ans. C Atavistic epiphysisRef: Clinical Anatomy, Kulkarni 2nd ed. P 73TYPES OF EPIPHYSIS* Pressure: Seen at the end of long bones subjected to pressure. E.g. Femur, head of humerus, condyles of tibia and femur.* Traction: Formed due to pull of muscles. E.g. Mastoid process, tibial tuberosity, tubercles, trochanters.* Atavistic: Functional in lower animals. Degenerated in humans e.g. Coracoid process of scapula, os trigonum of talus* Abberant: It is an extra epiphysis. E.g. Proximal end of 1st metacarpal bone.
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Which of the following is the least likely cause of infant moality rate?
The principal causes of infant moality in India are low bih weight (57%), respiratory infections (17%), diarrhoeal diseases(4%), congenital malformations (5%), cord infections (2%), bih injury (3%) Park 23e pg:569
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Mittelschimerz pain is -
Ans. is 'b' i.e., Pain during the usual time of ovulation in menstrual cycle o Has been explained in previous sessions.
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Osteoporosis is seen in all the following except-
Osteoporosis It refers to reduction ofbone mass per unit volume (loss of matrix and defective mineralisation) (Fig. 9.47). Aetiology 1.Involutional 2.Endocrinological 3.Gastrointestinal 4.Haematological 5.Rheumatological 6.Collagen vascular Normal bone Type I (postmenopausal) and Type II (senile) Hypehyroidism Hyperparathyroidism Diabetes mellitus Hypogonadism Cushing's syndrome Malnutrition Malabsorption Anorexia nervosa Multiple myeloma Mastocytosis Rheumatoid ahritis Marfan's syndrome Ehler-Danlos syndrome Osteogenesis imperfecta Osteoporosis Fig. 9.47 Anticonvulsants Steroids Vitamin A Alcohol Heparin Furosemide Thyroid hormone in excessive doses Lithium GnRH agonist Cyclosporin Cytotoxic drugs 8.Cigarette smoking 9.Glucocoicoid therapy 10.Hypogonadism 11.Alcoholism 12.Renal disease 13.GI/Hepatic disorders. Bone forming agents a.Fluoride--75 mg/day b.Anabolic steroids: Testosterone is used in the treatment of osteoporotic man with gonadal deficiency. R ALAGAPPAN MANUAL OF PRACTICAL MEDICINE FOUH EDITION PAGE NO-690
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All local anesthetic produces vasodilation on local application except
Cocaine is a vasoconstrictor as it is sympathomimetic. * Cocaine was the first local Anesthetic to be used clinically. IT is only natural local anesthetic. Koller introduced this in the field of ophthalmology. It is the only local anesthetic with vasoconstrictor action. It is sympathomimetic and inhibits metabolism of catecholamine. * Procaine - 1st synthetic local anesthetic. It is used primarily to reduce the pain of intramuscular injection of penicillin. * Chloroprocaine - It is shoest acting local anesthetic used for sho procedures * Benzocaine - Is a common ingredient in topical sprays, can also cause methemeglobinamia. (See complications) * Tetracaine - Also called amethocaine mostly used topically.
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Which is not elevated in a child presenting with icterus, Pruritus and clay coloured stools
The child is suffering from obstructive jaundice or Cholestasis Enzymes elevated in Chloestasis ALP 5'-Nucleotidase Gamma glutamyl transpeptidase Ref: Harrison's 19th edition Pg no : 1997
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Distal muscles of the hand needed for fine wrok are controlled by-
Ans. is 'c' i.e., Ulnar nerve * Ulnar nerve is also known as musicians nerve as it is needed to carry out fine and precision movements of the hand.
