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A patient presented with a 3.5-cm size lymph node enlargement, which was hard and present in the submandibular region. Examination of the head and neck did not yield any lesion. Which of the following investigations should follow? | Suspected lymph node may have metastases from the upper aerodigestive tract. Since no lesion is found on physical examination of head and neck, triple endoscopy would be justified next. Supravital staining helps in selecting the site of biopsy in a lesion. As no lesion is discovered, it will not be very useful. | 3,900 | medmcqa_train |
Hour glass deformity is seen in - | Hour glass stomach is caused due to cicatracia contraction of a saddle shaped ulcer at the lesser curvature. | 3,901 | medmcqa_train |
Most common detion used in social medicine is- | Ans. is 'd' i.e., Standard detion "Standard detion is most common and generally most appropriate measure of dispersion (variation)". | 3,902 | medmcqa_train |
Which of the following is an investigation of choice to diagnose gall stones? | Ans. B. Ultrasound abdomenCholelithiasis involves the presence of gallstones which are concretions that form in the biliary tract, usually in the gallbladder. Choledocholithiasis refers to the presence of one or more gallstones in the common bile duct (CBD) Patients with uncomplicated cholelithiasis or simple biliary colic typically have normal laboratory test results, however these children should be investigated with haemoglobin, reticulocyte count, peripheral blood picture and other investigations to exclude haemolytic disease. Ultrasonography is the procedure of choice in suspected gallbladder or biliary disease. MRCP and ERCP have better accuracy than ultrasonography in diagnosing common bile duct stones. | 3,903 | medmcqa_train |
The Most common complication in varicose vein surgery is | (A) Ecchymosis # Complications of varicose vein surgery: Bruising and discomfort are common following removal of varices, especially where the veins were of very large diameter. However, the pain usually requires only mild analgesics. | 3,904 | medmcqa_train |
Females with orgasmic difficulties are advised following exercises to strengthen pubococcygealmuscles- | Ans. is 'a' i.e., Kegel's exercises o Kegels exercises are used to strengthen the pelvic floor muscles mainly pubococcygeal.o These exercises can thus be used to treat orgasmic difficulties and prevent genital prolapse. | 3,905 | medmcqa_train |
A 3 year old male presents with a skin rash and epistaxis. He has had several, severe sinopulmonary infections. A careful history reveals that his maternal uncle died of bleeding complications following an emergency cholecystectomy. What additional findings are likely in this case? | This clinical scenario is typical for Wiskott-Aldrich syndrome. This is a sex-linked recessive disorder presenting with the triad of thrombocytopenia, eczema, and recurrent sinopulmonary infections. Serum IgM levels are low but IgG, IgA, and IgE levels are increased. Patients have a defective response to polysaccharide antigens, which is due to a cytoskeletal defect in T cells that inhibits their binding to B cells. A CD4/CD8 ratio of < 1.5:1 is the pattern seen in AIDS due to selective tropism of the CD4+ T-helper cell population. Cerebellar ataxia is pa of the ataxia-telangiectasia syndrome. The ataxia develops between age 2 and 5. The defect is associated with a DNA repair enzyme deficiency. Elevated platelet count and increased serum levels of IgG, IgA, and IgE is not associated with a paicular syndrome. Polyclonal gammopathies result in an increase in immunoglobulin of more than one class. This benign alteration is frequently seen in viral or bacterial infections. Thrombocythemia may be associated with a myeloproliferative syndrome or with a secondary reactive process. Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 8. Immunology. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e. | 3,906 | medmcqa_train |
Age for regular mammography is | Screening mammography: For screening purpose it is done after 40 years. Early screening is indicated when there is family history of carcinoma breast or histological risk factor. Mammography before 35 years of age is usually not done unless there is a suspicious lump or a strong family history. Screening is done in asymptomatic female where even cancer is suspected. Ref; (page no; 515) 5th edition of SRB&;S manual of Surgery. | 3,907 | medmcqa_train |
The spine of the scapula can be palpated at which of the following level of veebrae? | Spine of the scapula lies at the level of T3 veebrae. Scapular spine is seen on the posterior surface of the scapula and it expands into a terminal process called acromion process. The scapulae overlie the posterior poion of the thoracic wall, and cover the upper seven ribs. The superior angle of scapula can be palpated at the T1 veebral level and the inferior angle lies at the level of T7 veebrae. | 3,908 | medmcqa_train |
NAD acts as a cofactor for | In the TCA cycle,Step 3. In the third step, isocitrate is oxidized and releases a molecule of carbon dioxide, leaving behind a five-carbon molecule--a-ketoglutarate. During this step, \text{NAD}^+NAD + N, A, D, sta superscript, plus, end superscript is reduced to form \text{NADH}NADHN, A, D, H. The enzyme catalyzing this step, isocitrate dehydrogenase, is impoant in regulating the speed of the citric acid cycle.Ref: DM Vasudevan, 6th edition, page no: 218 | 3,909 | medmcqa_train |
Criteria for a pancreas donor include: | - Combined liver-pancreas procurement should be routine, even if the right hepatic aery arises from the superior mesenteric aery. - In this situation, since the transplanted liver is the life-saving organ, the proximal superior mesenteric aery should remain with the liver and the distal superior mesenteric aery supplying the head of the pancreas can be reconstructed on a Y-graft of iliac aery with the splenic aery. - Successful pancreas transplantation can be performed using donors who have previously undergone splenectomy; however, there should be no significant pancreatitis and no history of diabetes in the donor. | 3,910 | medmcqa_train |
Indication for intramuscular iron therapy is | Refer KDT 6/e p 868 Drug of choice for acute iron poisoning is desferroxamine, however it has to be admistered parentarally It is not effective by oral route In beta thalassemia major iron excess can result due to repeated blood transfusions and massive Hemolysis Cheating agent has to be admistered for long time OK this case | 3,911 | medmcqa_train |
Beta 2 selective agonist are often effective in | Ref-KDT 6/e p127 Beta 2 agonist are useful in premature uterine contraction to delay labour and not for delayed labour. Beta blockers are used in the treatment of the angina | 3,912 | medmcqa_train |
Which of the following refers to the occurrence of hypehyroidism following administration of supplemental iodine to subjects with endemic iodine deficiency goiter? | Jod Basedow Effect: Refers to induction of thyrotoxicosis by iodine in the form of dietary supplements or medication, especially especially in patients who are relatively iodide deficient. Treatment includes combination of antithyroid drugs and perchlorate paicularly in amiodarone-induced thyrotoxicosis. Ref: Harrison's Internal Medicine, 18th Edition, Pages 2914, 2917, 2927, 2928, 2930 and 2932, Chapter 341 ; Acute Endocrinology: From Cause to Consequence By Greet Van Den Berghe, Page 9 ; Werner and Ingbar's Tthe Thyroid : A Fundamental and Clinical Text, Volume 549 By Lewis E. Braverman, 9th Edition, Page 548 ; Textbook of Cardiovascular Medicine, Volume 355 By Eric J. Topol, 3rd Edition, Page 598. | 3,913 | medmcqa_train |
Seoli cells play a key role in which of the following process | Seoli cells are elongated cells in the seminiferous tubules that ensheathe spermatogenic cells, providing a microenvironment that suppos spermiogenesis and spermatocytogenesis; they secrete androgen-binding protein and establish the blood-testis barrier by forming tight junctions with adjacent Seoli cells.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-419 | 3,914 | medmcqa_train |
