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A 7 years old child from Bihar is having hypo pigmented anaesthetic patch on his face. What is the most probable diagnosis? | Recurrent scaly hypopigmented macule on the face of a child - P. alba Recurrent scaly hypopigmented macule on the face of an adult - P. versicolor Resident of the endemic zone with an anaesthetic patch over face - Indeterminate leprosy | 5,400 | medmcqa_train |
Mycobacterium tuberculosis was discoverd by ? | Ans. is 'b' i.e., Robe koch Scientist Associated with Fracastorius Proposed a contagium vivuin (cause of infectious disease) Von Plenciz Suggested that each disease is caused by a separate agent Augustino Bassi Earliest discovery of pathogenic microorganism Davaine and Pollender Observed anthrax bacilli in blood of animal Louis Pasteur Father of microbiology (Also see above explanation) Robe Koch Father of medical microbiology Discovered M. tuberculosis and V cholerae Introduced staining techniques methods of obtaining bacteria in pure culture on solid media Suggested Koch's postulate Joseph Lister Father of Aseptic surgery Proved that sepsis could be prevented by Hand hygiene Antony Van Leeuwen hoek Invented microscope (Father of compound microscope) Father of Bacteriology Edward Jenner Father of Immunology Peyton Rous Isolated virus causing sarcoma in fowl Von Behring & Kitasato Described antibody | 5,401 | medmcqa_train |
Which of the following is used for abdominal pregnancy | Studdiford criteria : To diagnose the abdominal pregnancy Both the tubes and ovaries are normal without any recent injuries Absence of uteroperitoneal fistula Presence of pregnancy related exclusively to the peritoneal surface and young enough to eliminate the possibility of secondary implantation following the primary nidation in the tube. Ref: Dutta Obs 9e pg 177. | 5,402 | medmcqa_train |
Commonest stomach tumour which bleeds ? | Ans. is 'c' i.e. Leiomyosarcoma | 5,403 | medmcqa_train |
Farber&;s disease is due to the deficiency of | Farber disease (also known as Farber&;s lipogranulomatosis, ceramidase deficiency, "Fibrocytic dysmucopolysaccharidosis," and "Lipogranulomatosis" is an extremely rare autosomal recessive lysosomal storage disease marked by a deficiency in the enzyme ceramidase that causes an accumulation of fatty material sphingolipids leading to abnormalities in the joints, liver, throat, tissues and central nervous system. Normally, the enzyme ceramidase breaks down fatty material in the body's cells. In Farber Disease, the gene responsible for making this enzyme is mutated. Hence, the fatty material is never broken down and, instead, accumulates in various pas of the body, | 5,404 | medmcqa_train |
A specific test for gout is - | Demonstration of intracellular monosodium urate crystals (MSU) in synovial fluid from affected joint is diagnostic of gout. | 5,405 | medmcqa_train |
In severe cases of anterior uveitis whole circle of pupil gets adhered to lens capsule resulting in: | Seclusio pupillae/ring synaechiae/annular synaechiae is seen in severe iritis or recurrent uveitis, in which whole circle of pupillary margin becomes tied down to the lens capsule. It can lead to secondary angle closure glaucoma. Note: Occlusio pupillae/blocked pupil occurs when exudation in uveitis is extensive. They organize across the entire pupillary area and opaque fibrous tissue fills the pupillary area. Festooned pupil: Pupil dilatation with atropine leads to failure of dilation of adhered segments resulting in irregularly shaped pupil. Pupil will be miotic and sluggishly reacting in uveitis. Ref: Parson's diseases of the eye, 21st edition, page no: 230 | 5,406 | medmcqa_train |
In RMNCH+A Staegy, what is plus ? | Ans. is 'a' i.e., Adolescent health The RMNCH+A strategy is based on provision of comprehensive care through the five pillars, or thematic areas, of reproductive, maternal, neonatal, child, and adolescent health, and is guided by central tenets of equity, universal care, entitlement, and accountability. The "plus" within the strategy focusses on :Including adolescence for the first time as a distinct life stage.Linking maternal and child health to reproductive health, family planning, adolescent health. HIV, gender, preconception and prenatal diagnostic techniques.Linking home and community-based services to facility-based care.Ensuring linkages, referrals, and counter-referrals between and among health facilities at primary (primary health centre), secondary (community health centre), and teiary levels (district hospital). | 5,407 | medmcqa_train |
Infection/ inflammation of all of the following causes enlarged superficial inguinal lymph nodes except: | D. i.e. Penile urethra Penile (spongy) urethra of male mostly drain to deep inguinal lymph nodes | 5,408 | medmcqa_train |
Peripheral resistance is decreased in which type of shock -a) Hypovolemic shockb) Neurogenic shockc) Septic shockd) Cardiogenic shock | Septic shock has already been described → in hyperdynamic stage there is vasodilation and ↓ TPR.
Neurogenic shock
Neurogenic shock occurs when there is Neurological injury as occur in head trauma or high cervical cord injury or cephalad migration of spinal anaesthesia.
Interruption of sympathetic vasomotor input occurs that causes vasodilatation, decreased heart rate and Cardiac output and shock.
Then what is the difference between neurogenic shock and hyperdynamic stage of septic shock ?
In septic shock, there vasodilatation ( ↓ TPR) due to NO with associated reflex sympathetic activity that increases heart rate and cardiac output.
