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Metabolism of a drug primarily results in | Ref-Katzung 10/e p50 After metabolism most of the drugs become inactive and their excreted through the kidney. Lipids soluble drugs wil be reabsprbed whereas water soluble drugs are easily excreted.thus, metabolism of drugs helps in the conversion of liquid soluble drugs to water soluble metabolites | 5,200 | medmcqa_train |
A 43-year-old 190 cm man post a flight to Chennai presents with left-sided chest discomfort and dyspnea. On chest X-ray, there is a small area devoid of lung markings in the apex of the left lung. Diagnosis is? | Ans. A Spontaneous pneumothoraxRef: CMDT 2019 pg. 325Spontaneous pneumothorax occurs from a rupture of an apical pleural bleb and is associated with tall, young males and is also seen with aeroplane ascent. | 5,201 | medmcqa_train |
Which of the following properties make pyridostigmine different from neostigmine ? | Though less potent than Neostigmine, Pyridostigmine has longer duration of action (3 to 6 hrs)
Duration of action of neostigmine is 0.5 to 2 hrs. | 5,202 | medmcqa_train |
Aniseikonia is- | Ans. is 'd' i.e., Difference in the size of image formed by the two eyes * Anisoeikonia is defined as a condition wherein the images projected on the visual cortex from the two retinae are abnormally unequal in size or shape. Causes may be : -i) Optical aniseikonia: - When the difference between refractive error of two eyes is of high degree, the image of an object may be of different size or shape in two eyes. So the defect is at refractive structures level.ii) Retinal aniseikonia: - Defect is at retinal level and occurs due to displacement of retinal elements towards the nodal point in one eye due to stretching or edema of the retina.iii) Cortical aniseikonia: - Defect is at higher central level. There is asymmetrical simultaneous perception inspite of equal size of images formed on the two retinae. | 5,203 | medmcqa_train |
Middle meningeal aery passes through which foramen? | The middle meningeal aery is a branch of the first pa of the maxillary aery, given off in the infratemporal fossa. In infratemporal fossa, the aery runs upwards and medially deep to the lateral pterygoid muscle and superficial to the sphenomandibular ligament. Here it passes through a loop formed by the two roots of the auriculotemporal nerve. It enters the middle cranial fossa through foramen spinosum. Notes: Middle meningeal aery is impoant to the surgeon because this aery is the commonest source of extradural hemorrhage. Ref BDC volume 3,6th edition pg 201 | 5,204 | medmcqa_train |
Denominator in General fertility rate is? | ANSWER: (B) Women in reproductive age group in a given yearREF: Parks textbook 20th edition page419Repeat from December 2008General fertility rate: Number of live births per 1000 women in reproductive age group in a given yearGeneral marital fertility rate: Number of live births per 1000 married women in reproductive age group in a given yearAge specific fertility rate: Number of live births in a year to 1000 women in any specified age groupAge specific marital fertility rate: Number of live births in a year to 1000 married women in any specified age group | 5,205 | medmcqa_train |
A patient presented in emergency with tachycardia, hyperthermia, bronchial dilatation and constipation. The person is likely to be suffering from overdose of: | Ans. (A) Atropine(Ref: Modi's Medical jurisprudence and Toxicology. 23rd, 2005/92, 403, 429-430, Goodman and Gilman 12/e p234-235)These are the characteristic features of anti-cholinergic overdose. | 5,206 | medmcqa_train |
A 58-year-old woman presents with an irregular nodularity that has developed in her right breast over the past 3 months. Mammography demonstrates irregular densities in both breasts. A needle biopsy of one breast lesion is shown. An excisional biopsy of the contralateral breast shows similar histology. Which of the following is the most likely pathologic diagnosis? | Lobular carcinoma in situ arises in the terminal duct lobular unit. Malignant cells appear as solid clusters that pack and distend the terminal ducts but not to the extent of ductal carcinoma in situ. The lesion does not usually incite the dense fibrosis and chronic inflammation so characteristic of intraductal carcinoma in situ and is, therefore, less likely to cause a detectable mass. It is not uncommon for lobular carcinoma in situ to be an "incidental" finding in a biopsy that was prompted by benign changes. As with intraductal carcinoma in situ, 20% to 30% of women with lobular carcinoma in situ receiving no further treatment after biopsy will develop invasive cancer within 20 years of diagnosis. However, about half of these invasive cancers will arise in the contralateral breast and may be either lobular or ductal cancers. Thus, lobular carcinoma in situ, more than ductal carcinoma in situ, serves as a marker for an enhanced risk of subsequent invasive cancer in both breasts. The histologic appearance is not consistent with any of the other choices.Diagnosis: Lobular carcinoma in situ | 5,207 | medmcqa_train |
The following muscle is an opener of the glottis - | Opener (abductor) of glottis is posterior cricoarytenoid. | 5,208 | medmcqa_train |
True about hiatus hernia | HIATUS HERNIA is the most common type of a diaphragmatic hernia classified into type 1 -commonest, small, reducible and is the cephalad displacement of the gastro oesophagal junction into the mediastinum. type 2 -superior migration of fundus of the stomach alongside the GE junction type 3 -combination of both sliding hernia is most commonly associated with GORD. A rolling hernia (para-oesophageal )common in elderly.The usual clinical features include postprandial bloating, dysphagia and early satiety.This can lead to complications such as gangrene of stomach, perforations, volvulus ischaemic longitudinal gastric ulcer. treatment is always surgical. *excision of the sac and repair of the defect.mesh reinforcement to close the hiatus may be required.approaches can be abdominal, thoracic or laparoscopic. Ref: SRB&;s manual of surgery,5th ed, pg no 796 | 5,209 | medmcqa_train |
Which of the following staphylococcal protein is a superantigen- | Ans. is 'a' i.e., Exfoliative toxin Examples of superantigeno Staphylococcal toxic shock syndrome toxino Staphylococcal enterotoxinso Staphylococcal exfoliative (erythrogenic) toxino Streptococcal toxic shock syndrome toxino Certain nonhuman retroviral proteinso Yersinia pseudotuberculosiso Mycoplasma arthritis,o Mouse mammary' tumor virus. | 5,210 | medmcqa_train |
Base substitution of GAC (Asp) to GAG (Glu) is an example ofa) Point mutationb) Silent mutationc) Non-sense mutationd) Conserved mutatione) Non-conserved mutation | It is a point mutation because only single nucleotide is changed (C by G).