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Diagnostic feature of parathyroid carcinoma is
Parathyroid carcinomas may be circumscribed lesions that are difficult to distinguish from adenomas. Cells are usually uniform and resemble normal parathyroid cells and of enclosed in a capsule. Diagnosis of carcinoma based on cytologic detail is unreliable , and invasion of surrounding tissues and metastasis are the only reliable criteria. Ref: Robbins and cotrans 9e Pg 1102
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D.I.C. is seen in-
Answwr is option 1 Abstract Malignancy is associated with a "hypercoagulable" state and a high risk for thrombohemorrhagic complications. Clinical complications may range from localized thrombosis to bleeding of varying degrees of severity because of disseminated intravascular coagulation (DIC). Life-threatening bleeding is frequent in acute leukemias, paicularly in acute promyelocytic leukemia (APL). Laboratory assessments show profound hemostatic imbalance in this condition, with activation of coagulation, fibrinolysis, and nonspecific proteolysis systems. Ref Robbins 9/e pg 455
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The most common ocular motility defect noted in ocular Graves' disease is due to involvement of:
Ans. Inferior rectus
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Drug of choice for neurogenic diabetes insipidus
Desmopressin is used to treat neurogenic diabetes insipidus, bedwetting, hemophilia A, von Willebrand disease it acts as an agonist to vasopressin receptor or ADH receptor- produce antidiuresis- less urine production-used in DI, bedwetting, vasoconstriction - used in esophageal varices and produces vwf- used in von Willebrand disease ref KD Tripathi 8th ed
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A 20 Yr old male presented with repeated episodes of hemetemesis. There is no history of jaundice or liver decompensation. On examination the significant findings include splenomegaly (8cms below costal margin), and presence of esophageal varices. There is no ascites or peptic ulceration. The liver function tests are normal. The most likely diagnosis is
Non cirrhotic poal fibrosis Condition of liver characterized by widespread fibrosis of liver(mainly poal, subcapsular and rarely perisinusoidal) causing wide variation in normal architecture There is no true cirrhosis Etiology Chronic ingestion of arsenic, copper, vinyl chloride Clinical features Youny age patient with features of poal hypeension with conspicuous absence of liver cell failure Patient are usually on 2nd or 3rd decade Onset of symptoms is gradual Most common presenting symptom is GI bleed (90% cases) Splenomegaly Jaundice, Hepatomegaly, ascites and stigmata of liver cell failure are uncommon Diagnosis Site of block is smaller branches (3rd or 4th order branches) Ultrasound shows normal splenopoal axis. Withered tree appearance and peripoal fibrosis is seen in NCPF Ref: Blumga 5th edition Pgno : 1099-1105
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Which electrolyte should be replenished in hyperophic pyloric stenosis ?
Hypochloremic, hypokalemic metabolic alkalosis is the classic electrolyte and acid-base imbalance of pyloric stenosis. This prolonged vomiting causes progressive loss of fluids rich in hydrochloric acid, which causes the kidneys to retain hydrogen ions in or of potassium. Reference: GHAI Essential pediatrics, 8th edition
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Feed forward mechanism is employmed in regulation of:
Feed forward control ,in which no stimulus is required but the system still anticipates and makes changes.it is also known as anticipatory control or adaptive control .It is seen in: Temperature regulation Cephalic phase of gastric acid secretion Role of cerebellum in motor coordination Thinking about exercise Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:7
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Perifascicular atrophy is seen in –
Muscle biopsy in dermatomyositis shows myonecrosis, myophagocytosis and perifascicular atrophy.
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Antenatal screening is done using the following except :
Peripheral lymphocytes
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The intra-abdominal pressure during laparoscopy should be set between:-
Laparoscopy Needle used for pneumoperitoneum veress needle Most commonly used gas: CO2 Flow of gas: 1L /min Intra-abdominal pressure: 12-15 mm Hg Trocar is inseed at or just below the umbilicus penetrating skin, superficial & deep fascia, fascia transversals & parietal peritoneum
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Cells which surround the oocyte in Graafian follicle are called:
Oocyte lies eccentrically in the ovarian (Graafian) follicle surrounded by some granulosa cells called cumulus oophorus. Discus proligerus is the attachment point of the cumulus oophorus to the most peripheral granulosa cells of an antral follicle. Large fluid-filled antrum (A) Cumulus oophorus (CO) Membrane granulose (stratum granulose, SG)
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In transtentorial herniation, a pa of the brain is displaced from the supratentorial to the infratentorial compament through the tentorial opening. It results in all of the following, EXCEPT:
The uncus (on the medial aspect of the temporal lobe) herniates under the tentorium cerebelli. The uncus can compress the oculomotor nerve (CN III), compromising the parasympathetic fibers and resulting in ipsilateral pupillary dilation with associated ophthalmoplegia ("down and out"). Cheyne-Stokes respirations are commonly seen with mesial temporal transtentorial herniation. If the uncus is forced fuher medially, it compresses the cerebral peduncle, producing contralateral hemiparesis. After the brain herniates, the patients are decerebrate and comatose, have fixed and dilated pupils, and eye movements are absent. Ref: Cowan J.A., Thompson B. (2010). Chapter 36. Neurosurgery. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
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Drug of choice in thyrotoxicosis in pregnancy is :
Carbimazole
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Which of the following is the skeletal muscle relaxant of choice in liver and renal disease ?