On the other hand, in neurogenic shock there is decreased sympathetic drive that leads to decrease in all, i.e., peripheral resistance, cardiac output and heart rate. | 5,409 | medmcqa_train |
A 50-year-old woman presents with lower back pain of 3 weeks in duration. Radiologic studies reveal several discrete lytic lesions in the lumbar back and pelvis. Laboratory studies show elevated serum levels of alkaline phosphatase. Serum calcium, serum protein, and peripheral blood smears are normal. Aspiration biopsy of a pelvic lesion shows keratin-positive cells. Which of the following is the most likely diagnosis? | Multiple lytic lesions associated with keratin-positive cells strongly suggest metastatic bone cancer. Metastatic carcinoma is the most common tumor of bone, and skeletal metastases are found in at least 85% of cancer cases that have run their full clinical course. The vertebral column is the most commonly affected bony structure. Tumor cells usually arrive in the bone by way of the bloodstream. Some tumors (thyroid, gastrointestinal tract, kidney, neuroblastoma) produce mostly lytic lesions. A few neoplasms (prostate, breast, lung, stomach) stimulate osteoblastic components to make bone. The other choices are not keratin positive.Diagnosis: Metastatic bone cancer | 5,410 | medmcqa_train |
Preventable causes of Mental Retardation are | Cretinism is congenital iron deficiency syndrome which can be preventable by intake in required amounts. Reference: GHAI Essential pediatrics, 8th edition | 5,411 | medmcqa_train |
Medial border of Hesselbach's triangle is formed by: | Ans. (b) Linea semilunarisRef: Gray's 41st edn/1080-81; Keith L Moore clinical anatomy 4thed/ 193-4# HESSELBACH'S TRIANGLE* Medial border: Lateral margin the rectus sheath, also called linea semilunaris* Superolateral border: Inferior epigastric vessels* Inferior border: Inguinal ligament, sometimes referred to as Pouparts ligament. | 5,412 | medmcqa_train |
Which of the following are ineffective against gram negative bacteria? | Vancomycin is a glycopeptide antibiotic used in the prophylaxis and treatment of infections caused by Gram-positive bacteria. Cefixine is an oral third generation cephalosporin antibiotic. It has good activity for gram-negatives. Metroridozole is highly active against gram-negative anaerobic bacteria, such as B. fragilis, and gram-positive anaerobic bacteria, such as C. difficile. Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, paicularly those caused by Gram-negative organisms. | 5,413 | medmcqa_train |
Ator fracture is - | Fracture neck of talus results from forced dorsiflexion of the ankle. Typically this injury is sustained in an aircraft crash where the rubber bar is driven forcibly against the middle of the sole of the foot (ATOR&;s fracture), resulting in forced dorsiflexion of the ankle, the neck being a weak area, gives way. Reference - Essential ohopaedics- Maheshwari -5th edn pg no 166. | 5,414 | medmcqa_train |
A 4-month-old child presents with excessive irritability & crying, unexplained hyperpyrexia, vomiting, difficulty feeding for last 15 days. On admission he has rigidity & visual inattentiveness; CT scan brain shows the following finding. What is the probable diagnosis? | Bilateral basal ganglia calcification is seen on CT brain in Krabbe disease. Fuher,Globoid cells are seen in microscopic exmaination,which is a diagnostic feature. C/F: Irritability, muscle weakness, feeding difficulties, episodes of fever without any sign of infection, stiff posture, and delayed mental and physical development. As the disease progresses, muscles continue to weaken, affecting the infant's ability to move, chew, swallow, and breathe. Affected infants also experience vision loss and seizures. Alexander disease- hypodensity of white matter, frontal lobe predominance Metachromatic Leukodystrophy- tigroid appearance on MRI Adrenoleukodystrophy- Hyperintense signal changes in parieto-occipital region & splenium of corpus callosum on MRI | 5,415 | medmcqa_train |
NVBDCP includes ail except? | Ans. is 'd' i.e., Chikungimya o National Vector Borne Disease control programme (NVBDCP) includes 6 vector borne diseases- Malaria Dengue Filaria Kala azar JE Chikungunya fever 1. Chickungunya has been included now Health programmes In India o Since India become indepedent, several measures have been undertaken by National Government to improve the health of the people. o Prominant among these measures are the NATIONAL HEALTH PROGRAMMES which have been launched by the central Government for control/eradication of the communicable diseases, improvement of environmental sanitation, raising the standard of nutrition, control of population and improving rural health. National Health Programmes curently working in India : - National vector Borne Disease Control Programme - Malaria, Dengue. Filaria, JE, Kala-azar. National leprosy eradication programme. Revised National TB control programme. National programme for control of blindness. National iodine deficiency disorders control programme, National menal health programme National AIDS control programme National cancer control programme UP National Programme for prevention & control of deafness. Piolet Progamme on prevention & control of DM, CVD, & deafness. National tobacco control programme RCH programme | 5,416 | medmcqa_train |
The usefulness of the technique of transcutaneous electrical nerve stimulation is explained by which of the following? | Transcutaneous electrical nerve stimulation is a method used to lessen severe, chronic pain by overly stimulating the involved neurons. This is thought to trigger inhibitory interneurons in lamina II of the spinal cord, thereby paially blocking the transmission of pain impulses. These interneurons are considered to be "gatekeepers", that can, to some degree, isolate the peripherally generated signals from the brain. Allodynia is the term used for the perception of pain following a normally innocuous stimulation of a mechanoreceptor. Central pain, such as that caused by thalamic lesions, is pain that originates at the level of the brain rather than in the periphery. Referred pain is the perception of pain initiated in one body site (typically an internal organ) as being localized to another body site (frequently on the more superficial pas of the body). An example is that of diaphragmatic pain, which may be referred to the top of the shoulder. The phenomenon occurs because both internal organs and more superficial structures may arise from, and consequently be innervated by, the same dermatome. | 5,417 | medmcqa_train |
Which is must for prothrombin time? | Prothrombin time test - Time needed for plasma to clot after addition of tissue thromboplastin and Ca2+ ions. | 5,418 | medmcqa_train |
Fluroacetate inhibits - | B i.e. Aconitase | 5,419 | medmcqa_train |
Following angiography findings are most likely seen in which condition: | Ans. B. PANImage shows angiographic vascular pathologya. Most probably it is seen in PAN (Polyarteritis nodosa)b. It is medium vessel vasculitis of renal & visceral vessels sparing the pulmonary circulationc. In PAN, small aneurysms are strung like the beads of arosary known as Rosary sign. | 5,420 | medmcqa_train |
Axillary hair growth is caused by? | Testosterone REF: Ganong's 22nd ed p. 430 Secondary sexual hair production in both man and woman is under control of androgens | 5,421 | medmcqa_train |
Triglycerides are maximum in | Ans. is 'a' i.e. Chylomicrons [Ref: Chatterjee & Shinde Biochemistry 6/e, p 338 (T21.2); Harper 26/e, p 206;Maximum content of TG's is seen in - Chylomicrons*Maximum content of exogenous TG's is seen in - Chylomicrons*Maximum content of endogenous TG's is seen in - VLDL*Maximum cholesterol is seen in - LDL*Chylomicrons are the lipoprotein particles lowest in density and largest in size, and contains the highest percentage of lipids and the smallest percentage of proteins. VLDLs and LDLs are successively denser, having higher ratios of protein to lipid. HDL particles are the densest.Composition of the lipoproteinsLipoproteinSourceDiameter (nm)Density (g/mL)CompositionMain Lipid ComponentsApolipoproteinsProtein (%)LipidChylomicronsIntestine90-1000<0.951-298-99TriacylglycerolA-I, A-II, A-IV,l B-48, C-I, C-II, C-III, EChylomicron remnantsChylomicrons45-150< 1.0056-892-94Triacylglycerol, phospholipids,cholesterolB-48, EVLDLLiver (intestine)30-900.95-1.0067-1090-93TriacylglycerolB-100, C-I, C-II, C-IIIIDLVLDL25-351.006-1.0191189Triacylglycerol, cholesterolB-100, ELDLVLDL20-251.019-1.0632179CholesterolB-100HDLLiver, intestine,VLDL, chylomicrons20-251.019-1.0633268Phospholipids, cholesterolA-I, A-II, A-IV, C-I, C-II, C-III, D,2 EHDL1HDL210-201.063-1.1253367HDL35-101.125-1.2105743PreP-HDL3<5>1.210 A-IAlbumin/free fatty acidsAdipose tissue >1.28199-1Free fatty acids 1 Secreted with chylomicrons but transfers to HDL.Associated with HDL2 and HDL3 subtractions.3Part of a minor fraction known as very high density lipoproteins (VHDL). | 5,422 | medmcqa_train |