It is a conserved mutation because altered AA has same properties as the original one (Both are acidic). | 5,211 | medmcqa_train |
Nerve supply of Glans penis is | Innervation of penis : nerves deriving from S2-S4. Sensory & sympathetic innervation: provided by the dorsal nerve of penis (terminal branch of pudendal nerve), which runs lateral to dorsal aery of penis. It Supplies both skin and glans. The sensory endings are more numerous on the glans). Ilioinguinal nerve branches supply skin at the root. Parasympathetic innervation: provided by cavernous nerves that innervate the helicine aeries in the corpora cavernosa (that is why erection is parasympathetically stimulated). Ref - medscape.com | 5,212 | medmcqa_train |
All of the following structures forms the boundaries of the quadrangular space which is present under the deltoid muscle in the shoulder region, from the posterior side, EXCEPT: | Structures forming the boundaries of the quadrangular space from the posterior side are:Superiorly by teres minorInferiorly by teres majorLaterally by surgical neck of humerusMedially by long head of triceps brachiiContents of the quadrangular space are:Axillary nervePosterior circumflex humeral vesselsSagging pa of shoulder joint capsuleRef: Clinical Anatomy: (a Problem Solving Approach) By Kulkarni page 110. | 5,213 | medmcqa_train |
platelet activating factor causes all except: | PAF is another phospholipid derived mediator having the following inflammatory effects: Platelet aggregation Vasoconstriction Bronchoconstriction At extremely low concentration, it may cause vasodilation and increased venular permeability Increases leukocyte adhesion to the endothelium (by enhancing integrin-mediated leukocyte binding), chemotaxis, degranulation, and the oxidative burst. Stimulates the synthesis of other mediators, paicularly eicosanoids, by leukocytes and other cells. ref robbins 9/e page 89 | 5,214 | medmcqa_train |
Skin involvement in toxic epidermal necrolysis? | Ans. is 'd' i.e., > 30% Erythema multiforme It is an acute , often self limited eruption characterized by a distinctive clinical eruption, the hallmark of which is target lesions (Iris lesions). EM can present with wide spectrum of severity which can be classified into 1. Erythema multiforme minor It is simply referred to as erythema multiforme (i.e. if not specified about other 2 types, erythema multiforme means EM minor). Localized eruption of skin with or without mucosal involvement. 2. Steven- Johnson syndrome (SJS) There are mucosal erosions with pruritic macules. In this epidermal detatchment is 10-30% of the body surface area. 3. Toxic epidermal necrolysis (TEN) When skin detachment is more then 30% of BSA. It is also called Lyell's syndrome. Therefore TEN & SJS are considered as single syndrome i.e. SJS-TEN syndrome (Erythema multiforme major). If area involved is more than 30% it is TEN & if area involved is 10-30%, it is SJS. | 5,215 | medmcqa_train |
Coronary vasodilatation is caused by | Refer kDT 7/e p536 It serves as a metabolic coupler between oxygen consumption andcoronary blood flow. ... Parasympathetic stimulation of the hea (i.e., vagal nerve activation) elicits modest coronary vasodilation(due to the direct effects of released acetylcholine on the coronaries). In some types of blood vessels, there is evidence that adenosine producesvasodilation through increases in cGMP, which leads to inhibition of calcium entry into the cells as well as opening of potassium channels. Incardiac tissue, adenosine binds to type 1 (A1) receptors, which are coupled to Gi-proteins. | 5,216 | medmcqa_train |
Which of the laboratory test supports the diagnosis of preeclampsia | Pre - eclampsia Diagnostic criteria
B.P > 140 /90 mmHg after 20 weeks in previously normotensive women
Proteinuria > 300 mg / 24 hours or
Protein : Creatinine ratio > 0.3 or
Dipstick 1 + Persistent.
Platelets < 100,000 / μ L
Creatinine > 1.1 mg / dL
Serum transaminase levels twice normal. | 5,217 | medmcqa_train |
Craniospinal irradiation is employed in the treatment of: | Medulloblastoma | 5,218 | medmcqa_train |
Madelung's deformity involves - | Ans. is 'c' i.e., Distal radiusMadelung's deformityo Madelung's deformity is a congenital disorder that affects growth of distal radius.o The primary defect is failure of normal growth of medial and palmar halves of the distal radial physis, leading to curvature in an medial (ulnar) and palmar direction,o The ulna is relatively long and becomes prominent dorsally.o The carpus (carpal bones) sinks, along with the medial (ulnar) half of the distal radial articular surface, into the gaps between the two forearm bones. | 5,219 | medmcqa_train |
Oolani&;s test is used in | OOLANI&;STEST is used to test DDH in infants In this test the baby&;s thighs are held with the thumbs medially and the fingers resting on the greater trochanters; the hips are flexed to 90 degrees and gently abducted. In NORMAL baby, there is smooth abduction to almost 90 degrees. In CONGENITAL DISLOCATION the movement is usually impeded,but if pressue is applied to the greater trochantehere is a soft &;CLUNK&; as the dislocation reduces,and then the hip abducts fully(JERK OF ENTRY) If abduction stops halfway and there is no jerk of entry, there may be an irreducible dislocation. ref:APLEY&;S 9th edition page no.499 | 5,220 | medmcqa_train |
Ideal substance for measuring GFR should have all characteristics except | The Ideal substance to measure GFR is Inulin or following reasons ; It is non-toxic; It is freely filterable by the glomeruli; it is not bound to proteins It is neither secreted nor reabsorbed by the tubules; It is not synthesized, stored, or destroyed by the kidney . Thus, Filtered inulin = excreted inulin .Hence, it will give an exact estimate of the GFR. Endogenous creatinine clearance is used most commonly used to estimate the GFR. | 5,221 | medmcqa_train |
Oakley fulthrope procedure is | Antibody (antiserum) is incorporated in agar, poured into a tube and allowed to harden. A second layer of agar without antibody is placed above and allowed to solidify. Antigen solution is placed above the agar. The precipitin band appears in the plain agar column. Ref ananthnarayana and panikers microbiology textbook 8/e | 5,222 | medmcqa_train |
A 75-year-old male presented with chief complaint of pain in the right shoulder. CXR is shown below. Which of the following could be the cause of pain in this patient? | CXR shows a mass in the right lung apex and there is associated destruction of the right 2nd and 3rd ribs posteriorly. A combination of an apical mass along with the destruction of the rib is characteristic of Pancoast tumor/ Superior Sulcus Tumor. MRI is a more sensitive investigation in identifying the extension of tumor into adjacent soft tissue and bone. | 5,223 | medmcqa_train |
A 50-year-old woman undergoes neurosurgery for resection of a well-circumscribed intracranial neoplasm attached to the dura. The tumor compressed the underlying brain parenchyma without infiltration. Which of the following is the most likely diagnosis? | The gross features of this dural-based tumor are consistent with meningioma, the most frequent benign intracranial neoplasm. It arises from meningothelial cells and histologically consists of whorls of elongated cells with scattered psammoma bodies. The benign behavior of this tumor is apparent from its "pushing" pattern of growth. The tumor tends to expand downward, compressing the brain, but without invading it. For this reason, this tumor can be easily removed at surgery. An aeriovenous malformation is a vascular aggregate of aeries, veins, and vessels with intermediate characteristics. These lesions are usually intracerebral and manifest with hemorrhage or seizures. Glioblastoma multiforme is the most frequent malignant intracerebral tumor. It arises from neoplastic transformation of astrocytes within the white matter. Grossly, it is characterized by a variegated appearance, with areas of solid tumor alternating with necrosis and hemorrhage. Medulloblastoma develops from the cerebellar vermis, usually in children. It is composed of small, primitive-appearing neoplastic cells. | 5,224 | medmcqa_train |
Which is the commonest indication of classical cesarean section? | ANSWER: (C) Dense adhesion in lower uterine segmentREF: William's obs 22nd e p- 5987Classical caesarean section is not done these days f however its done in cases where the lower segment is not approachable. Uterine incision is made on upper segment above the reflection of uterovesical fold of peritoneum.Indications of classical caesarean sectionI Where lower segment approach is difficultDense adhesion due to previous operationsSeverely contracted pelvis ( osteomalcic or rachitic)Where lower segment approach is riskyBig fibroid in lower segmentCa cervixRepair is difficult and high vesico vaginal fistulaSevere degree of placenta previa with engorged vesselsPost mortem contemplating to have a live baby | 5,225 | medmcqa_train |
All of the followoing non-mycobacterial microorganisms display acid fastness, EXCEPT: | Microorganisms other than mycobacteria that display some acid fastness includes Nocardia, Rhodococcus, Legionella micdadei, Protozoa Isospora and Cryptosporidium. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 1340 | 5,226 | medmcqa_train |