According to WHO, crede's method is applied for prophylactic use in ophthalmia neonatorum, is | (Silver nitrate solution): Ref: 164-65-P, 71-KHOPHTHALMIA - NEONATORUM: any discharge or even watering from the eyes in the first week of life should arouse suspion of ophthalmia neonatorum* Use of either 1% tetracycline ointment or 0.5% erythromycin ointment or 1% silver nitrate solution (Crede's method) into the eyes of the babies immediately after birth* Single injection of ceftriazone 50 mg/Kg IV or IV (not to exceed 125 mg) should be given to infants born to mothers with untreated gonococcal infections. | 3,915 | medmcqa_train |
A 6-week pregnant lady is diagnosed with sputum positive TB. Best management is - | Ans. is 'b' i.e., Start Category I ATT in first trimester * Tuberculosis during pregnancy should be diagnosed promptly and as early as possible. Late diagnosis and care is associated with 4-fold increase in obstetric morbidity and 9-fold increase in preterm labor.* Poor nutritional states, hypoproteinemia, anemia and associated medical conditions add to maternal morbidity and mortality.* True congenital TB is believed to be rare. A fetus can get TB infection either by hematogenous spread through umbilical vein or by ingestion or aspiration of infected amniotic fluid. The risk to neonate of getting TB infection shortly after birth is greater.* ATT should be started as soon as possible, as untreated disease is a hazard to the mother and fetus.* The regimens recommended for use in pregnancy are same as for the nonpregnant state except for withholding of streptomycin. Currently, an intermittent regimen (thrice weekly on alternate days) under the DOTS strategyof RNTCP is being increasingly used worldwide for pregnant women having TB.* None of the AKT drugs are teratogenic and AKT should be started as soon as the diagnosis is made. Sputum positive tuberculosis is category 1. | 3,916 | medmcqa_train |
Commonest cause of acute intestinal obstruction is: | SMALL BOWEL OBSTRUCTION - Adhesions secondary to previous surgery are the MC cause of SBO. - Causes: Adhesions (60%) > Malignant tumors (20%) >Hernia (10%) > Crohn's disease (5%)Q. - Primary colonic cancers (paicularly those arising from the cecum and ascending colon) may present as a SBO. | 3,917 | medmcqa_train |
The criteria for validity of a screening test are - | Ans. is 'b' i.e., Predictability Screening test to be applied o The screening test to be applied should fulfil the following impoant criteria before it is considered suitable for screening : ? 1. Acceptability The test should be acceptable to the people at whom it is aimed. In general painful or embarrasing tests e.g., per rectal or vaginal examination are not likely to be acceptable. 2. Repeatability (reliability) Repeatability means, the test must give consistent results when it is repeated more than once on the same individual under same conditions. That means the results of test are precise (exact), So repeatability is some time called precision, reliability or reproducibility. 3. Validity (accuracy) Validity refers to what extent the test accurately measures which is purpos to measures. That means a valid test distinguish the people who have the disease from those who do not. Validity has components ---> Sensitivity and specificity. | 3,918 | medmcqa_train |
Aery supplying major pa of superolateral surface of brain is | The middle cerebral aery is the largest terminal branch of the internal carotid aery and it runs laterally in the lateral cerebral sulcus of the brain.It supplies the entire lateral surface of the cerebral hemisphere except the narrow strip along the superomedial border extending from the frontal pole to the parieto-occipital sulcus(which is supplied by the anterior cerebral aery) and the occipital pole and inferior temporal gyrus (both of which are supplied by the posterior cerebral aery). | 3,919 | medmcqa_train |
Double apical impulse is seen in? | ANSWER: (A) HOCMREF: Harrison's 17th ed chapter 227"Most HOCM patients demonstrate a double or triple apical precordial impulse and a fourth heart sound. Those with intraventricular pressure gradients may have a rapidly rising arterial pulse. The hallmark of HOCM is a systolic murmur, which is typically harsh, diamond-shaped, and usually begins well after the first heart sound. The murmur is best heard at the lower left sternal border as well as at the apex, where it is often more holosystolic and blowing in quality, no doubt due to the mitral regurgitation that usually accompanies HOCM"Some important points about apical impulse:Normal: visible in the midclavicular line at the fifth intercostal spaceHypokinetic:Hypovolumic shockCalcified mitral stenosisSchemic heart disease with failureMyxedemaCardiomyopathiesEmphysemaHyperkinetic: (Duration of impulse is normal, increased amplitude)Aortic regurgitationMitral regurgitationASDPDAHyperdynamic circulatory states like anemia 8c thyrotoxicosisHeaving apical impulse: Duration of apical impulse is more than one third of systole. It is seen inAortic stenosisCoarctation of aortaSystemic hypertensionTapping apical impulse: only seen in uncomplicated mitral stenosis characterized by hypokinetic apical impulse with palpable loud SI | 3,920 | medmcqa_train |
Tocilizumab used against Rheumatoid arthritis is a monoclonal antibody against : | Monoclonal antibody against IL-6 : Tocilizumab
Monoclonal antibody against IL-6 receptor : Sarilumab
Both are approved for Rheumatoid arthritis. | 3,921 | medmcqa_train |
Sequence which is responsible for retaining proteins in membrane | D i.e. Halt signal | 3,922 | medmcqa_train |
Most important amino-acid substrate for gluconeogenesis - | Ans. is 'd' i.e., Alanine o The major noncarbohydrate precursors (substrate) for gluconeogenesis are lactate, pyruvate, glycerol, glucogenic amino acids, propionate and intermediates of the citric acid cycle. All aminoacids, exceptfor leucine and lysine, are substrate for gluconeogenesis. Alanine is the most important gluconeogenic amino acid. | 3,923 | medmcqa_train |
Investigation of choice in appendicitis in adults | Answer- A. CT Scan | 3,924 | medmcqa_train |
A 66 year old female is posted for subtotal gastrectomy for adenocarcinoma. The important procedure related complication: | Ans. (d) Bilious vomitingRef: Sabiston 20th Edition, Page 1212Complications of Gastric Surgeries:* Dumping syndrome* Afferent loop syndrome* Efferent loop syndrome* Malabsorption syndrome (Anemia, hypocalcemia, B12 deficiency)* Alkaline reflux gastritis* Bile reflux gastritis* Gastric atony* Duodenal stump blow out. | 3,925 | medmcqa_train |
Treatment of TOF ? | Ans. is 'a' i.e., Modified BT shunt | 3,926 | medmcqa_train |
All of the following are cause of blood in stools in children except - | Ans. is 'b' i.e., Carcinoma | 3,927 | medmcqa_train |
Seoli cells secrete ? | Ans. is 'd' i.e., InhibinLeydig cells have receptors for LH and secrete androgens, i.e. Testosterone, dihydrotestosterone (DHT), androstenedione, and dehydroepiandrosterone (DHEA).Seoli cells have receptors for FSH and secrete ABP, inhibin and MIS. seoli cells also have receptor for testosterone. | 3,928 | medmcqa_train |
The term 'psychoanalysis' is associated with: March 2009 | Ans. C: Sigmond Freud Psychoanalysis/Freudian psychology is a body of ideas developed by Austrian physician Sigmund Freud and continued by others. It is primarily devoted to the study of human psychological functioning and behavior, although it can also be applied to societies. Psychoanalysis has three applications: A method of investigation of the mind and the way one thinks; A systematized set of theories about human behavior; A method of treatment of psychological or emotional illness. | 3,929 | medmcqa_train |
All the following can occur in a neonate for heat production except – | "Always remember that newborn cannot produce heat by shivering."
Thermogenesis in Newborn
A newborn is more prone to develop hypothermia because of a large surface area per unit of body weight.