A 55 years lady presented with sudden onset of severe pain in the eye with, Shallow anterior chamber. Treatment of choice is | (1/V mannitol & Acetazolamide): (242-Nema 6th edition; 244-Khurana 5th/e)It is a case of Acute primary angle closure glaucomaImmediate medical therapy to lower IOP1. Systemic hyper osmotic agents* Intravenous mannitol (1 gm 1 kg body weight)* Oral hyperosmotics eg glycerol2. Systemic carbonic anhydrase inhibitor eg acetazolamide3. Topical antiglaucoma drugs -* Beta blocker - 0.5% timolol or 0.5% betaxolol* Alpha adrenergic agonist eg. brimonidine - 0.1 - 0.2%* Prostaglandin analogue eg - latanoprost - 0.005%Intensive miotopic (Pilocarpine 2%) therapy is not advised now a day4. Analgesics and anti-emetics5. Compressive gonioscopy6. Topical steroid eg - prednisolone acetate 1% or dexamethasone* Laser iridotomy is the treatment of choice for the management of early acute PACG* *** Prophylactic laser iridotomy should be performed on the fellow asymptomatic eye as early as possible as chances of acute attack are 50% in such cases | 5,423 | medmcqa_train |
Which of the following structure passes through the triangular interval of the arm? | Ans. is 'a' i.e., Radial nerve RegionBoundariesContentsUpper triangular space of armSuperior: Teres minorInferior : Teres majorLateral: Long head of tricepsCircumflex scapular arteryLower triangular space of armSuperior: Teres majorMedial: Long head of tricepsLateral; Shaft of humerusRadial nerveProfunda brachii vesselsQuadrangular space of armSuperior: Teres minor, subscapularis, joint capsuleInferior :Teres majorMedial: Long head of tricepsLateral: Surgical neck of humerusAxillary nervePosterior circumflex humeral vessels | 5,424 | medmcqa_train |
What is the function of DNA ligase ? | Ans. is 'b* i.e., Seals the single strand nick between the .......... ProteinFunctionDNA polymerasesDeoxynucieotide polymerizationHelicasesProcessive unwinding of DNATopoisomerasesRelieve torsional strain that results from helicase-induced unwindingDNA primaseInitiates synthesis of RNA primersSingle-strand binding proteinsPrevent premature reannealling of dsDNADNA ligaseSeals the single strand nick between the nascent chain and Okazaki fragments on lagging strand | 5,425 | medmcqa_train |
Most common organ affected in blast injury: | Lungs | 5,426 | medmcqa_train |
The cyclical flexion and extension motions of a leg during walking result from activity at which level of the nervous system? | The spinal cord has the intrinsic circuitry in the form of central paftern generators to produce the basic motions of walking. | 5,427 | medmcqa_train |
Auerbachs plexus is present in the - | All of the above | 5,428 | medmcqa_train |
A person of 60 years age is suffering from myositis ossificans progressive. The usual cause of death would be: | C i.e. Lung disease | 5,429 | medmcqa_train |
A 29-year-old woman on oral contraceptives presents with abdominal pain. A computed tomography (CT) scan of the abdomen demonstrates a large hematoma of the right liver with the suggestion of an underlying liver lesion. Her hemoglobin is 6, and she is transfused 2 units of packed red blood cells and 2 units of fresh frozen plasma. Two hours after staing the transfusion, she develops respiratory distress and requires intubation. She is not volume overloaded clinically, but her chest x-ray shows bilateral pulmonary infiltrates. Which of the following is the management strategy of choice? | The patient has TRALI or transfusion-related acute lung injury which manifests as respiratory distress, hypoxemia, and bilateral pulmonary infiltrates not due to volume overload. The treatment of choice is respiratory suppo, including mechanical ventilation, as needed. The major risk factor for TRALI is transfusion of any plasma-containing blood products from multiparous female donors. Other complications of transfusions and their treatments include: (1) allergic reactions such as rash and fever--mild reactions are treated with an antihistamine; (2) transfusion-associated circulation overload (TACO) which occurs in patients with underlying hea failure who receive large volume transfusions--the treatment is administration of diuretics; and hemolytic reactions--diagnosis is made by a positive Coombs test and treatment is to stop the transfusion and identify the responsible antigen to prevent future reactions. There is no evidence that the patient has pneumonia or any other indication to perform bronchoscopy or to sta antibiotics. | 5,430 | medmcqa_train |
All are absolute contraindication of OCP except: | Ans. D. EndometriosisOCP are contraindicated in pregnancy, hepatic renal failure, thromboembolic disorder, breast CA, hypertension, diabetes. But in case of endometriosis, it regulates the irregular bleeding which is non-contraceptive use of OCP. | 5,431 | medmcqa_train |
Which of the following statement on microalbuminuria is not true? | The significance of microalbuminuria: Microalbuminuria is the finding of albumin in the urine not detectable by the urine dipstick which is sensitive to protein concentration > 1gm%. It precedes the decline in GFR and indicates the presence of renal and cardiovascular complications. Annual screening for microalbuminuria will allow the identification of patients with nephropathy at a point very early in its course. Definition of abnormalities in albumin excretion Category 24-hr-urine albumin (mg/24h) Dipstick analysis Spot collection (ug/mg creatinine) Normal Microalbuminuria Clinical albuminuria <30 30-299 >300 Negative Negative, trace, 1+ 1+ to 3+ <30 30-299 >300 | 5,432 | medmcqa_train |
Which of the following antigens are associated with cicatricial pemphigoid? | Cicatricial Pemphigoid:
Autoimmune blistering disease associated with autoantibodies directed against basement membrane zone target antigens.
Autoantibodies of IgG subclass, particularly IgG4, are associated with CP.
IgA antibodies have also been detected.
The two major antigens associated with CP are bullous pemphigoid antigen 2(BPAG2) and epiligrin (laminin-5). | 5,433 | medmcqa_train |
Local anaesthetics act by- | Ans. is 'a' i.e., Na channel inhibition inside gate o Local anesthetics act by inhibiting Na+ channels from inside.Mechanism of action of LAo Local anaesthetics block generation and conduction of nerve impulse at all part of neuron where they come in contact, without causing structural damage.o Thus not only sensory but motor impulses and autonomic control is also interrupted,o Mechanism of action# Normally Na+ channel in axonal membrane has following phases :LAs prolong the inactive state - channel takes longer to recover - refractory period of the fiber is increased.LAs first penetrate the axonol membrane to come inside and then their active species (cationic form) bind to Na+ channel from inside.Cationic form (active form) is able to approach its receptor only when the channel is open at the inner face - So resting nerve is resistant to block as Na+ channels are not activated and cationic form is not able to approach its receptor.So blockade develops rapidly when the nerve is stimulated repeatedly.Degree of blockade is frequency dependent - greater blockade at higher frequency of stimulation.Exposure to higher concentration of Ca+2 reduces inactivation of Na+ channels and lessens the block.o Order of blockade of fibres B > C > Ad > Aa, b & g (Autonomic > Sensory > Motor). Order of recovery is in reverse order.o Among sensory afferent order of block is : Temperature (cold before heat) > Pain > touch > deep pressure,o When applied to tongue, bitter taste is lost first followed by sweet and sour, and salty taste last of all.o Myelinated nerves are blocked earlier than nonmyelinated,o Smaller fibres are more sensitive than larger fibres. | 5,434 | medmcqa_train |
38 years old Mala has Pap smear suggestive of HSIL.Colposcopy directed biopsy can reveal all, EXCEPT: | Ans. is 'a' i.e., CIN-1 * As per Bethesda system:# Low-grade squamous intraepithelial lesion (L-SIL) = CIN I# High-grade squamous intraepithelial lesion (H-SIL) = CIN II/CIN III/CIS | 5,435 | medmcqa_train |
Mikulicz and russel bodies are characteristic of - | Ans. is 'a' i.e., Rhinoscleroma o Biopsy of rhinoscleroma show's infiltration of submucosa writh plasma cells, lymphocytes, eosinophils, Mikulicz cells and Russell bodies. The latter two are the diagnostic features of the disease,Rhinoscleromao The causative organism is Klebsiella rhinoscleromatisor Frisch bacillus ^ which can be cultured from the biopsy material. The disease is endemic in several parts of world. In India, it is seen more often in northern than in the southern parts. Biopsy shows infiltration of submucosa with plasma cells, lymphocytes, eosinophils, Mikulicz cells & Russell bodies. The latter two are diagnostic features of the disease. The disease starts in the nose & extends to nasopharynx, oropharynx, larynx, trachea & bronchi. Mode of infection is unknown. Both sexes of any age may be affected. | 5,436 | medmcqa_train |
Neurotransmitter in striatal pathway is? | The nigrostriatal pathway or the nigrostriatal bundle (NSB), is a dopaminergic pathway that connects the substantia nigra with the dorsal striatum (i.e., the caudate nucleus and putamen). Dopaminergic neurons of this pathway synapse onto GABAergic neurons. Glycine is an inhibitory neurotransmitter in the central nervous system, especially in the spinal cord, brainstem, and retina. Serotonin is a neurotransmitter and is found in all bilateral animals, where it mediates gut movements and the animal's perceptions of resource availability Ref Harrison20th edition pg 2765 | 5,437 | medmcqa_train |
Which of the following pathways does not occur in mitochondria | Fatty acid synthesis takes place in cytoplasm.