Surgery of choice for chronic acquired dacryocystitis | Ans. is 'a' i.e., Dacryocystorhinostomy Treatment of chronic dacryocystitis Congenital Adult (acquired) Massage over lacrimal sac with antibiotic eye drops Conservative :- Massage, antibiotic drops, probing, Syringing (irrigation) with normal saline & syringing antibiotic solution Dacryocystorhinostomy (DCR) :- Surgery of hoice Probing of nasolacrimal duct Dactyocystectomy (DCT) Intubation with silicone tube Conjunctivocystorhinostom Dacryocystorhinostomy (DCR) | 5,227 | medmcqa_train |
A mother presents to the neonatology OPD with her baby because of yellow extremities. On examination, there is petechial rash over the body, hepatosplenomagaly, microcephaly. What is the causative organism? | Features of congenital CMV infection are: petechial rash, jaundice, hepatosplenomegaly, microcephaly, periventricular calcification, deafness, chorioretinitis,IUGR. congenital rubella syndrome: triad of cardiac defects, cataract and conductive hearing loss neonatal herpes presents as skin lesions with eye involvement, encephalitis, disseminated disease. fetal varicella syndrome: cicatrizing/ scarring skin lesions, chorioretenitis, hypoplastic limbs, LBW, CNS defects- due to cerebral atrophy. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition | 5,228 | medmcqa_train |
Smokeless gun powder is composed of ? | Ans. is 'c' i.e., Nitrocellulose Smoke producing powder :- Black powder (black gun powder), Pyrodex. Smokeless powder :- Black powder plus nitrocellulose/nitrocellulose + nitroglycerine/nitroglycerine + nitrocellulose nitroguanidine. Semismokeless powder :- 80% black powder plus 20% smokeless powder. | 5,229 | medmcqa_train |
Soap bubble appearance on Xray is seen in which bone tumor ? | Ans. is 'A' i.e., Rheumatoid ahritis Repeat from previous sessions. See explanation-3 of session-3. | 5,230 | medmcqa_train |
Which of the following is the organism causing chronic burrowing ulcer? | Chronic Burrowing ulcer is also known as Meleney's ulcer. This type of ulcer is caused by a hemolytic microaerophilic Streptococci, and usually develops after surgery on the intestinal or genital tract. Ref: A Manual On Clinical Surgery, By, S.Das,Page, 52, 53; Oxford Textbook Of Surgery, 2000, 2nd Edition, Page 105; Textbook of Surgery By Gupta, 2nd edition page 66. | 5,231 | medmcqa_train |
Most common tumour in undescended testis is : | Approximately 95% of testicular tumors are derived from germ cells. Seminomas tend to remain localized in the testis for a longer period, are radiosensitive, and metastasize to lymph nodes, whereas nonseminomatous neoplasms metastasis sooner, are radioresistant, and tend to metastasize hematogenous routes. Risk factors for development of testicular neoplasms Cryptorchidism (i.e., undescended testicle). Syndromes with testicular dysgenesis (e.g., Klinefelter syndrome). Family history and history of a tumor in the contralateral testis. Ref : Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 17. Pathology of the Male and Female Reproductive Tract and Breast. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds),Pathology: The Big Picture. | 5,232 | medmcqa_train |
Which of the following disorder is an indication for the use of steroids in neonates? | Bronchopulmonary disorder is a chronic lung disorder which occur in children born prematurely with low bihweight and who recieved prolonged mechanical ventilation to treat respiratory distress syndrome. Treatment modalities includes use of surfactant, inhalational glucocoicoids with beta 2 agonists . | 5,233 | medmcqa_train |
Somatosensory area I largest representation is for | Coical areas for sensation from trunk and back are small, whereas large areas are concerned with impulses from hand and pas of mouth. And from the figure 11-4 it is evident that area for hand is more than face. Ref: Ganong&;s review of medical physiology; 23rd edition; pg:175 | 5,234 | medmcqa_train |
In trichomonas - vaginalis: | (Greenish discharge) (125-Smaw's 13th) (107-S14th)* Trichomoniasis - 70% show typical discharge, which is profuse, thin creamy or slightly green in colour irriting and frothy discharge (almost self diagnostic)Multiple small punctate strawberry spots on the vaginal vault and portio-vaginalis of the cervix {strawberry vagina)* Candidiasis (Monilliasis) - Profuse curdly discharge and intensere pruritis.* Gardnerella - (Bacterial vaginosis) - white milky, nonviscous discharge adherent to the vaginal wall, fishy odour, when mixed with 10% KOH, Presence of clue cells. | 5,235 | medmcqa_train |
Regarding sudeck's osteodystrophy all are true except | D i.e. Self limiting & good prognosis - International Association for the Study of Pain (IASP) has advocated the term complex regional pain syndrome type 1 (CRPS-1) for reflex sympathetic dystrophy and term complex regional pain syndrome type 2 (CRPS-2) to describe causalgia or similar signs and symptoms associated with a known peripheral nerve injury. - So the main difference between CRPS-1 (RSD, Sudceck's osteodystrophy) and CRPS-2 (Causalgia) is etiology. CRPS type 1 being associated with a soft tissue injury or immobilization while CRPS type II follows a peripheral nerve injury. - Presence of delayed onset, out of propoion, severe persistent, burning pain, decreased range of motion (stiffness), and shiny skin (trophic changes), erythematous & cyanotic discoloration 4 weeks to 2 months after sustaining soft tissue injury (ankle sprain) or bony injury (Colle's fracture) suggest a diagnosis of CRPS type 1 (i.e. reflex sympathetic dystrophy). Prolonged disuse results in muscle atrophy, joint stiffness or contracture, and osteopenia and leads to prolonged recovery (poor prognosis). Sympathetectomy (eg stellate ganglion block) may be used for treatment. It is a group of vague painful conditions observed as a sequelae of trauma. The trauma is some times relatively minor and signs and symptoms are out of propoion of the trauma. It is characterized by pain, hyperaesthesia, swelling, stiffness, discolouration, and trophic changes wihich are out of propoion to the inciting eventQ The most characteristic symptom is pain out of propoion to the inciting event in both severity and duration. It is often burning in characterQ. Hence the term 'Causalgia' which means burning pain. - Due to hypeaesthsia to light touch, patients often withdraw when one attempts to examine the affected extremity - Swelling is the most consistent physical findingQ. It often begins in area of injury and is soft initially, as the process continues, oedema gradually becomes firm and involve much broader area. - Stiffness and discolouration of skin (red, blue & /or pallor)Q are other classic signs. - Trophic skin changes i.e. skin is shiny, thin with loss of normal wrinkles and creasesQ are characteristically seen late. - The most common radiographic finding is localized osteopeniaQ d/t increased blood flow to the bone - Prognosis is directly related to the time to diagnosis and initiation of therapy. The goal is to break abnormal sympathetic reflex and to restore motion. - The abnormal sympathetic response is interrupted by the use of sympatholytic drugs eg. a - adrenergic blockers, local somatic nerve blocks, (Bier's block, axillary block), stellate ganglion blocks, or surgical sympathetectomyQ - Physical therapy is of crucial impoance. Active and passive range of motion should be performed to the level of discomfo but not pain - Recovery is prolonged & painful both for patient and surgeon. 3 years usually elapse before the bones are remineralized & it is rare that full range of movements returns. In absence of major nerve damage diagnosis is CRPS-1 If major nerve damage is present & pain is limited to a single peripheral nerve the diagnosis is CRPS 2. CRPS Type 1: Reflex Sympathetic Dystrophy/ Sudeck's Osteoneuro Dystrophy - Pain after an (often minor) noxious event or immobilization (+-) - Continuing spontaneous pain or allodynia/hyperalgesia dispropoionate to the inciting event and not limited to a single peripheral nerve. - Edema, skin blood flow abnormality or abnormal pseudomotor activity at sometime in region of pain. - Excluded by conditions that otherwise account for the degree of pain and dysfunction. Autonomic Symptom Complex Sensory Hyperalgesia, Hyperaesthesia, Allodynia, Dysthesia Vasomotor Skin mottling, Cynosis, Erythema, Skin color asymmetry Sudomotor Edema, Hyperhidrosis, Sweating changes Trophic Changes of nail, hair & skin eg shiny, thin skin with loss of wrinkles Motor Muscle atrophy, stiffness or contracture of jointQ. X ray OsteopeniaQ Teche An erythematous line Cerebral sign develops, with in 10 to . 15 seconds & may persist for 10 to 15 minutes, by stroking the skin with blunt object. | 5,236 | medmcqa_train |
Increased BMR is associated with - | Ans. is 'c' i.e., Increased glycolysis o Increased BMR is associated with hyper metabolic state which is characterized by :-Carbohydrate metabolismi) | Glycolysis| Gluconeogenesis| Glvcogenesis| GlyeogenolysisLipid metablism| Lipogenesis| Lipolysis| Cholesterol Synthesis| Triacylglycerol Synthesis| Lipoprotein degradation| KetogenesisProtein metablismIncreased protein degradationDecreased protein biosynthesis | 5,237 | medmcqa_train |