Atracurium is degraded by both pH and temperature dependent Hofmann elimination (autolysis) and by ester hydrolysis; it therefore does not require a dosage adjustment in patients with renal or hepatic failure. However, acidosis and severe hypothermia decrease the rate of drug metabolism and should prompt dose reduction. Mivacurium is a sho-acting benzylisoquinoline with an onset of action comparable to atracurium but with one-third its duration of action, because of rapid hydrolysis by plasma pseudocholinesterase. However, patients with renal or hepatic insufficiency may have depressed pseudocholinesterase activity leading to delayed elimination. Vecuronium is an aminosteroid compound with an intermediate duration of action. It is hepatically metabolized to three active metabolites, all of which are eliminated by the kidney.
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Residual bodies are
lysosomes Residual bodies are nothing but secondary lysosomes with undigested wastes. The digested materials are diffused into the cell cytoplasm through the lysosomal membrane. (Ref: www.sivabio.50web.com)
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Measure of communicability of a disease -
Ans. is 'b' i.e., Secondary attect rate Secondary attack rateo SAR is defined as "the number of exposed persons developing the disease within the range of incubation period, following exposure to primary caseSAR =No of exposed persons developing disease within the range of the incubation period------------------------------------------Total number of exposed/susceptible contactx 100o The important features of SAR are:-i) The primary case is excluded from both the numerator and denominator.ii) Denominator is restricted to susceptible contacts of primary case.iii) In denominator, person should be suscetible - Immune person (to disease) are not susceptible to develop the disease, So they are excluded.iv) Disease should develop within the range of incubation period.o SAR is an important measure of communicability. Higher secondary attack rate means, more numbers of susceptible contacts are developing the disease after exposure to primary case. So, higher the SAR higher is the communicability (infectiousness) of disease.
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In Von Hippel-Lindau Syndrome, the retinal vascular tumours are often associated with intracranial hemangioblastoma. Which one of the following regions is associated with such vascular abnormalities in this syndrome'?
Answer is C (Cerebellum) Von Hipple-Lindau Syndrome is associated with haemangioblastomas of cerebellum, spinal cord, medulla or pons.
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Signature fracture of skull is seen in
DEPRESSED SKULL FRACTURE It is a common neurosurgical problem among the head injuries. It means fracture depression is more than the depth of inner table of the skull. Investigations: CT scan. Problems in depressed fracture Tear in the dura beneath Haematoma in the deeper plane Injury to the cerebrum Injury to the venous sinuses--may cause life-threatening haemorrhage. Fracture should not be elevated in such occasion, as it itself can precipitate bleeding Convulsions Meningitis Treatment Antibiotics, anticonvulsants. Elevation of the depressed fracture: Burr holes are made in the adjacent normal skull. Fracture is elevated. Bony fragments and necrotic materials are removed. Dural tear is closed with interrupted sutures. Ref: SRB's Manual of Surgery 5th edition Pgno : 1099
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True about intrauterine fetal death (IUD) :
Ans. is a, b and c i.e. Gas bubbles in great vessels; Overlapping of skull bone; and Decreased amniotic fluid volume
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Tetracycline inhibits protein synthesis by?
Ans. is 'b' i.e., Binding to 30 S subunit and inhibits binding of aminoacyl tRNA Tetracycline interact with small ribosomal subunits, blocking access of aminoacyl- tRNA to the mRNA-ribosome complex.
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Adverse effects of losaan are all EXCEPT -
Ans. is 'a' i.e., Angioedema
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Muscle's of anterior compament of leg is/ are:
Ans. (a) Peroneus teiusThe 4 muscles in the anterior compament of the leg are- the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis(Peroneus) teius
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40 years male with spherophakia is at risk for developing
(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 248) Phacomorphic glaucoma is an acute secondary angle-closure glaucoma caused by:Intumescent lens i.e., swollen cataractous lens due to rapid maturation of cataract or sometimes following traumatic rupture of the capsule is the main cause of phacomorphic glaucomaAnterior subluxation or dislocation of the lensSpherophakia (congenital small spherical lens) Phacomorphic glaucoma is the term used for secondary angle-closure glaucoma due to lens intumescence. The increase in lens thickness from an advanced cataract, a rapidly intumescent lens, or a traumatic cataract can lead to pupillary block and angle closure.