Beta Oxidation occurs in mitochondria.
Heme synthesis and Urea cycle occur both in cytoplasm and mitochondria. | 5,438 | medmcqa_train |
The above shown device is used for: | The above shown device is NST. The nonstress test measures the fetal hea rate in response to fetal movement over time. The term "nonstress" means that during the test, nothing is done to place stress on the fetus. If two or more accelerations occur within a 20-minute period, the result is considered reactive or "reassuring." A reactive result means that for now, it does not appear that there are any problems. A nonreactive result is one in which not enough accelerations are detected in a 40-minute period. | 5,439 | medmcqa_train |
True about tongue cancer: | Ans. (c) MC site is on Lateral marginRef. Bailey & Love 26th ed. 713-14TONGUE CANCER* MC site is middle of lateral border or ventral aspect of the tongue.* MC histological type is squamous cell carcinoma.* MC complaint: Mid-irritation of tongue.* MC associated risk factors are tobacco and alcohol.* MC variety is ulcerative.* ONLY 30% patients present with cervical node metastasis.* The intrinsic tongue musculature provides little restriction to tumour growth, thus it may enlarge considerably before producing symptoms.* Presents as painless mass or ulcer that fails to heal after minor trauma. | 5,440 | medmcqa_train |
Gottron’s papules Seen in? | DERM ATOM MYOSITIS:
DM is a distinctive entity identified by a characteristic rash accompanying, or more often preceding muscle weakness.
√ Heliotrope rash: The rash may consist of a blue-purple discolouration on the upper eyelids with edema
√ Gottron's sign: A flat red rash on the face and upper trunk and erythema of the knuckles with a raised violaceous scaly eruption.
√ Gottron's papules: Discrete erythematous papules overlying the metacarpal and interphalangeal joint
√ The erythematous rash can also occur on other body surfaces, including the knees, elbows, malleoli, neck and anterior chest (often in a V sign), or back and shoulders (shawl sign), and may worsen after sun exposure.
√ In some patients, the rash is pruritic, especially on the scalp, chest, and back. √ Dilated capillary loops at the base of the fingernails are also characteristic. The cuticles may be irregular, thickened, and distorted, and the lateral and palmar areas of the fingers may become rough and cracked, with irregular, "dirty" horizontal lines, resembling mechanics hands. | 5,441 | medmcqa_train |
A 67-year-old man with an 18-year history of type 2 diabetes mellitus presents for a routine physical examination. His temperature is 36.9 C (98.5 F), his blood pressure is 158/98 mm Hg and his pulse is 82/minute and regular. On examination, the physician notes a non tender, pulsatile, mass in the mid-abdomen. A plain abdominal x-ray film with the patient in the lateral position reveals spotty calcification of a markedly dilated abdominal aoic walI. Following surgery, the patient is placed on a low-fat diet to reduce the risk of continued progression of his atherosclerotic disease. A bile acid sequestrant is added to interrupt enterohepatic circulation of bile acids. Which of the following agents was MOST likely prescribed? | Cholestyramine and colestipol are bile acid sequestrants that bind bile acids in the intestine, thereby interrupting enterohepatic circulation of bile acids. This has an indirect effect to enhance LDL clearance and lower lipids in the blood. Atorvastatin and lovastatin are lipid-lowering drugs that competitively inhibit HMG-CoA reductase, an early step in cholesterol biosynthesis. Clofibrate and gemfibrozil are fibric acid derivatives that may increase the activity of lipoprotein lipase. Ref: Bersot T.P. (2011). Chapter 31. Drug Therapy for Hypercholesterolemia and Dyslipidemia. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. | 5,442 | medmcqa_train |
Patient says he hears music every time when someone touches his thumb. This is an example of | Functional hallucination : Here the stimulus and perecption are in same modality.