Histone acetylation causes | Histone acetylation and deacetylation are the processes by which the lysine residues within the N-terminal tail protruding from the histone core of the nucleosome are acetylated and deacetylated as pa of gene regulation. Histone acetylation and deacetylation are essential pas of gene regulation. These reactions are typically catalysed by enzymes with "histone acetyltransferase" (HAT) or "histone deacetylase" (HDAC) activity. Acetylation is the process where an acetyl functional group is transferred from one molecule (in this case, Acetyl-Coenzyme A) to another. Deacetylation is simply the reverse reaction where an acetyl group is removed from a molecule. Acetylated histones, octameric proteins that organize chromatin into nucleosomes and ultimately higher order structures, represent a type of epigenetic marker within chromatin. Acetylation removes the positive charge on the histones, thereby decreasing the interaction of the N termini of histones with the negatively charged phosphate groups of DNA. As a consequence, the condensed chromatin is transformed into a more relaxed structure that is associated with greater levels of gene transcription. This relaxation can be reversed by HDAC activity. Relaxed, transcriptionally active DNA is referred to as euchromatin. More condensed (tightly packed) DNA is referred to as heterochromatin. Condensation can be brought about by processes including deacetylation and methylation; the action of methylation is indirect and has no effect upon charge. | 5,238 | medmcqa_train |
A pregnant woman of >35 weeks gestation has SLE. All of the following drugs are used in treatment except: | Methotrexate is very effective in treating Systemic Lupus erythematosus(SLE) but during pregnancy, it can cross the placenta and cause the teratogenic effect to the fetus. The main teratogenic effect caused by Methotrexate is cleft palate, hydrocephalus, multiple defect, and fetal death. ESSENTIALS OF MEDICAL PHARMACOLOGY: SEVENTH EDITION -K.D TRIPATHI Page:862,89 | 5,239 | medmcqa_train |
Boorheave syndrome involves perforation of esophagus after | Ans. is 'd' i.e., Vomiting [Ref: CSDT 13th/ep.444 & 11th/e p. 490; Schwartz 9th/ep.874 & 8th/e, p. 906; Bailey & Love 25th/e p.1014 & 24th/ep.996}* Boerhaave's syndrome is spontaneous perforation of the esophagus, occuring usually due tosevere barotrauma when a person vomits against a closed glottis. The pressure in the esophagus rapidly increases and the esophagus bursts at its weakest point, sending a stream of material into the mediastinum and often the pleural cavity as well.* Most common location of perforation is in the left posterolateral aspect 3-5 cm above the gastroesophageal junction. Second most common site of perforation is at the midthoracic esophagus on the right side.* Most cases follow a bout of heavy eating and drinking.* The principal early manifestation is pain felt in the chest and upper abdomen. | 5,240 | medmcqa_train |
Horner syndrome causes all, except: | Mydriasis | 5,241 | medmcqa_train |
β - blocker toxicity is treated by | Glucagon is used to treat Overdose of β - blockers
Fomepizole is used to Ethylene Glycol poisoning. | 5,242 | medmcqa_train |
Investigation of choice for studying Renal Coical mass | C i.e. 99 - Tc - DMSA DTPA (Renogram) DMSA (Isotope Scanning) - DTPA is freely filtered at glomerulus with no - Tc.99 DMSA is used for renal morphological tubular reabsorption or excretion (i.e. GFR = (anatomic) imagine Excretory function) - This compound gets fixed in renal tubules & images - DTPA is useful for evaluating perfusion and may be obtained after 1-2 hours of injection. Lesions excretory function of each kidneyQ such as tumors & benign lesions as cysts show filling - Indications: defectQ 1. Measurement of relative renal - Used to assess coical function of KidneyQ and detect functionQ in each kidney. renal scarringQ. 2. Urinary tract obstructionQ 3. Diagnosis of Renovascular cause of hypeensionQ 4. Investigation of Renal transplantQ | 5,243 | medmcqa_train |
Drugs commonly used in pre-anaesthetic medication are all except | Succinylcholine is a neuro muscular blocker used during induction of General anaesthesia. Drugs used in premedication include benzodiazepines like midazolam, diazepam; opioids like morphine, fentanyl; anticholinergics like atropine, scopolamine, glycopyrrolate. | 5,244 | medmcqa_train |
All are the criteria for medical management of ectopic pregnancy except: | Ans. C. Pregnancy diameter <5cmCriteria are:a. Asymptomatic patient.b. Serum b-hCGlevel<2000IU/L.c. Pregnancy diameter <2cm.d. Unruptured tube.e. Non-active bleeding.f. No fetal cardiac activity on USG.g. <100ml blood in the pouch of Douglas. | 5,245 | medmcqa_train |
Stain with parasite having Charcot-Layden crystals but no pus cells: | Ans. is 'c' i.e., E. histolytica(Ref: Harrison, 19th/e, p. 1685; D.R. Arora, 2nd/e, p. 26, 27)* Fecal finding in amoebiasis are:I. Charcot-Leyden crystals.II. Positive test for heme.III. Paucity (lack) of neutrophils (pus cells). | 5,246 | medmcqa_train |
A 75-year-old man with a history of myocardial infarction 2 years ago, peripheral vascular disease with symptoms of claudication after walking half a block, hypeension, and diabetes presents with a large ventral hernia. He wishes to have the hernia repaired. Which of the following is the most appropriate next step in his preoperative workup? | The patient should undergo persantine thallium stress testing followed by echocardiography to assess his need for coronary angiogram with possible need for angioplasty, stenting, or surgical revascularization prior to repair of his hernia. Although exercise stress testing is an appropriate method for evaluating a patient's cardiac function preoperatively, this patient's functional status is limited by his peripheral vascular disease and therefore a pharmacologic stress test would be the preferred method of cardiac evaluation. An ECG should be performed in this patient with a history of cardiovascular disease, hypeension, and diabetes, but a normal ECG would not preclude fuher workup. While myocardial infarction (MI) within 6 months of surgery is considered to increase a patient's risk for a cardiac complication after surgery using Goldman's criteria, a remote history of MI is not prohibitive for surgery in and of itself. | 5,247 | medmcqa_train |
Which of the following drugs used to treat MDR TB can cause hypothyroidism: | Adverse effects of Ethionamide Gastro-intestinal: epigastric discomfo, anorexia, nausea, metallic taste, vomiting, excessive salivation, and sulfurous belching Psychiatric: hallucination and depression Hepatitis Hypothyroidism and goitre with prolonged administration Gynaecomastia, menstrual disturbances, impotence, acne, headache, and peripheral neuropathy Ref: | 5,248 | medmcqa_train |
Classic Galactosemia is due to deficiency of: | Galactose 1-Phosphatase Uridyltransferase (GALT) the rate-limiting enzyme of galactose metabolism is deficient in galactosemia. Galactose undergoes an exchange reaction with UDP-glucose to produce glucose 1-phosphate and UDP-galactose, using the rate-limiting enzyme galactose 1-phosphate uridyltransferase (GALT). Galactose metabolism: Galactose and its derivatives play a central role in the biosynthesis of complex carbohydrates, glycoproteins and glycolipids. In many organisms galactose also can serve as an impoant source of energy. No direct catabolic pathways exist for galactose metabolism. Galactose is therefore preferentially conveed into Glucose-1Phosphate, which may be shunted into glycolysis or into UDP galactose which can be used in synthetic pathways, including synthesis of lactose, glycoproteins, glycolipids, and glycosaminoglycans. Leloir pathway for Galactose metabolism: Galactose metabolism involves conversion of Galactose into Glucose-1-Phoshate, which may be shunted into Glycolysisor into UDP Galactose which can be used in synthetic pathways, including synthesis of Lactose, glycoproteins, glycolipids and glycosaminoglycans. This is carried out by the three principal enzymes in a mechanism known as Leloir pathways. Three major Enzymes of Galactose Metabolism and the metabolic consequence of result of their Deficiency: GALT: Galactose-1-Phosphate-Uridyl-Transferase (Classical Galactosemia; Most common: rate limiting Step) GALK: Galactokinase (Non classical Galactosemia; Less common) GALE: UDP-Galactose-4-Epimerase (Rare) These are diseases associated with deficiencies of each of these three enzymes the Leloir pathway Type 1 Type 2 Type 3 GALT GALK1 GALE Classic Galactosemia Galactokinase Deficient Galactosemia Galactose Epimerase Deficient Galactosemia Ref: Harper | 5,249 | medmcqa_train |
A female presents with placenta previa with active bleeding and blood pressure of 80/50 mm Hg and pulse rate of 140 bpm. The choice of anaesthesia for emergency cesarean section in this female is? | Ans. (B) General anesthesia with intravenous ketamine(Ref: Williams Obstetrics 24th/e p518; Morgan 4th/197-199)The patient is presenting with shock, so spinal anesthesia cannot be used. Among the general anesthetics, ketamine is drug of choice for induction in patients with low blood pressure. | 5,250 | medmcqa_train |
Drug of choice in bacterial vaginosis is : | Metronidazole | 5,251 | medmcqa_train |
Which of the following statements is wrong regarding hematoma | Ref. Sabiston Textbook of Surgery. Pg. 436
Hematoma
A hematoma is a localized collection of blood outside the blood vessels ,due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries .
A hematoma is initially liquid in form spread among the tissues including in sacs between tissues where it may coagulate and solidify before blood is reabsorbed in to blood vessels
Hematoma need not be operated | 5,252 | medmcqa_train |
Lymphatic drainage of upper outer quadrant of breast ? | Ans. is 'a' i.e., Anterior axillary Most lymph, especially that from the superior lateral quadrant and center of breast, drains into the axillary lymph nodes, which, in turn, are drained by the subclan lymphatic trunk. Among the axillary nodes, the lymphatics end mostly in the anterior groups and paly the posterior and apical groups. Lymph from the anterior and posterior groups passes to the central and lateral groups, and through them to the apical (terminal) groups. Finally it reaches the supraclavicular nodes. The lymph vessels of the breast are arranged into two groups :? Superficial lymphatics : Drain skin of the breast. Deep lymphatics : Drain parenchyma of breast along with nipple and areola :? 75% is drained into axillary nodes (mostly into anterior axillary). 20% is drained into internal mammary lymph nodes. 5% is drained into posterior intercostal lymph nodes. | 5,253 | medmcqa_train |
Opsonization takes place through- | 1. All the three complement activation pathways(classical , alternate , lectin) lead to activation of C3, resulting in the production of C3b. Hence, C3b is considered as the central molecule in the activation of the complement cascade. 2. The C3b has two impoant functions to perform First, it combines with other components of the complement system to produce C5 convease, the enzyme that leads to the production of membrane attack complex(MAC) Second, it opsonizes bacteria due to the presence of receptors for C3b on the surface of the phagocytes. Biological Effects of Complement C5a: C5a is a chemotactic molecule specifically recognized by polymorphonuclear leukocytes or phagocytic cells. This substance causes leukocytes to migrate to a tissue in which an antigen-antibody reaction is taking place. At that site, a phagocytic cell recognizes opsonized paicles and ingests them. | 5,254 | medmcqa_train |
What is your diagnosis:- | Following image shows a defect in the orbital floor and the 'tear drop' sign in the antrum characteristic of blow out fractures of orbit. WATER'S view on X-RAY is helpful in eliciting orbital blow out fracture | 5,255 | medmcqa_train |
All are true about fully frozen Ice pack except:- | Fully Frozen Ice Pack; Fill water up to horizontal mark with plain tap water. Smallest Component of cold chain. If there is any leakage such ice-packs should be discarded. 2 vaccines are kept in two holes inside the ice pack. Can maintain vaccine temeprature for 2-4 hours. | 5,256 | medmcqa_train |
Most common presentation of nasopharyngeal carcinoma is? | Ans. is'a'i.e., Neck mass(Ref: Dhingra Sn/e p. 265)Neck mass is the most common presentation (60-90%) due to cervical lymphadenopathy. | 5,257 | medmcqa_train |
Sixth cranial nerve lies at? | Sixth cranial nerve which supplies the lateral rectus muscle of the eyeball. one nerve fibre supplies approximately six muscles fibers. Abducent nucleus is situated in the upper pa of the floor of fouh ventricle in the lower pons, beneath the facial colliculus.ventromedially it is closely related to the medial longitudinal bundle. Ref;BDC volume 3;6th edition. | 5,258 | medmcqa_train |
Treatment of Ca Cervix IIIB include - | Ans-D i.e., Intracavity brachytherapy followed by external beam radiotherapy Stage 1IA * Invasion limited to the measured stromal invasion with the maximum depth of 5mm and not wider than 7 mm IA1 * Invasion of stroma not greater than 3 mm in depth and no wider than 7mmIA2 * Measured invasion of stroma greater than 3mm but not greater than 5mm and not wider than 7 mm At this stage, the cancer is micro-invasiveMicroinvasive cervical cancer carries a minor risk of lymph node involvement and excellent prognosis following t/t.Therefore conservative t/t i.e., "conization" may also be considered many in these patients.Management of Stage IA1These are associated with the lowest risk of lymph node involvementThe risk increases only when there is lymphovascular space invasionThe t/t also varies according to the lymphovascular space invasion Lymphovascular space - Fertilities to be preserved invasion absent - Cervical Conization Do not wish to retain fertilities - Total infra fascial hysterectomy Lymphovascular - Modified radical hysterectomy and space invasion present pelvic lymphadenectomyManagement of State IA2These patients have 7% risk of lymph node metastasis and a greater than 4% risk of disease recurrence.Conservative management cannot be done for this degree of micro-invasion.These patients require "modified radical hysterectomy and pelvic lymphadenectomyIf fertility is to be preserved - Radical trachelectomy and lymphadenectomyPatients with micro-invasive cancers (Stages IA1and IA2) can also be treated with intracavitary brachytherapy aloneThis is usually done in older women who do not wish to preserve ovarian or sexual function stage IB* Clinical lesions confined to the cervix or preclinical lesions greater than IAIB,* Clinical lesions <=4 cm in sizeib2* Clinical lesions >=4 cm in sizeSTAGE II* Carcinoma extends beyond the cervix but has not extended to the pelvic wall, involves vagina, but not lower thirdHa* No obvious parametrial involvement but do extend vaginally at far as proximal thirdHb* Invades vagina to a similar extent as well as invade the parametriumManagement of stage IB to IIa TumoursBoth Radiotherapy and surgery are viable options in these patientsThe current practice is: IB1 ib2Radical hysterectomyManaged primarily with chemoradiation similar to advanced staged cancers* In general radical hysterectomy for stage IB through IIA tumors is usually selected for younger women with low BMI's who wish to preserve ovarian function and have concerns about sexual function following radiotherapy. STAGE IIICarcinoma has extended to the pelvic wall on pelvic examination there is no cancer-free space between the tumor and the pelvic wallTumor involves a lower third of the vaginaAll cases with hydronephrosis or nonfunctioning kidney should be includedIIIAIIIbInvolvement of lower third of vagina but no extension to the pelvic wallExtension to the pelvic wall, or hydronephrosis or nonfunctioning kidney due to the tumor.STAGE IV* Carcinoma has extended beyond the true pelvis or has clinically involved mucosa of bladder or rectumIVa* Spread of growth the adjacent organsIVB* Spread to distant organsManagement of stage IIB through IVa These are advanced stage cervical cancers, they extend past the confines of the cervix and often involve adjacent organs and retroperitoneal lymph nodesMost of the advanced stage tumors have a poor prognosis and their survival rate is less than 50%Two treatment modalities are available for these patientsRadiation therapyChemoradiation"Radiation therapy" was the cornerstone of advanced stage cervical cancer managementBut current evidence indicates that concurrent chemotherapy significantly improved overall and disease-free survival of women with advanced cervical cancerThus most patients with stage IIB through IVA cervical cancer are best treated with "chemoradiation" - Cisplatin containing regimens are associated with best survival rates since chemoradiation is not given in the option, radiotherapy is the answer.Management of stage IVBThey have poor prognosis and are treated with a goal of palliationThey are administeredPelvic radiation - To control vaginal bleeding and painSystemic chemotherapy - To palliate symptoms | 5,259 | medmcqa_train |