A low birth weight baby has decreased thermal insulation due to reduced subcutaneous and brown fat. | 3,930 | medmcqa_train |
Muscle not included in Anterior compartment of thigh | Gracilis is a muscle of Medial compartment | 3,931 | medmcqa_train |
Ziemann's dots in RBC are seen in infection with | Ziemann dots in RBC-PL Malaria Schaffner dots in RBC- Pl vivax Accola rings-falciparum Ref: D.R. Arora. Medical parasitology 4th ed pg 108 | 3,932 | medmcqa_train |
Which of the following is not an example of Phase II drug metabolic reaction? | phase 1 reactions- oxidation, reduction, cyclization, decyclization and hydrolysis Phase II reactions: 1. Glucuronidation 2. Acetylation 3. Glutathione conjugation 4. Glycine conjugation 5. Sulfation 6. Methylation 7. Water conjugation Reference: Katzung Pharmacology; 13th edition; Chapter 4; Drug Biotransformation | 3,933 | medmcqa_train |
Which of the following is not true about tabes Dorsalis - | Ans. is 'b' i.e., Deep tendon reflexes are brisk Tabes dorsaliso Usually develops 15 - 20 years after syphilis infectiono Major symptoms are- lightning pain, ataxia, urinary' incontinenceLightning paino Lightning or lancinating pain are sharp stabbing pain and brief like a flash of lightning.o More common in legs.o Are associated invariably with impairment of tactile pain and thermal sensation.Urinary incontinenceo Bladder is insensitive and hypotonic resulting in unpredictable overflow incontinenceo Sometimes constipation, megacolon as well as impotence can occurAtaxiao Purely sensory ataxiao Charcoat joints and trophic ulcers can occurPathology:There is involvement of:o Involvement of posterior root of lumbosacral regiono Posterior column involvedo Dorsal root gangliaNow, it is believed that inflammation is present all along the posterior root where as the dorsal ganglion cell los and posterior column degeneration are secondaryClinicopathological correlationClinical featureTract involvedo Hyptonia, areflexia ataxia-Destruction of proprioceptive fibres in sensory root gangliao Bladder involvement-Posterior root involvement of lumbosacral regiono Lightning pains-Incomplete posterior root lesions at different levelso Analgesia and joint insensitivity-Partial loss of A and C fibres in the root. | 3,934 | medmcqa_train |
'Scalloping' of the edge of sigmoid colon on barium enema seen in: | Ans. Pneumatosis intestinalis | 3,935 | medmcqa_train |
The cutoff point of serum estrogen level for the diagnosis of ovarian failure: | Diagnosis of menopause is from classical symptom of hot flush (50%) confirmed by elevated FSH levels to more than 100 mlU/ml and serum estradiol < 20 pg/ml. | 3,936 | medmcqa_train |
Post term pregnancy is the pregnancy which continues beyond: September 2006 | Ans. C: 294 days The normal duration of pregnancy is approximately 37 to 42 weeks, with the estimated due date at 40 weeks or 280 days from the first day of the last menstrual period. A postterm pregnancy/prolonged pregnancy/post maturity is one that has extended beyond 2 weeks of the expected date of delivery (beyond 294 days). Nearly 10 percent of pregnancies are postterm. | 3,937 | medmcqa_train |
A 45-year-old man is admitted to the hospital with breathing problems. During physical examination the patient shows signs of airway obstruction. A CT scan examination reveals a nasal polyp obstructing the airway. Drainage from which of the following structures is also obstructed? | (b) Source: GAS 797, 879, 1018, 1020, 1022; GA 487, 518, 525 The nasal polyp also involved the maxillary sinus, located immediately laterally to the nasal cavity. The sphenoid sinus, located posterosuperiorly to the nasopharynx, is unlikely to be affected by a nasal polyp. The ethmoidal sinuses, located medially to the orbit and lateral to the nasal cavity, are also unlikely to be affected by a nasal polyp, although this possibility cannot be ruled out. The frontal sinuses located superomedially to the eyes are unlikely to be affected by the nasal polyp. The frontonasal ducts, the communication between the frontal sinus and the nasal cavity, are also unlikely to be affected. | 3,938 | medmcqa_train |
Gene associated with autosomal dominant breast cancer? | Ans. B. BRCA 1. (Ref. Bailey and Love 26th/pg. 817)The BRCA1 gene has been associated with an increased incidence of breast (and ovarian) cancer and is located on the long arm of chromosome 17 (17q). The gene frequency in the population is approximately 0.0006. It does, however, occur with greater frequency in certain populations such as Ashkenazi Jews, in whom there is often a common (founder) mutation. BRCA2 .is located on chromosome 13q and there is an association with male breast cancer. Women who are thought to be gene carri- ers may be offered breast screening (and ovarian screening in the case of BRCA1, which is known to impart a 50 % lifetime risk of ovarian cancer), usually as part of a research programme, or genetic counselling and mutation analysis. Those who prove to be 'gene positive' have a 50-80 % risk of developing breast cancer, predominantly while premenopausal. Many opt for prophylactic mastectomy.GeneChromosomeAssociated tumourRb12qRetionablastoma, osteosarcomaBRCA-l and 217q, 13qBreast and ovarian cancerAPC5Colonic cancerP5317qMost human cancers, Li-Fraumeni syndromeHereditary cancer occurs in multiple family members due to germline mutations in high-risk genes which are inherited in autosomal dominant pattern. BRCA1 and BRCA2 are two major high-risk genes associated with hereditary breast cancer.Likelihood of genetic mutation with family history.No. of family cases <50 years oldBRCA1 (%)BRCA2 (%)243317134413355544BRCA1 is also associated with ovarian and, to a lesser extent, colorectal and prostate cancer. bBRCA2 is associated with familial male breast cancer.Genetics of breast cancer.The majority of breast cancers are sporadic, occur randomly, and carry somatic genetic alterations. Hereditary cancer occurs in multiple family members due to germline mutations in high-risk genes which are inherited in autosomal dominant pattern. BRCA1 and BRCA2 are two major high-risk genes associated with hereditary breast cancer. Mutations in CHEK2 contribute to a substantial fraction of familial breast cancer. Carriers of TP53 mutations develop Li-Fraumeni syndrome and are at high risk of developing early onset breast cancer, but these mutations are very rare. Susceptibility alleles in other genes, such as PTEN, ATM, STK11/LKB1, and MSH2/MLH1 are also very rare causes of breast cancer. ~ Devita. | 3,939 | medmcqa_train |
A 35-year-old lady presents with vaginal discharge. Smears from vaginal discharge show presence of? | Ans-A Trichomonas VaginalisThe image shows the presence of the anaerobic flagellated protozoan parasite, which causes vaginitis in women with the development of greenish malodorous discharge. | 3,940 | medmcqa_train |
A mother brings her 1 year old child to the hospital with complaints that he turns blue while breastfeeding. It resolves when he assumes a squatting position. On examination, a cleft palate is seen. Labs show hypocalcemia. Which of the following abnormalities are expected to be seen in the lymphoid organs? | Decreased size of paracoical areas of lymph nodes is expected as this child has DiGeorge Syndrome. DiGeorge Syndrome: Deficient CMI is seen due to aplasia of thymus and hence deficiency of T cells. This leads to paracoical areas of lymph nodes and periaeriolar sheaths of the spleen being reduced in size. B cells are usually not affected. Clinical Features of DiGeorge Syndrome - DiGeorge syndrome is a cellular immunodeficiency disorder caused by the deletion of a small segment of chromosome 22 (22q11) leading to a developmental defect involving the endodermal derivatives of the third and fouh pharyngeal pouches. (Thymus and parathyroid glands) The clinical features can be remembered with the mnemonic - CATCH C - Cardiac defects A - Abnormal facies T - Thymic aplasia C - Cleft palate H - Hypocalcemia Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition | 3,941 | medmcqa_train |
Length of Posterior vaginal wall is | The anterior wall of the vagina is about 8 cm long and the posterior wall about 10 cm long. ref - BDC 6e vol2 pg 393 | 3,942 | medmcqa_train |
Austin flint murmur is seen in cases of | The Austin Flint murmur of chronic severe AR is a low-pitched mid to late apical diastolic murmur that sometimes can be confused with MS. The Austin Flint murmur typically decreases in intensity after exposure to vasodilators, whereas the murmur of MS may be accompanied by an opening snap and also may increase in intensity after vasodilators because of the associated increase in cardiac output. | 3,943 | medmcqa_train |