v/s
Reflex hallucination : Here the stimulus and pereception are in different modality. | 5,443 | medmcqa_train |
Epipharynx is also called- | Ans. is 'a' i.e., Nasopharynx Epipharvnx / Nasophavnxo The part of the pharynx that lies above the soft palate; anteriorly it opens into the nasal cavities through the choanae;inferiorly, it communicates with the oropharynx through the pharyngeal isthmus; laterally it communicates withtympanic cavities through pharyngotympanic (auditory) tubes. | 5,444 | medmcqa_train |
Red man syndrome is caused by which drug: | Vancomycin is a glycopeptide antibiotic that releases histamine leading to "Red man syndrome" | 5,445 | medmcqa_train |
DOC for migraine prophylaxis - | Ans. is 'a' i.e., Propranolol Treatment and prophylaxis of migraineo For aborting an acute attack of migraine, sumatriptan (or any other triptan) is the drug of choice. Other drugs used for treatment are NSAIDs, ergotamine and dihydroergotamine, and intranasal butorphanol.o For Prophylaxis, Beta-blocker (propranolol) is the drug of choice. Other drugs used for prophylaxis are tricyclic antidepressants (amitriptyline), calcium channel blockers (cinnarizine, verapamil), serotonine antagonists (methysergide, cyproheptadine), MAO inhibitors and anticonvulsants (valproate, topiramate, gabapentine), fluxetin, onabotulinum toxine A, pepaverine andphenalzine. | 5,446 | medmcqa_train |
Which ligament transfers weight from peripheral to axial skeleton? | The gap anteriorly is filled by a syol bursa. The coracoclavicular ligaments have a vital role to play in movements of the pectoral girdle. The conoid ligament limits anterior movement of the scapula with respect to the clavicle. The trapezoid limits posterior movement between these two bones | 5,447 | medmcqa_train |
Most common cause of stridor after birth: | (c) Laryngomalacia(Ref. Current Diagnosis & Treatment Otolaryngology, Lalwani, 3rd ed., 481; Scott Brown, 8th ed., Vol 2; 333)Laryngomalacia, which is the most common congenital anomaly of the larynx, is the most common cause of congenital laryngeal stridor.Vocal cord palsy is the 2nd most common cause of congenital stridor. Laryngeal web, a rare malformation can also lead to stridor.Laryngeal papilloma is the most common benign tumour of the larynx in children. Here also the child presents with stridor. In laryngeal papilloma there is additionally hoarseness of voice as it involves the vocal cord, whereas in laryngomalacia which is supraglottic the cry of the child is normal. Also laryngeal papilloma is seen in children from 2 to 5 years whereas laryngomalacia disappears by 2 years of age. | 5,448 | medmcqa_train |
"Corner sign of park" is feature of: | Ans. A. ScurvyScurvy-Radiographic findings:1. Osteoporosis2. Pencil thin cortex3. Wimberger's sign4. Trummerfeld zone of rarefaction5. Corner sign of Park6. Line of Frankel7. Subperiosteal hemorrhage | 5,449 | medmcqa_train |
Not true regarding retinal anatomy | Layer in contact with vitreous is internal limiting membrane Foveal Avascular Zone- * No blood vessels in this zone * Geometric centre is centre of macula & Fixation point * Impoant landmark in FA * Ora serrata > Foveola: Thinnest pa of retina * Posterior Pole: Macula + Optic nerve head * Optic disc approx: 1.75 mm (H), 1.90 mm (V) * Macula: 5.5 mm (Temporal to optic disc) * Fovea - Centralis : Central depressed pa of Macula, 1.5 mm Foveola - 0.35 mm. * Thinnest pa of retina after ora serrata. * Contains no rods, only cone are there that are covered by internal limiting membrane * The axons are arranged horizontally and are called Henles layer | 5,450 | medmcqa_train |
Septum secundum arises from - | Ans. is 'c' i.e., Primitive atrium o The primitive atrium is divided into left and right atria by interatrial septum which is formed by fusion of septum primum and septum secundum. The sequnece of events are as follows# Septum primum arises from the roof of common atrium (primitive atrium) and grows caudally towards septum intermedium (fused AV cushions).# Foramen primum is formed between free border of growing septum primum and fused AV cushions (septum intermedium).# Shortly afterwards the septum primum fuses with septum intermedium (fused AV cushions), obliterating foramen primum# Foramen secundum is formed by degeneration of cranial part of septum primum.# Septum secundum grows caudally to the right of septum primum and overlaps the foramen secundum. The passage between septum primum and septum secundum is called foramen ovale. After birth, foramen ovale closes by fusion of septum primum with septum secundum. Failure of fusion of these two septa results in patent foramen ovale. | 5,451 | medmcqa_train |
Drug used for kala-azar | Ans. is 'c' i.e.,Paromomycin Drugs used for kala-azarParentral : Amphotericin-B (iv), Paromomycin (im), sodium stibogluconate (iv or im).Oral : Miltefosine | 5,452 | medmcqa_train |
A 70 kg old athlete was posted for surgery, Patient was administered succinylcholine due to unavailability of vecuronium. It was administered in intermittent dosing (total 640 mg). During recovery patient was not able to respire spontaneously & move limbs. What is the explanation ? | B i.e. Phase 2 blockade produced by succinylcholine - Sch is depolarizing/ non competitiveQ M.R. with shoest duration of actionQ (3-5 min) d/t rapid hydrolysis by pseudo cholinesteraseQ. It causes dual/ biphasic blockQ. It increases K. (ie hyperkalemiaQ 1/t diastolic cardiac arrest), intraocular & intragastric pressure and temperature (l/t) malignant Hypehermia)Q - Depolarizing block (phase I & II) caused by Succinyl cholineQ is also called Dual or Biphasic Block. In contrast to phase II depolarization block & Non depolarizing block, phase I depolarization block does not exhibit fade during tetanus or train-of-four, neither does it demonstrate post tetanic potentiation. Phase I block is potentiated by isoflurane, Mg, Li & Anticholine-esterase while phase II block is potentiated by enflurane. - The onset of paralysis by succinylcholine is signaled by visible motor unit contractions called fasciculation.Q Patients who have received suxamethonium have an increased incidence of postoperative myalgiaQ. This is more common in healthy female outpatients. Pregnancy & extremes of age seem to be protective. Succinylcholine releases a metabolite succinylmonocholine, causing excitation of the cholinergic receptors in the sinoatrial node resulting in bradycardia. Q Intravenous atropine is given prophylactically (paicularly in children, who are more susceptible) in children and always before a second dose of sch. - Prolonged apnea after suxamethonium is best managed by providing mechanical ventilation, maintaining anesthesia and continuous monitoring until muscle function returns to normal.Q Transfusion of fresh frozen plasma is beneficial (as it provides pseudocholinesterase) its infectious risks outweigh its potential benefits -Morgan Administration of purified pseudocholinesterase, blood or plasma may antagonize the block. However because of the risk associated with their use, infusion of banked blood or fresh frozen plasma cannot be recommended - Churchill. - Succinylcholine & mivacurium are metabolized by pseudocholinesterase, while esmolol and remifentanyl are metabolized by RBC es terase.(2 - Pseudo cholinesterase deficiency causes prolonged residual paralysis at normal Sch dose (1-2 mg/kg)Q whereas, phase 2 non-depolarization blockade occurs after administration of higher doses >6 (7-10) mg/kgQ Despite large decrease in pseudo cholinesterase activity (level) there is only moderate increase in duration of action of Sch. In contrast to the doubling or tripling of blockade duration seen in patients with low pseudo cholinesterase enzyme levels or hetozygous atypical enzyme, patients with homozygous atypical enzyme will have a very blockade (4-8 hrs) following Sch administration. | 5,453 | medmcqa_train |
An 18-year-old presents with a well- circumscribed 2 cm mass in her right breast. The mass is painless and has a rubbery consistency and discrete borders. It appears to move freely through the breast tissue. What is the likeliest diagnosis? | Fibroadenomas are most often found in teenage girls. They are firm in consistency, clearly defined, and very mobile. The typical feature on palpation is that they appear to move freely through the breast tissue ("breast mouse"). | 5,454 | medmcqa_train |