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Crystalline Lens is derived from (JIPMER May 2019)
- Eye ball have contribution from several structures - Neural plate ectoderm forms Neural tube form - CNS which have diencephalon pa of brain aExtension of diencephalon (optic sulcus) into eyeball form retina (optic cup) & optic nerve (optic stalk) - Neural plate ectoderm also forms - epithelium of ciliary body & iris muscle - Muscles of Iris - Sphincter pupillae, dilator pupillae - Eye ball have some contribution from surface ectoderm as well which gives Surface epithelium of cornea (1st layer) Eye lens - Most of derivatives in eyeball come from neural crest cells which gives Secondary mesoderm of eyeball - Forms sclera, choroid, ciliary body & Iris (not epithelium) - All other layers of cornea except 1st layer develops from N.C.C
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Morbid jealousy is associated with which addiction?
Ans. is 'a' i.e., Alcohol Morbid jealousy (Pathological jealousy)* Also referred to as delusional jealously, obsessive jealousy and Othello syndrome. This condition occurs when a person feels an unreasonable fear that a partner has been unfaithful, is presently unfaithful, or plans to be unfaithful.* Morbid jealousy can occur in alcoholism, Schizophrenia, manic phase of bipolar illness, OCD, depression, or anxiety disorder.Also knowAlcoholic paranoia falcohal induced psychotic disorder with delusions)* Alcoholic parania refers to alcohol induced psychotic disorder with delusions. Delusions in alcoholic paranoia are fixed, ie. Alcoholic paranoia is associated with fixed delusions. Patients develop delusion of either persecution or jealousy, accompanied by delusion of reference. Auditary hallucinations may occur but play a minor role.
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Tripod fracture is the name given for
Zygoma fracture is also known as tripod fracture. Clinical features of zygoma fracture Considerable swelling over zygomatic arch is common and makes clinical diagnosis more difficult. Flattening of malar prominence. Step-deformity of infraorbital margin. Anaesthesia in the distribution of infraorbital nerve. Trismus, due to depression of zygoma on the underlying coronoid process. Oblique palpebral fissure, due to the displacement of lateral palpebral ligament. Restricted ocular movement, due to entrapment of inferior rectus muscle. It may cause diplopia. Periorbital emphysema, due to escape of air from the maxillary sinus on nose-blowing. The mucosa of the maxillary sinus may be lacerated and cause epistaxis on that side. Fracture of the zygoma may or may not be painful to palpation and running a finger along the zygomatic arch may give a feel of a depressed fracture or a small dimple. The cheek may appear flattened compared to symmetry with the opposite side. This may be obvious immediately following trauma or several days later once swelling has subsided.
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Which of these are seen on Romanowsky stain
Ref : PJ Mehta 16/e p372,T. Singh 1/e p34 Ref Robbins 9/e pg 24 Romanowsky dyes are used for staining blood films,They are made up of combination of acid and basic dyes. The nucleus and neutrophils granules are basophilic and stains blue.hemoglobin is acidophilic and stains red. Various modification available are leishman's stain,Wright's stain, Giemsa and and Jenner's stain. Basophilic stripping,Howell jolly bodies and Cabot rings are seen by romanowsky stain
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In all of the found except:
Ans. (a) Measles cZef Park 22/e, p 154 In measles and whooping cough only cases are found with no carriers. Chronic carriers seen in: Typhoid Dysentery Hepatitis B Cerebrospinal meningitis Malaria Gonorrhea
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Which is the drug of choice for prophylaxis of meningococcal meningitis in pregnancy:
N. meningitidis is dangerous because it can cause Waterhouse Friderichsen syndrome & Addisonian crisis So, chemoprophylaxis is recommended Ceftriaxone as a single IM or IV injection is highly effective in carriage eradication and can be used at all ages and in pregnancy
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Regarding pleomorphic adenoma of salivary gland true statement (s) is /are
Eighty percent salivary neoplasms are in the parotids of which 80% are benign.Pleomorphic adenoma is more common in parotids(80%).It is more common in females in a ratio of 3:1.It is also called as mixed salivary tumour.Malignant transformation can occur in 3-5% in early tumours and 10% in long duration tumours.(15 or more years).Adenolymphoma is Wahin 's tumour. SRB,5th,414
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Least failure in sterilization occurs with :
The success rates are best when clips and rings are used and worst with electrocoagulation. TEXTBOOK OF GYNECOLOGY SHEILA BALAKRISHNAN SECOND EDITION PAGE NO 393
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Bowel can get strangulated in all of the following space, EXCEPT:
Omental bursa, paraduodenal recess and ileocolic recess are peritoneal recesses. Peritoneal recesses These are small pockets of the peritoneal cavity enclosed by small, inconstant folds of peritoneum. These are best observed in fetuses and are mostly obliterated in adults. Sometimes they persists to form potential sites for internal hernias and strangulation. These are: Lesser or omental bursa Duodenal recesses: includes superior duodenal recess, inferior duodenal recess, paraduodenal recess, retroduodenal recess, Duodenojejunal recess and mesenterico-parietal fossa (of waldeyer) Caecal fossa: Superior ileocaecal (or ileocolic) recess, Inferior ileocaecal (or ileocolic) recess and retrocaecal recess. Intersigmoid recess Ref: BDC Vol II, 3/e, Page 204.