Pheochromocytoma is associated with - | Ans. is 'b' i.e., Cafe-au-lait spots o About 25-33% of patients with a pheochromocytoma or paraganglioma have an inherited syndrome.# Neurofibromatosis type 1 (NF1) was the first described pheochromocytoma-associated syndrome.o The NF1 gene functions as a tumor suppressor by regulating the Ras signaling cascade. Classic features of neurofibromatosis include:# Multiple neurofibromas# Cafe au lait spots# Axillary freckling of the skin# Lisch nodules of the iris.o Pheochromocytomas occur in only about 1% of these patients and are located predominantly in the adrenals. | 3,944 | medmcqa_train |
Not a feature of brain death | The structural and functional damage of brain-stem may be diagnosed depending upon the following observations: Dilated fixed pupils, not responding to sharp changes in intensity of incident light. Absence of motor responses within the cranial nerve distribution on painful stimulation. Absence of corneal reflexes. Absence of vestibulo-ocular reflexes. Absence of gag reflex or reflex response to bronchial stimulation by a suction-catheter passed down the trachea. Absence of spontaneous breathing. Ref : Krishnan vij Textbook of Forensic medicine and Toxicology 5th edtion ; pg no - 75 | 3,945 | medmcqa_train |
False statement regarding adductor pollicis muscle: | Ans: B (Supplied by Median nerve) Ref : Gray s Anatomy, 39th edition, 2008.Page.918Explanation:Adductor pollicis:Has 2 heads, i) Obi ique head ii) Transverse headOblique head: Origin from capitate, bases of 2nd, & 3rd metacarpal bonesTransverse head: Origin from palmar surface of 3rd metacarpal honeInsertion: Two heads united by a tendon which attached to the ulnar side of base of proximal phalanx of thumbBlood supply: Arteria princeps pollicis & Arteria radialis indicis and branches from deep palmar archNerve supply: Deep branch of ulnar nerve (C8 & T1 fibres)Action: Adduction of thumb i.e. approximates the thumb to the palm of handTesting: With the thumb lying along the palmar aspect of the index finger, the subject is asked to retain a strip of paper between the thumb and palm against resistance.To remember:There are 2(1 muscles in the hand. Out of this only 5 muscles supplied by median nerve and remaining 15 muscles are supplied by ulnar nerve.Muscles supplied by MEDIAN NERVE are:Flexor pollicis brevisAbductor pollicis brevisOpponens pollicisFirst lumbricalSecond lumbricalMuscles supplied by ULNAR NERVE are:By its superficial branchPalmaris brevis By its deep branchi Adductor pollicisFlexor digiti minimiAbductor digiti minimiOpponens digiti minimiThird & fourth lumbrical4 Dorsal interosseous4 Palmar interosseous | 3,946 | medmcqa_train |
Testing for microdeletion of Y-chromosome is offered for which patient with a normal Karyotype | A patient with severely decreased sperm counts and a normal Karyotype is offered testing for microdeletion of Y chromosome. | 3,947 | medmcqa_train |
True statement regarding insulin: | Ref: Harper's Illustrated Biochemistry,28th editionExplanation:InsulinSecreted from pancreatic islet b cellsReleased regulated by blood (glycemic thresholdSynthesized as a single chain : pro-insulinInsulin is formed from proinsulin (removal of the connecting or "C" peptide)Insulin is thus made up of 2 chainsA (21 amino acids) and B (30 amino acids)Connected to each other by 2 inter disulfide bridges and 1 intra disulfide bridgeAll necessary for its hormone activity.ActionsStimulates glucose oxidation & storage and inhibits glucose productionStimulates glycogen synthaseInhibits phosph orylaseInhibits gluconeogenesisStimulates glucose transport into adipocytes, which is then converted intoTGInhibits hormone-sensitive lipase (HPL) (|cAMP) and lipoprotein lipaseActivates GLUT1Stimulates fatty acid and triglyceride synthesisInhibits I i poly sis and proteolysisShifts potassium ions from ECF to ICF | 3,948 | medmcqa_train |
Nipple shadows in chest xray characteristically have a sharp | Miller et al proposed that solitary pulmonary nodules that reach some or all of the following criteria can be considered nipple shadows :Bilateral and symmetric"fuzzy" margins or radiolucent "halo"Sharp lateral border and poorly defined medial border (may be present only on pa projections 3)Nodules are in a characteristic position:Male: between fifth and sixth rib anteriorlyFemale: at the inferior aspect of the breast shadowWere not present on a very recent filmProminent nipples may be visible on a lateral projectionHowever, if there is doubt repeat chest x-ray with nipple markers should be performed.(Ref: Miller WT, Aronchick JM, Epstein DM et-al. The troublesome nipple shadow. AJR Am J Roentgenol. 1985;145 (3): 521-3.) | 3,949 | medmcqa_train |
What changes the conformation of alpha helix in collagen | Ans. (b) ProlineRef: Harper's Biochemistry, 30th ed. pg. 141, 298-99* Proline is the amino acid which changes the conformation of the alpha helix in collagen due to the nature of proline having a cyclical structure. It also forms the ends of the beta sheets in the secondary structures. | 3,950 | medmcqa_train |
Disruption or disorganization of biological rhythm is observed in | Disturbance of biological functions is common with depression, with insomnia (or sometimes increased sleep), loss of appetite and weight (or sometimes hyperphagia and weight gain), and loss of sexual drive. When the disturbance is severe, it is called as melancholia ( somatic syndrome) The somatic syndrome in depression is characterised by: a. A significant decrease in appetite or weight b. Early morning awakening, at least 2 (or more) hours before the usual time of awakening c. Diurnal variation, with depression being worst in the morning d. Pervasive loss of interest and loss of reactivity to pleasurable stimuli e. Psychomotor agitation or retardation. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.72 | 3,951 | medmcqa_train |
All of the following are features of musculocutaneous nerve injury at axilla except | Loss of flexion of shoulder* Flexion at shoulder is done by major muscles like pectoralis major, anterior fibres of deltoid, which are intact here. Musculocutaneous nerve (MCN)originates from the lateral cord of the brachial plexus of nerves. It pierces the coracobrachialis muscle and gives off branches to the muscle, as well as to brachialis and biceps brachii, the chief flexors at elbow joint. Coraco-brachialis is a flexor at shoulder joint Biceps brachii is a powerful supinator, hence supination is weakened. MCN terminates as the lateral cutaneous nerve of the forearm. | 3,952 | medmcqa_train |
Material used in veebroplasty: | Ans. Polymethyl methacrylate | 3,953 | medmcqa_train |
Paramesonephric duct in males remains as | The paramesonephric ducts remain rudimentary in the maleThe greater pa of each duct eventually disappearsThe cranial end of each duct persists as a small rounded body attached to the testis(appendix of testis)It has been considered that the prostatic utricle represents the uterovaginal canalRef: Inderbir Singh&;s Human embryology; Tenth edition; Pg 300 | 3,954 | medmcqa_train |
Following injury to the right temple region, patient complaints of pain in the right eye and loss of vision. On examination the eye movements are normal, and pupil normally reacts to light. The diagnosis is | (C) Traumatic glaucoma# Traumatic Glaucoma: Atraumatic separation to the iris root and citiary body. Is not an uncommon cause of trauma by blunt object or by penetrating injury to globe.> Symptoms: Pain, blurred vision, history of blunt and penetrating injury.> Sings: Hyphaema, an irregular pupil in acute phase, slightly reduced IOP due to Iris/increased aquous.> Transient elevated IOP due to hyphema or anteriorly dislocated lens.> Signs in Chronic Phase: Chronic pressure elevation due to obstruction of aquous outflow system Optic disc cupping Visual field loss. | 3,955 | medmcqa_train |
Under EMCP launched in 1997,the criteria for selection of PHCs included the following EXCEPT: | Under EMCP (Enhanced Malaria Control Project) launched in 1997, the criteria for selection of PHCs (Primary Health Center) include API more than 2 for the last 3 years, Plasmodium falciparum more than 30% of total malaria cases and the area has been reporting deaths. | 3,956 | medmcqa_train |
All of the following statements about purification of water are true except : | Spores of Cl. perfrignence (in the absence of coliform group) indicate remote fecal contamination of water.
Total coliform bacteria must not be detectable in any 100 ml of sample.
Sodium thiosulphate is used to dechlorinate tap water for aquariums or treat effluent from waste water treatments prior to release into rivers.
It is also used to lower chlorine levels in swimming pools and spas following superchlorination.
Presumptive coliform count is done by multiple tube method and membrane filtration technique.