Which of the following inhalational anesthetic agent is contraindicated in liver disease? | Ans. b (Halothane). (Ref. Lee's synopsis of Anesthesia 12th ed. 163)Ether may cause a transient depression of liver function but does not cause significant damage.HALOTHANE# Dose: 0.5% (MAC 0.75%)# Actions: analgesic, anaesthetic# Advantages:- Potent and effective,- Allows for high FI02 delivery,- Bronchodilatation,- Low irritant,- Nice smell; can be used for induction# Disadvantages:- CVS depression,- Cerebral Vasodilatation- | ICP,- Respiratory depression, Airway irritation,- "halothane hepatitis",- Arrhythmias,- Myocardial depression,- Incidence of malignant hyperpyrexiaISOFLURANE# An isomer of enflurane.# It is a stable agent, so, no need of preservative.# It does not depress myocardium, so good for cardiac surgery.# Sensitizes heart to catecholamines, but not nephro/hepatotoxic.# Commonly used in neurosurgery.# Can cause coronary-steal syndrome.ENFLURANE# Nonirritating and noninflammable Liquid# Stimulates salivary and respiratory secretions slightly# Heart rate decreases little and reduction of cardiac output is less marked.# Does not sensitize the heart to adrenaline, arrhythmias are rare.# Bronchodilatation is similar to halothane.# It is a better skeletal muscle relaxant.# Contraindicated in epilepsy.METHOXYFLURANE# It has highest amount of fluoride content.# It can be converted into oxalate in the liver and can cause oxalate renal stone formation.# It is nephrotoxic and causes high out put renal failure.# Not used commonly.SEVOFLURANE# Induction and emergence from anaesthetic are fast and rapid changes in depth can be achieved.# Acceptability is good by pediatric patients.# Sevoflurane does not cause sympathetic stimulation and airway irritation even during rapid induction. Amount of fluoride liberated is safe for kidney and liver.# It is degraded by soda lime - not recommended for use in closed circuit.# Sevoflurane has rapid induction (1-2 min) and also emergence from anesthesia is more rapid than Isoflurane, and is comparable with than seen after continuous Propofol anesthesia. This makes it suitable for day -stay surgery.DESFLURANE# Anaesthetic for out patient surgery.# Induction and recovery are very fast.# Postanaesthetic cognitive and motor impairment is short-lived.# Desflurane is less potent than isoflurane; may induce coughing, breath holding and laryngospasm.# Desflurane can serve as a good alternative to isoflurane for routine surgery. | 5,260 | medmcqa_train |
X - linked inheritance of alport's syndrome is due to mutation of _________ | Mutation of COL4A5 gene ⇒ X - linked inheritence
Mutation of COL4A3 ,COL4A4 gene ⇒ Autosomal inheritence | 5,261 | medmcqa_train |
A chemical is tested for carcinogenicity by examining its mutagenic effects on bacterial cells in culture. Which of the following tests is used to make this determination? | The test described is the Ames test, which measures damage to DNA and correlates well with carcinogenicity in vitro. It is relatively inexpensive to perform, compared to other tests of carcinogenicity, and is frequently used as a screening test for potential carcinogens. The nitroblue tetrazolium test is used to examine the ability of neutrophils to undergo a respiratory burst, and is used in the diagnosis of hereditary immunodeficiencies. The Watson-Schwaz test detects porphobilinogen in urine, and is used in the diagnosis of porphyrias. The Widal test is used to diagnose typhoid fever. Ref: Lichtman M.A., Tefferi A. (2010). Chapter 91. Primary Myelofibrosis. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e. | 5,262 | medmcqa_train |
Treatment of choice for a patient with acquired vesicoureteric reflux with UTI? | Acquired renal scarring results from an episode or repeated episodes of acute pyelonephritis caused by infected urine in the presence of VUR. Infection activates a cascade of mediators, which leads to renal epithelial cells damage. Treatment with antibiotics during the first week after infection appears to limit inflammation, and consequently, scar formation. Only fine linear scars extending through the coex and small dimpling of the renal surface are evident if appropriate antibiotic therapy is instituted during the early inflammatory phase. Ref: Nguyen H.T., Tanagho E.A. (2009). Chapter 39. Reflux Nephropathy. In E.V. Lerma, J.S. Berns, A.R. Nissenson (Eds), CURRENT Diagnosis & Treatment: Nephrology & Hypeension. | 5,263 | medmcqa_train |
Which structure is present in the anatomical snuff box? | Ans. B Radial arteryRef: BDC, 6th ed. vol. I pg. 122; Gray's 41st ed. pg. 790* The anatomical snuffbox is formed by the tendons of extensor polloicis longus and brevis, and abductor pollicis longus.* It has the radial artery running in the floor of the snuffbox, and the radial nerve passing to the dorsum of the hand.* Boundaries of snuff box:# Postero-medial border is the tendon of the extensor pollicis longus.# Antero-lateral border is a pair of parallel and intimate tendons of the extensor pollicis brevis and the abductor pollicis longus.# The proximal border is formed by the styloid process of the radius.# The distal border is formed by the approximate apex of the schematic snuffbox isosceles. | 5,264 | medmcqa_train |
All are true of pond's fracture, except: CMC (Vellore) 13 | Ans. Depressed fracture of the skull | 5,265 | medmcqa_train |
Triacylglycerol and Cholesteryl ester are | In general, lipids are insoluble in water since they contain a predominance of non polar (hydrocarbon) groups. However, fatty acids, phospholipids, sphingolipids, bile salts, and to a lesser extent, cholesterol contain polar groups. Therefore, a part of the molecule is hydrophobic, or water insoluble; and a part is hydrophilic, or water. Such molecules are described as amphipathic. Water interfaces with the polar group in the water phase and the non polar group in the oil phase. A bilayer of such amphipathic lipids is the basic. | 5,266 | medmcqa_train |
which level the somites initially form ? | Ans. is 'b' i.e., Cervical levelThe first pair of somites develop a sho distance posterior to the cranial end of the notochord, and the rest of the somites from caudally."By the 20" day, the first pair of somites have formed in neck region." Textbook of embryologyParaxial mesoderm differentiates into somites. By the end of 20th day, the first pair of somites have formed in neck region. After this, about 3 pairs of somites are formed per day and by the end of 5" week about 42-44 somite pairs are formed (4-occipital, 8-cervical, 12-thoracic, 5-lumbar, 5-sacral and 8-10 cooccygeal). Somites are fuher differentiated into :-Dermatomyotome :- Give rise to skeletal muscles and dermis.Sclerotomes :- Give rise to veebral column. | 5,267 | medmcqa_train |
All are common sites of primary for bone metastasis except- | Ans. is 'c' i.e., Brain o Metastatic bone disease is the commonest malignancy of bones and is much more common than primary bone tumors.o The commonest sites for bone metastases are vertebrae (most common), pelvis, the proximal half of the femur and the humerus.o Extremities distal to elbow and knee are least commonly involved sites.o Spread is usually via the blood stream; occasionally, visceral tumors spread directly into adjacent bones e.g., the pelvis and ribs.o Certain tumors are known to be common sources of bone metastasis.o The following primary tumors are the most common to metastasize in the bone; breast, prostate, lung, thyroid, kidney, and gastrointestinal tract.o The commonest source of metastatic bone disease is carcinoma of the breast.o In males most common source is prostate carcinoma.o Bladder and uterine carcinomas are less common sources.o In children, skeletal metastases originate from neuroblastoma, Ewing's sarcoma, and osteosarcoma. | 5,268 | medmcqa_train |
Mendelsons syndrome is: | Aspiration of gastric contents | 5,269 | medmcqa_train |
Agoraphobia is commonly associated with:- | Agoraphobia: An irrational fear of open spaces or places where reaching a secure or safe base is difficult Commonest phobia encountered in clinical practice More common in women than men Panic disorder is commonly associated with agoraphobia Can cause significant dysfunctionality The individuals suffering from agoraphobia might become overly dependent on their phobic companion(s) - handful of people whom they trust. | 5,270 | medmcqa_train |
Earliest symptom showing improvement from classical triad of Wernicke's incephalopathv. to thiamine therapy ? | Ans. is 'b' i.e., Ophthalmoplegia Response to thiamine treatment in Wernicke's encephalopathy Ocular symptoms :- Earliest to respond, ophthalmoplegia (ocular palsies) improves within hours of thiamine administration. However, horizontal nystagmus may persist. Ataxia :- Ataxia responds more slowly than ocular palsies and half the patients recover incompletely with a residual ataxia. Encephalopathy :- Confusion and other CNS symptoms improve more slowly. As the symptoms of encephalopathy improve, Korsakoff's syndrome may become apparent in some patients | 5,271 | medmcqa_train |
Sulphur of cysteine are not used/utilised in the body for the following process/product: | Ans. C. Introduction of sulphur in methionine.Methionine is an essential amino acid, so it cannot be synthesized from Cysteine.But Sulphur of cysteine is donated by sulphur of methionine.This is called transulfuration reaction.PLP is the coenzyme of transulfuration.The reaction is catalysed by Cystathionine beta Synthase and Cystathionase enzyme. | 5,272 | medmcqa_train |
Not true about angioneurotic edema ? | Edema of angineurotic-edema is non-pitting.