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Low grade Central Nervous System tumour among the following is
(D) Meningioma # SPECTRUM OF CNS TUMORS range from Diffuse astrocytoma (grade ll/IV) Anaplastic astrocytoma (grade lll/IV) Glioblastoma (grade IV/IV)> Most meningiomas have a relatively low risk of recurrence or aggressive growth, and so are considered WHO grade l/IV.
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The risk of complex hyperplasia of endometrium with atypia progressing to malignancy in a postmenopausal woman is :
WHO classification of Progression to Carcinoma The risk of complex hyperplasia of endometrium with atypia progressing to malignancy in a postmenopausal woman is 29% Reference : Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; pg no: 248
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A female presents with 3 cm painless ulcer with raised edges on labia majora. Most common cause is: (E. REPEAT 2013)
Ref: E s sent to Is in Dermatology, 1st editionExplanation:* Presence of 3 cm ulcer with raised edges in the labia majora suggests Syphilis. (See the following table) SyphilisGranuloma Inguinale (Donovanosis)Chancroid(Soft sore. Soft Chancre, Ulcus molle)LymphogranulomaVenereumEtiologyTreponema pallidumCalymmatobacteriumdonovaniGram negative Obligate intracellularHemophilus ducreiChlamydia trachomatis (LI, L2 and L3 types)IncubationPeriodPrimary syphilis: 1-3 weeks Secondary syphilis: 6-12 weeks8-12 days(17 days average)3 days - 2 weeks (1-5 days average)3-30 daysClinicalSigns* Painless indurated* Single punched out* Usually non-bleeding* Lymph nodes are rubbery* Dark field microscopy* FTA-ABS - Most sensitive test and Earliest lest to become positive* VDRL* RPR liters* TPT - Most specific* TPH - 2nd most sensitive test* Painless genital ulcer* Soft. Beefy* Clean friable base* Distinct raised rolled margins* Massive scarring* Lymphatic obstruction* Pseudobubos(Subcutaneous granulomas not nodes)* Extremely painful. Suppurative ulcers of genital mucosa* Soft friable, non- indurated, ragged undermined edges* Foul smelling yellow grey exudate* Suppurative inguinal lymph nodes (Bubo)* Ito-Reenstierna test - Intradermal test* Skin or mucosal ulcer followed by ulcerated inguinal lymph nodes* "Sign of the groove"* Frei's Test: Intradermal test* Genital elephantiasis (Esthiomene)Pathology Hypertrophic ulcers Donovan Bodies (Safety pin shaped)Pyogenic ulcerationNecrotising granulomatous inflammation with stricture formationTreatmentPenicillin G -Drug of Choice forall stages of syphilisDoxycycline 100 mgBD for 3 weeksAzithromycin 1 gsingle oral dose (or)Ceftriaxone 250 mg1M single dose (or)Ciprofloxacin 500 mgbd for 3 daysDoxycycline 100 mgBD for 3 weeks
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Skeletal frame work of a cell is maintained by:
Ans. (b) Microtubules(Ref: Ganong, 25th ed/p.39)Microtubules provide structural support that can determine the shape of the cell and resist forces that tend to deform it
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systematic desensitization was introduced by
SYSTEMATIC DESENSITIZATION JOSEPH WOLPE Joseph Wolpe gave the concept of systematic desensitization This is a treatment used in phobia In phobia there is a conditioned fear response to aversive neutral stimulus and avoidance of that response leads to phobia Whenever there is a fear response there is stimulation of sympathetic system In that case stimulation of parasympathetic system by relaxation there is reduction in anxiety First step is to make a step ladder which are arranged based on the severity Then is go step by step and along with doing applied relaxation Slowly the the sympathetic system is reduced The patient will be able to approach stimulus without anxiety Ref. kaplon and sadock, synopsis of psychiatry, 11 th editio, pg no. 845
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Haabs striae are seen in-
Haabs striae -Tears and breaks in descemets membrane . These occur because Descemt's membrane is less elastic than the corneal stroma. Tears are usually peripheral, concentric with the limbus and appear as lines with double contour. Ref:Comprehensive ophthalmology-AK Khurana 6th edition chapter-10 page no:226
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Which of the following is not a minor diagnostic criteria for multiple myeloma?