After analysing presumptive coliform coutn, E coli count is confirmed by other tests litre Eijkmant test and indole production. | 3,957 | medmcqa_train |
In rhinosporidiosis the following is true: | (c) Surgery is the treatment(Ref. Scott Brown, 6th ed., 4/8/40)Rhinosporidiosis is managed by wide excision and cauterisation of base. Recurrence may occur if sporangium is left behind. Dapsone is given in the postoperative period to decrease the chances of recurrence. | 3,958 | medmcqa_train |
A 45-year-old woman is admitted to the emergency department with a complaint of severe abdominal pain. CT scan and MRI examinations reveal a tumor of the head of the pancreas involving the uncinate process. Which of the following vessels is most likely to be occluded? | The superior mesenteric artery arises from the aorta, deep to the neck of the pancreas, then crosses the uncinate process and third part of the duodenum. An uncinate tumor can cause compression of the superior mesenteric artery. The common hepatic artery arises superior to the body of the pancreas and is unlikely to be affected by a tumor in the uncinate region of the pancreas. The cystic artery and vein, supplying the gallbladder, are also superior to the pancreas. The inferior mesenteric artery arises at the level of L3, which is thus situated deep to and inferior to the head of the pancreas. The portal vein, formed by the confluence of the superior mesenteric vein and splenic vein, passes deep to the neck of the pancreas. | 3,959 | medmcqa_train |
A 35-year-old man presents with following problem. Most likely diagnosis? | Ans. C. Gouta. Acute gout causing swelling, erythema and extreme pain and tenderness of the first metatarsophalangeal joint.b. This is also known as Podagra- Colchicine and indomethacin are the drug of choice in this acute attack. | 3,960 | medmcqa_train |
All of the following passthrough lesser sciatic foramen except: | Internal pudendal vessels | 3,961 | medmcqa_train |
Extrapyramidal side effects of antipsychotics -a) Dystoniab) Akathisiac) Seizuresd) Diarrheae) Parkinsonism | Extrapyramidal side effects of antipsychotics
Extrapyramidal side effects are the major dose limiting side effects of antipsychotics.
Maximum extrapyramidal side effects are seen with haloperidol.
Least extrapyramidal side effects are seen with clozapine (amongst all antipsychotics).
Among typical antipsychotics, thioridazine has least extrapyromidal side effects (EPS).
Amongst atypical antipsychotics, resperidone has maximum tendency to cause EPS.
Different syndromes are : Parkinsonism, acute muscular dystonia, akathisia, malignant neuroleptic syndrome, tardive dyskinesia, rabbit syndrome. | 3,962 | medmcqa_train |
Hard exudates are seen in the following except | Leukaemic retinopathy It is characterised by pale and orange fundus background with dilated and touous veins. In later stages, greyish white lines may be seen along the course of the veins (due to perivascular leukaemic infiltration). Aerioles become pale and narrow. Retinal haemorrhages with typical white centre (Roth spots) are very common. Occasionally large pre-retinal (sub hyaloid) haemorrhages may also be seen. Ref:- A K KHURANA; pg num:-264 | 3,963 | medmcqa_train |
A newborn child presents with inverted foot and the dorsum of the foot cannot touch the anterior tibia. The most probable diagnosis is: | Ans. c. CTEV (Ref: Apley's 9/e p291, 591-594; Turek's 6/e p658-661; Campbell's 11/e p1474-1475)The most probable diagnosis in a newborn child with inverted foot in whom the dorsum of the foot cannot touch the anterior tibia is CTEV.Congenital Talipes EquinoVarus (CTEV):Congenital deformity involving one foot or both.Affected foot appears rotated internally at the ankle.As heels are rotated internally patient is not able to touch tibia by dorsum of his foot.Congenital Vertical Talus (CVT):It is irreducible dorsal dislocation of the navicular on the talus with a fixed talo-navieular complex.CVT is a common cause of rigid flat foot, which can be isolated, or can occur with chromosomal abnormalities, myeloarthropathies (myelomeningocele) and neurologic disorders.Clinically talar head is prominent medially, sole is convex, forefoot is abducted and dorsiflexed, and the hind foot is equinovalgusSole of foot has a rocker-bottom (convex) deformityPatients demonstrate peg-leg gait (awkward gait with limited forefoot push off)Arthrogryposis Multiplex Congenita:Rare congenital disorder that is characterized by multiple joint contractures and can include muscle weakness and fibrosis.It is a non-progressive disease.The disease derives its name from Greek, literally meaning 'curved or hooked joints'.Cerebral Palsy:Includes the group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement.Divided into four major classifications to describe different movement impairments; also reflect the areas of the brain that are damaged.The four major classifications are:Spastic: MC type (70-80%)Ataxic: Caused by damage to the cerebellum (10%)Athetoid/dyskinetic: Mixed muscle tone, trouble holding in an upright, steady position for sitting or walking; often show involuntary motions.Hypotonic: Patients have musculature that is limp, and can move only a little or not at all.Congenital Talipes EquinoVarus (CTEV)/Club FootCongenital deformity involving one foot or both.Affected foot appears rotated internally at the ankle.As heels are rotated internally patient is not able to touch tibia by dorsum of his foot.CTE-V is classified into 2 groups: Postural TEV and Structural TEV.Incidence: 1 in 1,000 live births: More common in malesEtiology and Associated Anomalies:Idiopathic (MC)Q; Secondary club footSecondary club foot* Neurological disorders and neural tube defectsQ (myelomeningocele and spinal dysraphism)* Paralytic disorder (due to muscular imbalance) as polio. spina bifidaQ, myelodysplasia, and Freidreich's ataxia* Arthrogryposis multiplexaQ* Larsen syndrome* Freeman-Sheldon (Mobius) syndrome* Diasirophic dwarfism* Sacral agenesis, tibial deficiency, constriction rings and amniotic bands* Fetal alcohol syndrome* Down's syndrome Deformities affecting joints of the foot in CTEV* Inversion at subtalar jointQ* Adduction at talonavicular jointQ* Equinus at ankle jointQ"InAdEquate" for Inversion, Adduction and EquinusQ.Screening Methods:The foot of a newborn child normally can be dorsiflexed until the dorsal surface of foot touches the anterior aspect of shin of tibiaQ.It is a useful screening method for detecting the milder cases of CTEV, in which the foot cannot touch anterior tibia.Clinical Presentation:Classical appearance of CTEV is small size foot and small heel with characteristic CAVE deformity (Cavus, Adduction, Varus, Equinus) i.e. heel in equinuis with foot inverted on end of tibia giving the foot an upside down club appearance.Inability to bring the foot in opposite directions to deformity.Deep skin creases on medial side of foot and back of heel.Outer side of foot is convex and contains bony prominences (e.g. head of talus) and dimples.Prognosis:Prognosis of non-idiopathic syndromic club foot is generally worse than that for an idiopathic club foot, although there are certain exceptions like Down's syndrome or Larsen's syndrome: in which because of significant ligamentous laxity underlying the syndrome itself, correction may be achieved with non-operative treatment.Management of CTEVConservative managementOperative management* Clubfoot always requires treatment, which should begin at birthQ.* Manipulation should be frequently repeated, and after manipulation some form of splint or cast must be usedQ.* In the first month of life, manipulation should be repeated 6 times at each nappy change and adhesive strapping which maintains the correctionQ.* In place of strapping, splintage (Dennis Brown Splint) and even casting usually at one-week interval in the first month of lifeQ can also be used.* In infants >1 month, corrective manipulations and above knee cast (from toe to groin) is applied for 2 weeks.* Delaying surgery is suitable for severe, rigid deformities; for less severe cases it may be preferable to operate at around 6 months of ageQ.* Posteromedial soft tissue release is best done at 6 months-3 yearsQ.* Triple arthrodesis is necessary for recurrent or persistent club foot deformity in older children (chronic cases)Q. It is best done at 10-12 years of age when foot growth is completeQ. Pseudoarthrosis (most commonly of talonavicular joint) is commonest complicationQ.Kite's MethodPonseti Method (Method of choice)6 months-3 yearsPosteromedial soft tissue releaseOrder of correction of deformity:* Adduction of forefoot* Inversion (varus) of heel / hind foot and inversion (supination) of fore /mid foot* Equinus (plantar flexion) of ankleOrder of correction of deformity:* Cavus* Adductus* Varus* Equinus4-10 yearsRevision of soft tissue release together with shortening of lateral side of foot by:* Lichtblau's Procedure (<6 years)* Even-Dillwyn Procedure (>6 years)>10-12 yearsTriple arthrodesisQ | 3,964 | medmcqa_train |