A group tested for a drug shows 60% improvement as against a standard group showing 40% improvement. The best test to test the significance of result is- | Ref: Parks 23rd edition pg 852 Chi-square test offers an alternate method of testing the significance of difference between two propoions.Advantage: it can also be used when more than 2groups are to be compared. Ref:Parks 23rd edition pg 852 Tests of significance: Qualitative: Chi- square : 2 or more than 2 groups Mc Nemar test : 1 group. ( before and after intervention) Quantitative: Paired T test: 1 group Student T test/ unpaired T test: 2 groups Anova: more than 2 groups. | 5,455 | medmcqa_train |
Most common malignant tumor of kidney: | Ans. (c) Renal cell CARef: Robbins 9th ed. 1952* Robbins 9th ed. States: "by far the most common malignant tumor is renal cell carcinoma, followed by Wilms tumor, which is found in children.* Incidence of RCC is: 85%* M > F (2:1)* Most of the RCC are sporadio AD (familial)Must KnowKIDNEY CA (extract from Robbins 9th ed)* MC benign tumor of kidney: Renal papillay adenoma* MC malignant tumor of kidney: RCC > Wilms tumor* MC kidney tumor associated with tuberous sclerosis: Angiomyolipoma* MC type of RCC: Clear cell CA (70 - 80%)* MC type of renal CA associated with dialysis: Papillary CA* MC renal CA associated with sicke cell trait: Medullary CA* Renal CA having best prognosis: Chromophobe I | 5,456 | medmcqa_train |
A 6 day old newborn infant develops lectonuria seizures and hypoglycemia. The likely diagnosis is? | Ans. is 'a' i.e., Aromatic amino aciduria | 5,457 | medmcqa_train |
Following acute failure of the left ventricle is the hea is man, pulmonary edema generally begins to appear when left atrial pressure approaches | Pulmonary edema is one of the most serious consequences of left ventricular cardiac failure. When the left ventricle fails or when the mitral valve fails, left atrial pressure (LAP) may increase substantially. The resulting increase in pulmonary capillary pressure (Pc) forces excess fluid filtration through the pulmonary capillary walls and into the lung tissue. At first, the fluid collects within the lung interstitial space. If LAP exceeds a critical level of ~25 mmHg, the volume of edema fluid will overwhelm the capacity of the interstitial spaces and fluid will flood the airways and alveoli (8). This airway edema directly interferes with gas exchange, and it can kill the patient. However, many people live for months or years with modestly elevated LAP (<25 mmHg). We believe that sustained, subcritical LAP elevations lead to two phases of change in the lungs. The first phase is the acute edema that develops in the first few hours of elevated LAP. The second phase concerns the effect of long-term (7 days or more) increases in LAP below the critical level. This review deals with the acute phase and long-term phase changes in the lung caused by modestly elevated LAP. The acute phase of pulmonary edema has been the subject of intense investigation for many years. In 1896, Starling (7) laid the foundation for our current understanding of pulmonary edema with his famous fluid filtration equation. The equation relates the rate of fluid filtration through the capillary wall (Jv) to the pressures across the capillary wall and to the filtration characteristics of the capillary membrane Ref: guyton and hall textbook of medical physiology 12 edition | 5,458 | medmcqa_train |
Chocking is constricting device within the barrel at the muzzle end of - | The synopsis of forensic medicine & toxicology ; Dr k.s narayan reddy ; 28th edition ; pg.no 122 The choke bore present in a shot gun ,the distal 7-10 cm of the barrel is narrow . There are some shotguns which have a small poion of their bore near the muzzle end rifled ,which are called "paradox gun" . | 5,459 | medmcqa_train |
Which of the following is lined by transitional epithelium | INDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:321 Both in the male and female,the greater pa of urethra is lined by pseudo stratified columnar epithelium.a sho pa adjoining the urinary bladder us lined by transitional epithelium | 5,460 | medmcqa_train |
Most common cause of death in amyloidosis is ? | Ans. is 'a' i.e., Hea Failure `Most common cause of death is hea failure and/or abnormal cardiac rhythm' Essentials pathology | 5,461 | medmcqa_train |
Who proposed the classification of primary dentition based on distal surface of second molar? | Classification of Primary Dentition given by Baume, 1959 | 5,462 | medmcqa_train |
Paragonismus westermani is commonly called: March 2005 | Ans. A: Lung fluke Paragonismus westermani Preferred definitive host: Carnivores (e.g. felids, canids, viverids, and mustelids), rodents, and pigs. Reservoir hosts: Humans Vector/intermediate hosts: Snail of Family Thieridae; - Crab-Eriocheir japonicus. Organs affected: Mainly the bronchioles of the lungs, but the worms may wander into the brain or mesentery. Symptoms and clinical signs: Victim suffers from breathing difficulties and chronic cough. Worm is often fatal due to penetration of the brain, spinal cord, or hea. Treatment: Bithionol, Praziquantel Tapeworms: Impoant ones are D. latum, Taenia solium and saginata, Echinococcus, Hymenolepis etc. Intestinal flukes: Small intestine: fasciolopsis buski, Hetreophyes, Metagonimus yokogawai, Watsonius watsoni and Echinostoma Large intestine: gastrodiscoides hominis Liver flukes: Fasciola hepatica and less often opisthorcis species Flukes in the biliary tract: Clonorchis sinensis | 5,463 | medmcqa_train |
In pregnancy : | Plasma fibrinogen levels are increased | 5,464 | medmcqa_train |
Singer&;s Alkali denatuaion test is performed for: | Singer&;s alkali denaturation test is performed for Vasa Pre. Detection of nucleated RBCs using apt test or Singer&;s alkali denaturation test is diagnostic of vasa pre. It is based on the fact that fetal hemoglobin is resistant to alkali denaturation. Both Apt and Kleihauer-Betke Test can be used to detect the presence of fetal blood within a sample. Apt Test Kleihauer Betke Test Reagent NaOH Citric acid Phosphate buffer Assessment Qualitative Quantitative Ref: DC Dutta&;s textbook of Obstetrics 8th edition Pgno: 301 | 5,465 | medmcqa_train |
Regarding phenytoin all are true except | At lower concentration it follows zero order kinetics A child with respiratory infection and membrane over peritonsillar area is suspected of having Diptheria. Both Blood Tellurite media & Loeffler serum slope can be used for culture but Diptheria is one emergency so the media in which it can be cultured quickly is used (Loeffler serum slope). Loeffler serum yield colony in 6-8 hrs Blood Tellurite yield colony in --3 36-48 hrs | 5,466 | medmcqa_train |
True about follicular cysts of ovary are all except | Follicular cysts are dependent on gonadotropins for growth. | 5,467 | medmcqa_train |
IUGR babies on delivery are called: | Small for date | 5,468 | medmcqa_train |
Heterophile antibody test is done for: September 2010 | Ans. B: Infectious mononucleosis A heterophile agglutination is a test that measures the agglutination of the red blood cells of sheep by the serum of patients with infectious mononucleosis. Diagnostic tests are used to confirm infectious mononucleosis but the disease should be suspected from symptoms prior to the results from hematology. These criteria are specific; however, they are not paicularly sensitive and are more useful for research than for clinical use. Only half the patients presenting with the symptoms held by mononucleosis and a positive heterophile antibody test (monospot test) meet the entire criteria. One key procedure is to differentiate between infectious mononucleosis and mononucleosis-like symptoms | 5,469 | medmcqa_train |
Gallstone are associated with which Neuro Endocrine Tumour :- | Somatostatinoma syndrome is a triad of diabetes mellitus, diarrhea and gallstones, but also includes weight loss and hypochlorhydria. | 5,470 | medmcqa_train |