C1 esterase inhibitor deficiency can cause hereditary angioneurotic edema.
Angioedema is a well known adverse effect of ACE inhibitors. | 5,273 | medmcqa_train |
Following are Granulomatous vasculitis except | . | 5,274 | medmcqa_train |
The most common site of metastasis in neuroblastoma? | Metastatic spread, which is more common in children older than 1 yr of age at diagnosis, occurs local invasion or distant hematogenous or lymphatic routes. The most common sites of metastasis are the regional or distant lymph nodes, long bones and skull, bone marrow, liver, and skin. Lung and brain metastases are rare, occurring in >3% of cases. Reference: Nelson; Neuroblastoma; Page no: 2461 | 5,275 | medmcqa_train |
Which of the about the composition of new ORS is wrong? | Total osmolarity is 245 mmol/litre. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:224. <\p> | 5,276 | medmcqa_train |
Root value of femoral nerve? | Root value of Femoral nerve: Dorsal divisions of ventral primary rami of lumbar 2, 3, 4 segments of spinal cord.Ref: Chaurasia; Volume 2; 6th edition; Page no: 62 | 5,277 | medmcqa_train |
Which of the following are also called as "Ghost cell tumors"? | Primary CNS lymphomas are also called as "Ghost cell tumors" as they show quick resolution after initiation of steroids. | 5,278 | medmcqa_train |
Which of the following eating disorder is most common? | Binge eating disorder is the most common eating disorder followed by Bulimia nervosa and Anorexia nervosa. | 5,279 | medmcqa_train |
Risk factor for suicide in depression are all except: | Risk factor for suicide : Increased Risk Decreased Risk Male sex (men successfully commit suicide three times more often than women) Female sex (although women attemptsuicide three times more oftenthan men) A plan for suicide (e.g., decision to stockpile pills) No plan for suicide A means of committing suicide (e.g., access to a gun) No means of suicide Sudden appearance of peacefulness in an agitated, depressed patient (he has reached an internal decision to kill himself and is now calm) Taking pills or poison, Slashing one's wrists Note- Males have higher suicide risk than females. Please remember that females make more suicide attempts than males, however males complete suicide more commonly than females. This difference is mostly due to method used, males tend to use more lethal methods such as gun and hence are more likely to complete suicide. History of previous suicide attempts has the highest predictive value for future attempts. | 5,280 | medmcqa_train |
30 year male with chronic diarrhoea, anemia, raised liver enzymes. Most likely associated with | Anti-endomysial antibody The clinical features are suggestive of celiac sprue0. The typical symptoms of celiac sprue are weight loss, chronic diarrhoea, abdominal distension, growth retardation anemia. Raised liver enzymes is not mentioned in many text books including Harrison. But according to C.M.D.T. 'Mild elevation of aminotransferases are seen in upto 40% of patientsdeg " Impoant points about the diagnosis of celiac sprue Small intestinal biopsy in celiac sprue demonstrates characteristic features but it is not specific for the diagnosis of celiac sprue. It can be seen in tropical sprue also. Serological tests helpful in the diagnosis of celiac sprue are - Anti endomysial antibody (Anti EMA) - Anti tissue (t) transglutaminase antibody Anti (t) TGA A negative test excludes the diagnosis of celiac sprueQ The diagnosis of celiac sprue still rests upon - Clinical demonstration of malabsotptioni2 - Demonstration of intestinal lesion by small bowel biopsyo - Unequivocal improvement in both symptoms and mensal histology on gluten with drawl from the diets'. Antimitochondrial antibody Antimitochondrial antibody testing is done for primary biliary cirrhosis. The points against the diagnosis of primary biliary cirrhosis. - It typically presents in middle aged females. - initial clinical manifestations of the disease are - Pruritus -Fatigue - Characteristic elevation of alkaline phosphatase Antismooth muscle antibody Antismooth muscle antibody testing is done for autoiminune hepatitis Antoimmune hepatitis is common in young women. The usual presentation is an acute attack of hepatitis. | 5,281 | medmcqa_train |
The radiopaque structure shown in the box is most likely: | The genial tubercles (also called the mental spine) are located on the lingual surface of the mandible slightly above the inferior border and in the midline. They are bony protuberances, more or less spine-shaped, that often are divided into a right and left prominence and a superior and inferior prominence.
They attach the genioglossus muscles (at the superior tubercles) and the geniohyoid muscles (at the inferior tubercles) to the mandible. They are well visualized on mandibular occlusal radiographs as one or more small projections. Their appearance on periapical radiographs of the mandibular incisor region is variable; often they appear as a radiopaque mass (3 to 4 mm in diameter) in the midline below the incisor roots. Lingual foramen is a radiolucent structure seen in the midline.
Ref: White and Pharoah, pg-144,145 | 5,282 | medmcqa_train |
Subconjunctival cyst is seen in QUESTION REPEATED | Parasitic cysts such as subconjuctival cyst is seen in Cysticercosis . Hydatid cyst and filarial cust are not infrequent in development countries. Common cystic lesions of conjunctiva are : Congenital cystic lesions Lymphatic cysts of conjunctiva Retention cysts Epithelial implantation cyst (traumatic cyst) Aqueous cyst Pigmented epithelial cyst Parasitic cysts Ref;A.K.Khurana; 6th edition; Page no: 92 | 5,283 | medmcqa_train |
ACTH is increased in all except | Adrenocoicotrophic hormone; hormone produced by the anterior lobe of the pituitary gland that stimulates the secretion of coisol and other hormones by the adrenal coex. Also called adrenocoicotropin, coicotropin.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-368 | 5,284 | medmcqa_train |
Hemiazygous vein crosses left to right at the level | Hemiazygos vein crosses from left to right at the level of T8, after piercing the left crus of diaphragm while ascending. | 5,285 | medmcqa_train |
Deposition of Anti ds DNA Ab in kidney, skin, choroid plexus and joints is seen in: | Answer is A (SLE): Antibodies against double stranded DNA (Anti, ds DNA) and Sm antigen (Anti Sm) are highly specific and viual!;' diagnostic of SLE - Robbins | 5,286 | medmcqa_train |
Index of potency of general anesthesia | Minimal alveolar concentrationIt is the lowest concentration of the anaesthetic in pulmonary alveoli needed to produce immobility in response to a painful stimulus (surgical incision) in 50% individualsIt is the measure of potency of inhalation Gas.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 162 - 163) | 5,287 | medmcqa_train |
Test of detecting damage to cochlea - | As discussed earlier absolute bone conduction test is a tuning fork test in which bone conduction of the patient is compared with BC of the examiner after occluding the external auditory meatus of both patient and examiner
Bone conduction is a measure of cochlear function.