Increase in body temp during ovulation is by - | Ans. is 'b' i.e., Progesterone o Ovulation mav be inferred bv measuring the basal body temperature throuehout the menstrual cycle.o Temperature recordings are done on a chart and sustained upward shift of temperature (0.3degrees F for three days) infers that progesterone is being synthesized and released into circulation as a result of ovulation.Test Time ObservationTest for documenting ovulation1. Basal body tempThroughout cycleBiphasic pattern2. Cervical mucusDay 12 - 14 Day 21 -23Cervical mucus is clear watery, stretchabilitv present, derming present Cervical mucus is thick, viscid, tack present, feming absent3. Vaginal cytologyDay 12 - 14Estrogen dominated smears-efear, discrete comifined, polygonal, superficial cells (predominant cells)Day 21-23Progesterone dominanted smear - containing dirty, predominantly intermediate (Navicular) cells4. Endometrial biopsyDay 24 - 26Secretory' endometrium (confirming ovulation)5. Serum progesteroneD8 and D21D - 8 < 1 ng/mi D - 21 > 6 5 ng/ml6. Foil icular monitoringD10- D14Follicle is measured by USG7. LaparoscopySecretory phaseRecent corpus luteum is directly seen | 3,965 | medmcqa_train |
Replacement of etonogestrel implant(Implanon) is normally done after how many years? | Implanon is a single rod subdermal implant with 68 mg of the progestin etonogestrel (ENG), and an ethylene vinyl acetate copolymer cover. It can be used as contraception for 3 years and then replaced at the same site or opposite arm. It is placed in the medial surface of the upper arm 6 to 8 cm from the elbow in the biceps groove within 5 days of onset of menses. Prolonged and frequent bleeding is the most common adverse effect. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 32. Contraception. | 3,966 | medmcqa_train |
True morbidity in a population can be calculated by | Active Surveillance Extra measures are taken to collect data and confirm diagnoses to ensure more complete repos for surveys and outbreak investigations. Active surveillance encompasses formal and informal communications. Eg: Malaria surveillance by a health worker Main objectives of Surveillance 1. Provide information about new and changing trends in the health status of population - morbidity, moality, nutritional status 2. Provide feedback 3. Provide timely warning Ref: Park's Textbook of Preventive and Social Medicine; 24th edition - Page no. 45 | 3,967 | medmcqa_train |
A middle aged man came with fever 2 weeks. He also complains of occasional night sweats and has significant weight loss. BAL was done, in which MTB was not detected. Extra pulmonary TB is suspected. Which of the following sites is most likely affected? | Lumph nodes are the most common site of extrapulmonary TB. Associated pulmonary disease is present in fewer than 50% of cases. The diagnosis is established by fine needle aspiration biopsy. Cultures are positive in 70- 80%. In descending order of frequency, the extrapulmonary sites most commonly involved in TB are the lymph nodes, pleura, genitourinary tract, bones and joints, meninges, peritoneum and pericardium. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition | 3,968 | medmcqa_train |
. A neonate is seen crying with eyes closed and moving all his limbs. What is the Neonatal Behavioral response scale - | Scale 6 Neonatal behavior assessment scale It is a scale developed by T. Berry Brazelton for evaluating the neurological conditions and behavior of newborn by assessing his or her aleness, motor maturity, irritability and interaction with people. Scores SLEEP STATE I)Deep sleep: - Sleep with regular breathing, eyes closed, no spontaneous activity except stales or jerky movements at quite regular intervals. 2)Light sleep: - Sleep with eyes closed: rapid eye movements can often be observed under closed lids; low activity level with random movements and stales. AWAKE STATE 3)Drowsy: - Drowsy or semidozing; eyes may be open but dull and heavylidded, or closed, eyelids fluttering; activity level minimal, Movements are usually smooth, although there may be stales. "Some infants may also show fuss/ cry vocalizations in this state"Q. What distinguishes state 3 from state 5 when both are accompanied by fuss/ cry vocalizations is the minimal movement in state 3 and considerable movement in state 5 4)Quiescent ale: - Ale, eyes open with bright look. Motor activity is minimal there can be a glazed look that is easily changed into a brighter look with appropriate stimulation. 5)Active ale : - Eyes likely to be open; considerable motor activity, with thrusting movements of the extremities, and even a few spontaneous stales reactive to external stimulation with increase in stales or motor activity. 6)Crying:- Crying characterized by intense, loud, rhythmic, and sustained cry vocalizations that are difficult to break through with stimulation; motor activity is hige. Eyes may be tightly closed. | 3,969 | medmcqa_train |
Ohobaric oxygen is used in | .HYPERBARIC OXYGEN It is administration of oxygen 1 or 2 atmospheres above the atmospheric pressure in a compression chamber. It increases the aerial oxygen saturation so that oxygen perfusion of tissues will be increased.Indications 1. Carbon monoxide poisoning. 2. Tetanus, gas gangrene infections. 3. Bedsores, frostbites, necrotising fasciitis. 4. Drenching in paralytic ileus to reduce the nitrogen gas in distended bowel. 5. As a radiosensitizer in the treatment of cancer. ref:SRB&;s manual of surgery,ed 3,pg no 98 | 3,970 | medmcqa_train |
All are true about Exenatide except - | Ans. is 'c' i.e., Used in type I diabetes mellitus Exenatide is a synthetic glucagon-like peptide -1 (GLP-l) analogue. o It acts similar to GLP-1 --> Enhancement of postprandial insulin release, suppression of glucagon release and appetite as well as slowing of gastric emptying. o It is given by subcutaneous route & used in type 2 DM | 3,971 | medmcqa_train |
Smallest diameter of pelvis is? | Interspinous diameter REF: Clinical Obstetrics 10th edition by S. Gopalan, Sarala & Jain, Vanita Page 4, Manual of Obstetrics, 3e by Shirish N Daftary Page 11-12, Manual Of Obstetrics (2Nd Edition) by Daftary Page 16-18 "Interspinous diameter (transverse diameter of midpelvis = 10 cm or somewhat more) is the smallest diameter of pelvis" REF: Williams's obstetric 22nd edition page 34 | 3,972 | medmcqa_train |
NSAIDS with least anti inflammatory' action - | Ans. is 'b' i.e., ParacetamolParacetamolo It does not possess anti - inflammatory activity because it is ineffective in the presence of peroxides generated at the site of inflammation.o It produces very little GI toxicity and can be administered in patients intolerant to other NSAIDs. | 3,973 | medmcqa_train |
H is helpful in all of the following except | . | 3,974 | medmcqa_train |
Direct fibrinolytics are/is: | Ans. b (Alfimeprase). (Ref. Harrison's medicine 16th ed. 690)Alfimeprase is a metalloproteinase that degrades fibrin in a plasmin-independent fashion. It is a novel thrombolytic based on snake venom derived protein. It is a direct fibrinolytic. It is not a plasminogen activator. It is neutralized by alpha-macroglobulin.PHARMACOLOGICAL REPERFUSION# Therapeutic plasminogen activators include streptokinase, urokinase, tPA and non-tPA fibrinolytics like Recombinant prourokinase, staphylokinase, and alfimeprase.- They are fashioned after endogenous tPA or urokinase that convert plasminogen into active plasmin. Plasmin degrades fibrinogen and fibrin in to FDPs.- tPA is released from endothelial cells, enters the fibrin clot, and activates plasminogen to plasmin.- Any free plasmin is complexed with a,plasmin inhibitor (a2PI).- Fibrin is degraded to low-molecular-weight fragments, fibrin degradation products (FDPs).# Innovative intravenous pharmacological reperfusion strategies include:- Novel fibrinolytic agents (tenecteplase, reteplase, desmetolplase, plasmin, and microplasmin),- GP Ilb/IIIa antagonists = platelet disaggregating effects (abciximab and tirofiban),- Combination therapies to improve efficacy of clot lysis (fibrinolytics and GP IIb/IIIa agents, and fibrinolytics and direct thrombin inhibitors), increase the time window for clot lysis (fibrinolytics and neuroprotectants), and reduce the frequency of hemorrhagic complications. | 3,975 | medmcqa_train |