A 69 year old male presents with an episode of slurring of speech which lasted for 12 hours and then resolved.He is heavy smoker having smoked 60 cigarettes per day for 40 years. He had a single episode of haemoptysis 4 weeks previously and has underlying lung cancer with brain metastases and is referred for an urgent CT chest. An ECG was performed which showed new AF. All blood tests including cardiac biomarkers were normal. Chest CT is shown. Which of the following is most probable diagnosis? | The axial image from a contrast enhanced CT scan, in aerial phase, shows a filling defect in the left atrial appendage layered along the anterior wall. Given the clinical history and the CT appearance, the most likely diagnosis is of thrombus in the LA as a consequence of AF. Myxomas generally arise from interatrial septum projecting into the left atrium Vegetation, abscess and new dehiscence of a prosthetic valve are the three major echocardiographic criteria for the diagnosis of infective endocarditis. | 5,471 | medmcqa_train |
The patho-physiological phenomenon that occurs during atheromatous plaque formation and is used for screening of 'asymptomatic coronary plaques' on CT scan is: | C i.e. Calcium deposition in the atheromatous plaque Screening of asymptomatic coronary plaques on. CT scan (EBCT & MDCT) uses calcium depositionQ as a surrogate marker for detecting the presence & amout of atherosclerosis. CT attenuation within non calcified fibrous pique (91-116) is greater than within noncalcified lipid-rich plaques (47-71 HU). However, large variability currently prevents accurate classification of non calcified plaques by CT. Agatston Coronary Aery Calcification Scoring Coronary calcium is used as a surrogate marker to detect the presence and quantify the amount of atherosclerosis. Both electron beam (EB) CT and MD-CT permit accurate detection and quantification of coronary aery calcium. With the exception of renal failure patients, calcification occurs almost exclusively in the context of atherosclerosis. Agatston developed a scoring system, which takes into account the area (in pixels) and the CT density of calcified lesion (defining calcification as densities >130 Hounsfield units) for quantifying coronary aery calcification in patients evaluated with EB-CT scans using 3mm slice thickness. Each lesion in each slice is scored based on maximum density with a paicular scale i.e. 1 = 130 to 199 HU; 2 = 200-299 HU; 3 = 300-399HU; 4 = 400HU or greater. Then a total score is obtained by summing the scores from all slices, broadly indicating grade of coronary aery disease (& risk of cardiovascular events +- . 0 = No; 1 to 10 = Minimal; 11 to 100 = Mild; 101 to 400 = Moderate; >400 = Severe. Currently, MDCT calcium scoring is widely used to calculate coronary clacium load, using 2.5 to 3 mm norienhanced axial CT images obtained with a prospective ECG gated acquisition. Modified Agatston score equivalent, takes into account the area of each calcified lesion and the maximum CT value within the lesion. The volumetric and absolute mass quantfication scoring algorithms are also available, showing increased accuracy, consistency and reproducibility (however, not been validated in clinical setting). It is impoant to understand that the amount of coronary calcium correlates moderately to overall atherosclerotic plaque burden. On the other hand, not every atherosclerotic coronary plaque is calcified and calcification is a sign of neither stability nor instability of an specific plaque. The absence of coronary calcium rules out the presence of coronary aery stenoses with high predictive value. However, even pronounced coronary calcification is not necessarily a/whemodynamically relevant luminal narrowing. So even the detection of large amounts of calcium does not indicate the presence of significant stenoses & it should not prompt invasive coronary angiography in otherwise asymptomatic individuals. | 5,472 | medmcqa_train |
Screening test used in first trimester for aneuploidy - | Ans. is'c'i.e., PAPP-A &beta HCG1st trimester aneuploidy screening:Human chorionic gonadotropin (either intact or free (b-hCG).Pregnancy-associated plasma protein A (PAPP-A).Fetal Down syndrome in 1st trimester:Higher serum free beta-hCG level.Lower PAPP-A levels.Trisomy 18 & 13:Lowered levels of both HCG PAPPP-A.2nd trimester analytes:Serum integrated screening.Accuracy of aneuploidy detection:Greater on combination with,Sonographic NT measurement. | 5,473 | medmcqa_train |
Which of the following is most dependent on vasovagal reflex? | Ans. c (Receptive relaxation). (Ref. Ganong, Physiology, 21st ed., 498)Receptive Relaxation# When food enters stomach, fundus and upper part of the body relax and accommodate food with little if any increase in pressure known as receptive relaxation.# It is vagally mediated and triggered by pharyngeal and esophageal movement.Segmentation# Segmentation are ring-like contractions of small intestine that appear at regular interval and then disappear and move chyme to and fro and increase exposure to mucosal surface.# They are initiated by focal increase in ca+ influx.Swallowing# Swallowing is a reflex response triggered by afferent impulse in 5th, 9th and 10th cranial nerves.# These impulses are integrated in NTS and nucleus ambigus. | 5,474 | medmcqa_train |
Position of mid-inguinal point is ? | Ans-B | 5,475 | medmcqa_train |
A woman develops chickenpox at 39 weeks. She has a single fetus in the cephalic presentation. She has no other pregnancy complications.What is the best method to prevent neonatal infection? | Ans. is a, i.e. Continue the pregnancy for at least one weekIf delivery can be postponed for at least 7 days, the mother will develop antibodies and there will be transplacental transfer of antibodies to the neonate. The neonate will have passive immunity and will not develop the infection. Therefore, the best method to prevent neonatal infection is to continue the pregnancy for at least one week after the mother develops the rash. If delivery occurs within one week, the baby should be given VZIG soon after birth. | 5,476 | medmcqa_train |
Which organs do not utilise ketone bodies? | In the fasting state, glucose must be spared for use by the central nervous system (which is largely dependent on glucose) and the red blood cells (which are wholly reliant on glucose). Therefore, tissues that can use fuels other than glucose do so; muscle and liver oxidize fatty acids and the liver synthesizes ketone bodies from fatty acids to expo to muscle and other tissues.Ref: Harper&;s Biochemistry; 30th edition; chapter 14; overview of Metabolism & the Provision of Metabolic Fuels | 5,477 | medmcqa_train |
'Hair on end' appearance is characteristically seen in | Ans. a (Thalassemia major) (Ref. Radiology Review Manual, 5th/pg.174)Causes of "hair on end" or "crew hair cut" skull are# Thalassemia (Characteristic)# Hereditary spherocytosis# Sickle cell disease# G-6-PD deficiency# Iron deficiency anaemia# Neuroblastoma | 5,478 | medmcqa_train |
Insulinoma is most commonly located in which part of the pancreas - | “Insulinomas invariably occur only in the pancreas, distributed equally in the pancreatic head, body and tail". — Harrison 17/e
Insulinomas are a β cell endocrinal tumur of the pancreas.
Insulinomas are the most common pancreatic endocrine neoplasms.
The symptoms are produced due to excessive secretion of insulin causing hypoglycemia
Most of the insulinomas are solitary and benign,
Only about 10-15% of insulinomas are malignant. (keep in mind that all other endocrine tumours of pancreas are usually malignant).
Symptoms of insulinoma
The most common symptom is due to the effect of hypoglycemia on the central nervous system.
These symptoms are - confusion, disorientation, visual difficulties, irrational behaviour, coma
Other symptoms are due to increased secretion of catecholamines which includes sweating, tremor and palpitations.
Classic diagnostic criteria is - Whipple's triad
Signs and symptoms of hypoglycemia during fasting.
Blood glucose below 2.8 mmol/L (50mg/dl) during symptomatic episodes.
Relief of symptoms by intravenous administration of Glucose.
The most useful diagnostic test and the only one indicated in almost all patients is demonstration Wasting hypoglycemia in the presence of inappropriately high level of insulin.
The patient is fasted for 72 hrs or till the symptoms of hypoglycemia develop.