Hence, ABC test is used to detect damage to cochlea.
Rinne’s test
— Measure air conduction
Weber’s test
Caloric test – assesses vestibular function | 5,288 | medmcqa_train |
Drug of choice in anaphylactic shock is? | Intravenous Adrenaline REF: Harrison's Internal Medicinel7th ed> Chapter 311. Allergies, Anaphylaxis, and Systemic M astocytosis Anaphylaxis: Treatment Mild symptoms such as pruritus and uicaria can be controlled by administration of 0.3 to 0.5 mL of 1:1000 (1.0 mg/mL) epinephrine SC or IM, with repeated doses as required at 5- to 20-min intervals for a severe reaction An IV infusion should be initiated to provide a route for administration of 2.5 mL epinephrine, diluted 1:10,000, at 5- to 10-min intervals, volume expanders such as normal saline, and vasopressor agents such as dopamine if intractable hypotension occurs. When epinephrine fails to control the anaphylactic reaction, hypoxia due to airway obstruction or related to a cardiac arrhythmia, or both, must be considered Oxygen alone a nasal catheter or with nebulized albuterol may be helpful, but either endotracheal intubation or a tracheostomy is mandatory for oxygen delivery if progressive hypoxia develops. Ancillary agents such as the antihistamine diphenhydramine, 50 to 100 mgIM or IV, and aminophylline , 0.25 to 0.5 g IV, are appropriate for uicaria-angioedema and bronchospasm, respectively. Intravenous glucocoicoids, 0.5-1.0 mg/kg of medrol, are not effective for the acute event but may allete later recurrence of bronchospasm, hypotension, or uicaria. | 5,289 | medmcqa_train |
A 30-year-old woman presents with a heart murmur. There is a history of recurrent episodes of arthritis, skin rash, and glomerulonephritis. Blood cultures are negative. Laboratory tests for antinuclear antibodies (ANA) and anti-double-stranded DNA are positive. Which of the following is the most likely cause of heart murmur in this patient? | In patients with systemic lupus erythematosus, endocarditis is the most striking cardiac lesion, termed Libman-Sacks endocarditis. Nonbacterial vegetations are seen on the undersurface of the mitral valve close to the origin of the leaflets from the valve ring (Libman-Sacks endocarditis). There is fibrinoid necrosis of small vessels with focal degeneration of interstitial tissue. Rheumatic fever (choice E) is not commonly associated with ANAs seen in this case.Diagnosis: Systemic lupus erythematosis | 5,290 | medmcqa_train |
Third hea sound is seen in all except | Ref Harrison 19 th ed pg 1448 The third hea sound (S3 ) occurs during the rapid filling phase of ventricular diastole. It can be a normal finding in children, adolescents, and young adults; however, in older patients, it signifies hea failure. A left-sided S3 is a low-pitched sound best heard over the left ventricu- lar (LV) apex. A right-sided S3 is usually better heard over the lower left sternal border and becomes louder with inspiration. A left-sided S3 in patients with chronic hea failure is predictive of cardiovascu- lar morbidity and moality. Interestingly, an S3 is equally prevalent among hea failure patients with and without LV systolic dysfunction | 5,291 | medmcqa_train |
Most common site of perforation of tympanic membrane in acute suppurative otitis media is: | In acute suppurative otitis media, 85% of cases show a small perforation in antero-inferior quadrant of pars tensa. Perforations in this location were associated with smooth margins, good drainage of pus, and a orable clinical course. Hence this area is termed as "perforation zone". Only 15% of perforations occurred in other locations, most typically the posterior-superior quadrant. | 5,292 | medmcqa_train |
EBV (epstein barr virus) causes all except: September 2005 & March 2013 | Ans. C: Pancreatic carcinoma Epstein-Barr virus (EBV) causes infectious mononucleosis as a primary disease. The virus infects more than 90% of the average population and persists lifelong in peripheral B-lymphocytes. The virus is produced in the parotid gland and spread the oral route. Serology suggests that the Epstein-Barr virus might be involved in the causation of two neoplastic diseases of humans: African Burkitt's lymphoma and nasopharyngeal carcinoma. Whereas the development of the lymphoma has an even better linkage with chromosomal rearrangements, nasopharyngeal carcinoma shows a unique association with Epstein-Barr virus It is also associated with causation of glandular fever and lymphoma | 5,293 | medmcqa_train |
TRUE/FALSE about features of Pyloric stenosis: 1. Hypokalemic alkalosis 2. Peristalsis right to left 3. Commonly caused by carcinoma stomach 4. Retention vomiting is present 5. Commonly females are affected | Hyperophic pyloric stenosis is more common in males. Male : female incidence is 4:1. Peristalsis is seen from left to right across the upper abdomen. Retention vomiting means vomiting due to any mechanical obstruction occurring usually hours after ingestion of a meal. In hyperophic pyloric stenosis the vomiting usually occur 10 to 30 min after the feed. Ref: Nelson 17/e, Page 1229 | 5,294 | medmcqa_train |
Among the following longest acting ocular beta-blocker is: | Betaxolol is a cardioselective beta-blocker which can be used for the treatment of glaucoma. | 5,295 | medmcqa_train |
All of the following are true about malignant otitis externa except: | Severe hearing loss is not the chief presenting complaint in malignant otitis externa. A patient of malignant otitis externa presents with: Severe, unrelenting, deep-seated otalgia, temporal headaches, purulent otorrhea, possibly dysphagia, hoarseness, and/ or facial nerve dysfunction. The pain is out of propoion to the physical examination findings. Marked tenderness is present in the soft tissue between the mandible ramus and mastoid tip. Granulation tissue is present at the floor of the osseo-cailiginous junction. This finding is viually pathognomonic of malignant external otitis. Rest of the options i.e. pseudomonas is the M/C cause, granulation tissue seen on superior wall of the external auditory canal and esr used for follow up are correct. | 5,296 | medmcqa_train |
Patients with diabetes frequently report changing visual acuities when their glucose levels are chronically high. Which of the following could explain the fluctuating acuity with high blood glucose levels? | Fluctuating levels of sugars and sugar alcohols in the lens can cause fluctuating visual acuity. With high blood glucose, there would be increased levels of sorbitol in the lens. The lens does not contain mitochondria and cannot use the TCA cycle/electron transport chain to generate energy. Galactitol causes the same problems as sorbitol, but galactitol is derived from galactose, whereas sorbitol is produced from glucose. The patient has high glucose levels, so galactitol would not be expected to accumulate in the lens. Macular degeneration affects the retina, but in this case, it is the lens that is the affected tissue. Reducing fructose levels in the lens would reduce sorbitol levels, which would ease the visual acuity problem, not make it occur. | 5,297 | medmcqa_train |
Sudden death, right sided hea failure (cor pulmonale or cardiovascular collapse occur when ? | Ans. is 'c' i.e., 60% or more of pulmonary aery is obstructed with emboli | 5,298 | medmcqa_train |
All the following statement about clozapine are true except - | Clozapine
It blocks D4, 5-HT, and α-adrenergic receptors.
Despite of anticholinergic property, it causes hypersalivation.
It also blocks H1-histaminic receptors.
The important side effects are agranulocytosis & myocarditis.
It can induce seizures even in nonepileptics.
It causes weight gain and precipitation of diabetes.
It does not produce extrapyramidal side effects. | 5,299 | medmcqa_train |
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