Drug of choice for sedation of a patient in ICU is: September 2009, March 2013 (a) | Ans. C: Propofol Benzodiazepines, e.g. diazepam, lorazepam and midazolam, are widely used as sedative agents in the ICU. Diazepam use has become less common as newer shoer-acting benzodiazepines have become available. Lorazepam is more potent than midazolam and, because of its low lipid solubility, crosses the blood-brain barrier more slowly, delaying its onset of action and prolonging the sedative effect. Hence, it is recommended for longer-term sedation while midazolam is preferred for sho-term sedation Propofol, another frequently used sedative agent, resembles midazolam in terms of pharmacological profile. Midazolam and propofol have similar efficacy and safety in sedating various groups of critically ill patients. Midazolam is, however, cheaper than propofol Neveheless, propofol, when used as a sedative in mechanically ventilated patients, is associated with shoer weaning times and hence, while midazolam may be cheaper, the overall cost-benefit analysis taking into account duration of mechanical ventilation and ICU stay may in fact be better with propofol. | 3,976 | medmcqa_train |
Decreased number of melanocytes are seen in: March 2005 | Ans. D: All of the above Melanopenic hypopigmentation is due to decrease in number of melanosomes, which could be due to: Genetic diseases-albinism, piebaldism A utoimmune diseases-vitiligo Post-inflammatory-Discoid lupus erythematosus Piebaldism is due to an absence of melanocytes in affected skin and hair follicles. The condition is present at bih and usually remains unchanged throughout life. This is caused by mutations of the KIT proto-oncogene. 14 point mutations, 9 deletions, 2 nucleotide splice mutations, and 3 inseions of the KIT gene are believed to be mutations causing piebaldism. The severity of the condition correlates with the site of the mutation within the KIT gene. Piebaldism is an autosomal dominant genetic disorder meaning half of an affected person's children will also have the condition. Piebaldism is one of the cutaneous signs of Waardenburg syndrome. Piebaldism is a rare inherited condition characterised by: White forelock in 80-90% of those affected (poliosis) White patch (due to absence of pigmentation) of the central poion of the forehead Eyebrow and eyelash hair may also be affected, either continuously or discontinuously with the forelock White patches of skin may also be seen on the face (paicularly the chin), trunk and extremities (hands and feet are not usually affected) Often a narrow border of hyperpigmented skin surrounds the white unpigmented patches Sometimes islands of normal or hyperpigmented skin occur within the white patches. Albinism is a condition in which people have little or no melanin pigment (compound that creates colour) in their eyes, skin or hair. Because of this people with albinism look a little different from other members of their family without albinism. They have very fair skin which is prone to sunburn, their hair is white or a very light colour, and they may squint a lot as their eyes are sensitive to sunlight. | 3,977 | medmcqa_train |
A 40 year old patient is suffering from carotid body tumor. Which of the following is the best choice of treatment for him? | Ans. is 'a' i.e., Excision of tumour | 3,978 | medmcqa_train |
Branchial cyst arises due to- | Ans. is 'a' i.e., Failure of obliteration of second branchial cleft Brachial Cyst* A branchial cleft cyst is a congenital epithelial cyst that arises on the lateral part of the neck usually due to failure of obliteration of the second branchial cleft in embryonic development. Less commonly, the cysts can develop from the first, third, or fourth clefts.* The cyst, usually presents as a smooth, slowly enlarging lateral neck mass that may increase in size after an upper respiratory tract infection.* Treatment is generally conservative. | 3,979 | medmcqa_train |
Most common pulmonary manifestation of SLE: | Ans. (b) PleuritisRef: Harrisons Principle of Internal Medicine 20th Ed; Page No- 2520Most Common Complication in SLE* Cutaneous Manifestations:# The most common acute SLE rash: Butterfly" rash# Most common chronic dermatitis in lupus: Discoid lupus erythematosus (DLE)* Vascular Occlusions: Myocardial infarctions are primarily manifestations of accelerated atherosclerosis.* Pulmonary manifestation: Pleuritis with or without pleural effusion.* Cardiac manifestations: Pericarditis.* Hematologic Manifestations: Anemia* Renal Manifestations: Nephritis* CNS Manifestations: The most common manifestation of diffuse CNS lupus is cognitive dysfunction, including difficulties with memory and reasoning.NoteOther pulmonary Complications* Pulmonary infiltrates are seen active SLE and it is very difficult to distinguish from infection on imaging studies.* Interstitial inflammation is a life-threatening pulmonary manifestation leading to fibrosis, shrinking lung syndrome, and intra-alveolar hemorrhage.* Pulmonary arterial hypertension occurs in a small proportion of SLE patients.Cardiac complications* More serious cardiac manifestations are myocarditis and fibrinous endocarditis of Libman-Sacks.* A patient has SLE if four or more of these 11 criteria are present at any time.Diagnostic criteria for SLEMucocutaneous signs (each counts as one)* Malar rash* Photosensitivity rash* Oral ulcers rash* Discoid rashArthritisPresent in 90 percent of patients; non-erosiveCardiac & PulmonaryPericarditis, myocarditis, Pleuritis (most common pulmonary finding), pleural effusion, pneumonitis, pulmonary HypertensionHematologic (Any blood involvement counts as 1 criteria)Hemolytic anemia, leukopenia, lymphopenia, thrombocytopeniaRenalIt benign from Proteinuria >0.5g/ day to end stage renal disease; such as:- Cellular casts, Glomerulonephritis, azotemia, pyuria, uremia, HTNCerebralSeizures, psychosis (may be subtle), meningitis TIA, cerebrovascular accidentSerology* ANA. It is 95 % sensitive but not specific; almost all patients with SLE have elevated serum ANA levels.* Anti-ds DNA (60-70%) or anti-Sm (Smith) (10-20%). The presence of either of these is diagnostic of SLE--very specific (but obviously not sensitive)NoteEach of the serologic abnormalities counts as 1 criterion. Hence, if the person has joint pain, a rash, and both an ANA and DS DNA, that patient would have 4 criteria.Points to RememberDiagnostic Test for SLE* Best initial test: ANA* Most specific test: Anti-DS DNA (60-70%) or anti-Sm (Smith) (10-20%)..* Rule of thumb- ANA positivity is a must in SLE diagnosis.* ANA negativity twice rules out SLE. Even though ANA positivity cannot confirm SLE - negativity can rule out.Note* There is no ANA negative SLE. But there is ANA negative scleroderma* Also Drug induced lupus - secondary to Quinidine/ Minocycline tends to be ANA negative. | 3,980 | medmcqa_train |
Person having heterozygous sickle cell trait is protected from infection of: | Ans. a. P. falciparum (Ref: Robbins 9/e p390, 8/e p387)Person having heterozygous sickle cell trait is protected from infection of P. falciparum."People who are heterozygous for the sickle cell trait (HbS) become infected with P. falciparum, but they are less likely to die from infectionQ. The HbS trait causes the parasites to grow poorly or die because of the low oxygen concentrationsQ."