Ans. (c) Plasmacytoma on biopsy(Ref: Wintrobes 12th/pg2377)Durie and Salmon criteria for diagnosis of Multiple myeloma.A minimum of 1 major and 1 minor criterion needed, although (1) + (a) is not sufficient, or 3 minor criteria that must include (a) and (b).However, International myeloma working group 2011 has revised the criteria as mentioned in pretexts.
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Frequency polygon is obtained by joining the points of
Ans. d (Histogram blocks) (Ref. Park PSM 22nd/ 788; Methods in Bio-statistics, by B. K. Mahajan 6th/p. 23)Quantitative data is presented by the following graphsQualitative or discrete or enumeration data is presented by the following graphs:# Histogram.# Bar diagram# Frequency polygon.# Pie or sector diagram# Frequency curve.# Pictogram# Line chart or graph.# Spot map# Cumulative frequency diagram (Ogive). # Scatter or dot diagram.
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Following are hepatotoxic anesthetic agents except-
Ans. is 'd' i.e.. Propofol o Following are the groups of hepatotoxic anesthetic agents:i) Group I: Drugs with well known hepatotoxic potential and containing Chlorine or bromine. Eg: chloroform,ii) Group II: Drugs which contain fluorine Eg: halothane, methoxyflurane. o Desflurane, enflurane, sevoflurane, isoflurane, nitrous oxide and carbon tetrachloride are also linked with hepatotoxic ity.
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Normal glomerular filtration rate is -
In man, resting glomerular filtration rate is about 125 ml/min (lSOL/day), the renal plasma flow is about 600 ml/min. Thus about one-fish (20%) of plasma passing through kidney is filtered„ i.e., a fraction of renal plasma flow that is filtered (filtration fraction)
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An elderly male presents with one episode of gross haematuria. All of the following investigations are recommended for investigating this patient except:
Answer is C (Urine tumor markers) Urine tumor markers are the single best answer of exclusion as these are neither sensitive nor specific enough to replace cystoscopy and cytology. 'Individuals older than 40 years of age who develop haematuria , should have a urine specimen for cytology and undergo cystoscopy and imaging of the urinary tract with an intravenous prelozram or CT Recommended investigations in individuals greater than 40 years who develop haematuria include: Devita/H16th Urinary cytologyQ for malignant cells Cvstocopy Imaging of the urinary tract with Intravenous Pyelogram or CT scanQ Other urine assay' (tumor markers) have been used to diagnose disease and follow up patients including flow cytometry, blood group antigens (Lewis x), cytokeratins, nuclear matrix proteins, Fibrin degradation products and telomerose. None is sensitive or specific enough to replace cystoscopy and urine cytology. - Devita
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Cold caloric test stimulates
Stimulation of semicircular canal produces nystagmus and the direction of nystagmus is determined by the plane of the canal being stimulated. In cold caloric test, the lateral semicircular canal is stimulated. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)
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Drug resistant in tuberculosis is due to ?
Drug resistance in M.tb is by Mutation in Chromosomes Metabolic defects occur as a result of mutation Eg - M.tb is normally catalase +ve INH resistant M.tb are Catalase -ve
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Cells present in Cerebellar coex are all except?
There are 5 types of neurons present in cerebellar coex:- Granule cell- Golgi cell- Basket cell - Stellate cell- Purkinje cellBipolar neurons are less common. A single axon and dendrite arise at opposite poles of the cell body. Their cell bodies are located in the retina, the olfactory epithelium, and the cochlear and vestibular ganglia.
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Telefono is
TELEFONO consists of repeated slapping of the sides of the head by open palms of the assailant this may cause rupture of ear drums. Ref : internet sources
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Rituximab is a targeted antibody against -
Ans. is 'a' i.e., CD 20 * Rituximab is a targeted antibody against cell surface molecule CD-20, i.e. Rituximab is anti CD-20 antibody.* It is used in:i) B-cell lymphomas Low grade lymphomas, mantle cell lymphomas, relapsed aggressive B cell lymphomas, CLLii) SLEiii) Rheumatoid arthritis
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