- Robbins 8/e p387Host Resistance to PlasmodiumTwo general mechanisms of host resistance to Plasmodium:Inherited alterations in red cells make people resistant to PlasmodiumQ.Repeated or prolonged exposure to Plasmodium species stimulates an immune response that reduces the severity of the illness caused by malariaQ.People who are heterozygous for the sickle cell trait (HbS) become infected with P. falciparum, but they are less likely to die from infectionQ.The HbS trait causes the parasites to grow poorly or die because of the low oxygen concentrationsQ.The geographic distribution of the HbS trait is similar to that of P. falciparumQ, suggesting evolutionary selection of the HbS trait in people by the parasite.HbC, another common hemoglobin mutation, also protects against severe malaria by reducing parasite proliferationQ.People can also be resistant to malaria due to the absence of proteins to which the parasites bindQ.P. vivax enters red cells by binding to the Duffy blood group antigenQ.Many Africans, including most Gambians, are not susceptible to infection by P. sivax because they do not have the Duffy antigenQ.Antibodies and T lymphocytes specific for Plasmodium reduce disease manifestations.Cytotoxic lymphocytes may also be important in resistance to P. falciparum.In the given image, irregularly shaped large rings and trophozoites are seen with enlarged erythrocytes, which are the characteristic features of Plasmodium vivax.Examination of Blood Films for Malaria ParasiteMalaria parasites pass through a number of developmental stages. In all stages, however, the specific parts of the parasite will stain a specific colour.Parts of parasiteStaining characteristicChromatin (parasite nucleus)* Usually round in shape & stains a deep red.Cytoplasm* Blue, although shade of blue may vary between malaria species.Recognition of a Malarial Parasite* Malaria parasite takes up Giemsa stain in a special way in both thick & thin blood films. Blood Smears of PlasmodiumFeaturesP. falciparumP. vivaxP, malariaeP. ovaleFeatures of red cellsSizeAll sizes/ normalLarge (young) paleSmall (Old), normalLarge (young)ShapeRound, may be crenatedRound or ovalRoundRound or pear- shaped fimbriatedStipplingMaurer's cleftsQ Large;red up to 20 Basophilic stippling +-Schuffner's dotsQ;numerous small redNone, Occasionally Zieman's dotsQSchuffner's dots, James dotQFeatures of ParasiteRing (early trophozoite)Threadlike, multiple infections, double chromatin dots form accoleQThickerQCompactQCompactQMature/Late trophozoites (amoeboid form)Absent/ occasionally seenAmeboid may fill cell-- More regular, smaller, Band formQLess ameboid &smaller than those of P vivaxDiagnostic keys Gametocyte, multiple rings, double chromatin dots, accoie forms, heavy infectionQSchizont, large RBCs, amoeboid formsQSchizont, small RBCs, band formsQSchizont and large RBCs; pear-shaped, fimbriated RBCsQ Characteristics of plasmodium species infecting HumansCharacteristicP. falciparumP. vivaxP. ovaleP. malariaeIncubation period12 days (shortest) Q14 days14 days30 days (longest) QDuration of erythrocytic cycle (hours)48 (malignant tertian malaria) Q48 (benign tertian malaria)50 (ovale tertian malaria)72 (Guatran malaria) QRed cell preferenceYounger cellsQ (but can invade cells of all ages), >2% of RBC infectedQRed cells upto 14 days oldQ, <1% of RBC infectedReticulocytesQOlder cellsQMorphologyUsually only ring forms, banana shaped gametocytesQIrregularly shaped large rings and trophozoites; enlarged erythrocytes; Schuffner's dotsQInfected erythrocytes enlarged and oval with tufted endsQ; Schuffners dotsSand ofrectangular formsof trophozoites commonPigmentBlackQYellow-brownQDark brownQBrown-blackQRelapse (hypnozoits or exo- erythrocytic schizogony)NoYesQYesQNo | 3,981 | medmcqa_train |
Johne's bacillus is: | M. Paratuberculosis | 3,982 | medmcqa_train |
A 30 year ols woman presented with secondary amenorrhoea for 3 years along with galactorrhea. The most likely cause of her symptoms would be - | prolactinoma stimulate pituitary causing excessive milk secretion and it also inhibit GnRH causing decreased FSH &LH level causing secondary amenorrhea (Harrison 17 pg 2206) | 3,983 | medmcqa_train |
Hypercalcemia is caused by all except: | Answer is D (Furosemide): Thiazide diuretics cause hypercalcemia while loop diuretics (furosemide) cause hypocalcemia. Furosemide is a loop diuretic that is characteristically associated with hypocalcemia and not hypercalcemia. | 3,984 | medmcqa_train |
All of the following are true regarding chronic active hepatitis, except: | Chronic hepatitis is defined as a chronic inflammatory reaction of the liver of more than 3-6 months duration, demonstrated by persistently abnormal serum aminotransferase levels and characteristic histologic findings. The causes of chronic hepatitis include. HBV, HCV and HDV autoimmune hepatitis, chronic hepatitis associated with ceain medications (paicularly isoniazid), Wilson's disease, and antiprotease deficiency. Autoimmune hepatitis responds to steroids and is more common in females with 4:1 ( F:M) ratio. | 3,985 | medmcqa_train |
HLA is present on - | Ans. is 'b' i.e., Sho arm of chromosomes 6 o HLA complex of genes is located on the sho arm of chromosome 6. | 3,986 | medmcqa_train |
Hemochromatosis affect the following organs | Ans: dRef: Harrison, 16,hed, p. 2301 | 3,987 | medmcqa_train |
SSRI is first-line treatment for | In social phobia, among the antidepressants, SSRIs are currently drugs of choice, with paroxetine being the most widely used drug. Other SSRIs, such as fluoxetine and seraline are also equally effective. Fluoxetine has the advantage of a longer half-life. Other antidepressants such as imipramine (TCA) and phenelzine (MAOI), are also helpful in treating the panic attacks associated with phobias, thereby decreasing the distress. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 95 | 3,988 | medmcqa_train |
The most common site of primary osteoarthrosis is - | In general, weight bearing lower limb joints are affected more commonly than upper limb joints.
However, No textbook has mentioned which is the commonest joint : knee or hip.
According to me it is knee because of following facts :-
I have seen hardly one or two cases of primary OA of hip; while, I have seen hundreds of cases of Primary OA of knee in my OPD. At least 4 to 5 patients of primary OA of knee comes daily to my OPD.
"OA commonly affects the knee joint" —Ebnezar
"OA of hip is second in frequency to the knee joint" —Ebnezar | 3,989 | medmcqa_train |
The classical example of muscular violence is | B i.e. of patella | 3,990 | medmcqa_train |
Which of the following sonographic finding suggests development of preeclampsia | Superabundance of chorionicvilli is implicated in etiopathogenesis of preeclampsia. | 3,991 | medmcqa_train |
Perl's stain or prussion blue test is for: | Perls' stain (Prussian-Blue Reaction) is to demonstrate Ferric salts in tissues. These are seen as iron granules in bone marrow macrophages, erythroblasts (Sideroblasts) and erythrocytes (Siderocytes) in blood films and haemosiderin in spun urine. | 3,992 | medmcqa_train |
Secondary hemorrhage is after how many days of tonsillectomy | Secondary haemorrhage (occur from 3rd day onwards (5th to 10th day higher chances) due to sloughing of aeries caused by infection). It is the result of sepsis and premature separation of membrane. Ref : ENT textbook by Dhingra 6th edition Pgno : 430 | 3,993 | medmcqa_train |
The most common cuase of renal scarring in a 3 year old child is - | Ans. is 'c' i.e., Vesicouretrial reflux induced pyelonephritis The small scarred kidney in childhood;. Risdon RA] `Reflux nephropathy is now a generally accepted term to describe small scarred kidneys discovered during childhood; it recognises the close association between this renal lesion and vesicoureteric reflux (VUR)'. Renal scarring is most commonly a result of chronic pyogenic injection of the kidney or chronic pyelonephritis. Chronic pyelonephritis occurs only in patients with major anatomic abnormalities, such as obstructive uropathy, struvite calculi or, most commonly, VUR (in 30 to 45% of young children with symptomatic UTI). | 3,994 | medmcqa_train |
In chronic inflammation confined to the portal tract with intact limiting membrane and normal lobular parenchyma, the histopathological diagnosis would be - | Intact limiting membrane with inflammation confined to portal area is seen in chronic persistent hepatitis. | 3,995 | medmcqa_train |
A neonate born to infected hepatitis-B mother, should be treated with: | D. Immunoglobulins and hepatitis-B-vaccine(Ref: Nelson's 20/e p 1942-1952)"Infants born to HbsAg positive mothers should receive both Hep B Ig and Hep B vaccine at separate sites within 12 hours of birth, followed by 2nd and 3rd dose of vaccine at 1 and 6 months. | 3,996 | medmcqa_train |
Advantage of coho study ? | Ans. is 'd' i.e., More than one outcomes can be studied | 3,997 | medmcqa_train |
The most earliest sign of anterior uveitis is: | Ans. Aqueous flare | 3,998 | medmcqa_train |
Ligament of Cooper, used in the surgery for femoral hernia repair, is formed by which of the extentions of inguinal ligament? | Answer-A. Lacunar ligamentIt is also called Gimbernat's ligament.From the medial end, deep fibres curve horizontally backward to the medial side of pectin pubis forming lacunar ligament.This ligament is trainagular in shape, with the apex attached to the pubic tubercle.Its sharp lateral edge forms the medial boundary of the femoral canal, which is the site of production of femoral hernia. | 3,999 | medmcqa_train |
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