When hypoglycemia develops, serum level of insulin is measured. A ratio of plasma insulin to glucose > 0.3 is diagnostic.
Localization of the tumour
Once the diagnosis has been made, localization of the tumour is must for surgery.
The most important examination for localization of tumour is intraoperative ultrasound, which can indentify pancreatic tumour in all cases.
It is more sensitive than any other method
Other important methods of localization -
High resolution CT and MN.
Endoscopic ultrasound examination of pancreas.
Selective arteriography
T/T - Surgical excision is the t/t of choice -
Since most insulinomas are benign simple enucleation is done. | 5,479 | medmcqa_train |
A child comes with cyanotic spells and chest X-ray was as shown below; What is the most probable diagnosis? | a. Tetralogy of Fallot(Ref: Nelson's 20/e p 2211-2217,, Ghai 8/e p 420-423)The given history along with chest X-ray finding of Boot shaped heart suggests a diagnosis of Tetralogy of Fallot. | 5,480 | medmcqa_train |
Which morphological type of cataract is most visually handicapping ? | Cupuliform (Posterior subcapsular) cataract lies right in the pathway of the axial rays and thus causes an early loss of visual acuity. | 5,481 | medmcqa_train |
A 16 yr old boy is brought to the emergency room by ambulance after suffering a concussion during a football game. When he awoke he had difficulty expressing himself verbally but was able to understand and follow commands. His condition is most likely caused by damage to which of the following? | Aphasia is a language disorder in which a person is unable to properly express or understand ceain aspects of written or spoken language. It is caused by lesions to the language centers of the brain, which, for the majority of persons, are located within the left hemisphere in the poions of the temporal and frontal lobes known as Wernicke's and Broca's areas, respectively Language disorders caused by memory loss, which could be the result of a hippocampal lesion, are not classified as aphasias. | 5,482 | medmcqa_train |
Atheroma resulting in angina has following characteristic except - | Ans. is 'c' i.e., Lack of macrophage o Atherosclerotic plaque is composed of three major components. Cellular component --> Predeminantly smooth muscle cells and macrophages. Others are lymphocytes. Connective tissue matrix (ECM) --> Collegen, elastic fibers, proteoglycans. Lipids --> Both intracellular and extracellular. The major lipid is cholesterol and cholesterol esters. o From initiation to the development, atheromatous plaque progresses from the following stages. Type I (Initial) lesion o These are due to accumulation of isolated lipid filled macrophages (foam cells) and begins as fatty dots. o These are not visible. Type II lesion (fatty streaks) o These lesions are due to accumulation of multiple lipid-filled macrophages (foam cells). o These are the earliest visible lesion of atherosclerosis. o They are not significantly raised and thus do not cause any disturbance in blood flow. Type III (intermediate) lesion o These are same as type II with small extracellular lipid pool. Type IV (atheroma) lesion o Type II change with core of extracellular lipid. Type V lesion (fibroatheroma or mature atherosclerosis) o This lesion is mature atherosclerotic plaque which has following structure. A.Fibrous cap It may be thin or thick. It contains-Smooth muscle cells, macrophages, foam cells, lymphocytes, collegen, elastin and proteoglycans. B.Necrotic core It is deep to the fibrous cap. Contains disorganised mass of lipid (primarily cholesterol and cholesterol esters), cell debris, some foam cells, fibrin, and other plasma proteins. | 5,483 | medmcqa_train |
Cyanosis is not seen in- | Ans. is 'c' i.e., CO poisoing Hypoxic hypoxia (hypoxemia)Anemic hypoxiaStagnant hypoxiaHistotoxic hypoxiao Cyanosis presentCauses :* Hypoventilation as seen in interstitial lung disease & COPD* Cyanotic CHD* Reduced diffusion capacity* Right to left shunt, e.g. A V malformation* V/Q mismatch* High altitudeo Cyanosis absent Causes :* Anemia* CO poisoningo Cyanosis presento Causes :* CHF* Shock* Peripheral vasoconstrictiono Cyanosis absento Causes:* Cyanide poisoning | 5,484 | medmcqa_train |
Make the diagnosis of a 26 day old Infant presenting with recurrent nonbilious vomiting with costipation and loss of wt? | Ans is 'd' ie Pyloric stenosis This is a typical picture of pyloric stenosis a) Infant presenting in 4th week b) Non-bilious vomitting. c) With constipation and wt. loss. Lets see other options. Esophageal atresia a) Infant presents soon after bih with complaints of regurgitation of milk, saliva pours almost continuously from its mouth. Attempt to feed are met with 'Spitting up' or frank vomitting. b) Persistence in feeding may produce aspiration, choking and respiratory distress. c) Diagnosis can be confirmed by passing a rubber catheter into the esophagus through the mouth which will encounter an obstruction. Thus point (a) helps in ruling out oesophageal atresia. Choledochal cyst a) Presentation is not so early in infancy. Though its a congenital anomaly only 1/2 the cases present before 20yrs. of age and only 1/3 present in the 1st decade of life. b) Classical triad of symptoms --> i) Obstructive jaundice * ii) Upper abdominal pain* iii) Fever* (c) A palpable epigastric mass may be discovered. Beal atresia a) Vomitting will be bilious b) Infant presents in the 1st week of life. | 5,485 | medmcqa_train |
Which of the following is seen in cryoglobulinemia | Abnormal Ig Bence Jones proteins Light chain of Ig ( Kappa or Lambda )WaldenstormmacroglobulinemiaIg M Heavy chain disease Fc pa of heavy chain CryoglobulinemiaPrecipitate at low temperature (Ref: Ananthanarayan 9th edition, 96-98) | 5,486 | medmcqa_train |
Malleus is derived from | i.e. (Meckel's Cartilage): (316-109 IBS- Embryology 8th)* Malleus and Incus are derived from the dorsal end of the Meckel's cartilage (First arch)*** Stapes is formed from the dorsal end of the cartilage of second pharyngeal archNerves of pharyngeal arches and muscles supplied by themArchNerve of ArchMuscles of ArchCartilage of ArchFirstMandibularMedial and lateral pterygoids, MasseterTemporalis, Mylohyoid,Anterior belly of digastricTensor tympani, Tensor palatiMalleus Incus Sphenomandibular ligamentSecondFacialMuscles of face, Occipito frontalis, Platysma,Stylohyoid, Posterior belly of digastric, Stapedius,\Auricular muscles* Stapes* Styloid process* Stylohyoid ligament* Smaller (lesser) comu of hyoid bone* Superior part of body of hyoid boneThirdGlossopharyngealStylopharyngeus* Greater comu of hyoid bone* Lower part of the body of hyoid boneFourthFifthSuperior laryngealRecurrent laryngealMuscles of larynx and pharynx* The cartilages of the larynx are derived from the fourth and sixth arches with a posible contribution from the fifth arch, but their exact derivation is controversial | 5,487 | medmcqa_train |
On otological examination all of the following will have positive fistula test except: | (a) Dead ear(Ref. Shambaugh, 6th ed., page 181)If there is a fistula on the medial wall but inner ear is dead (not responding to pressure changes), then in spite of presence of fistula, fistula test will be negative. This is false negative fistula test.If the footplate of stapes is hypermobile, it results in false positive fistula test.Fenestration operation is an iatrogenic cause of positive fistula test. | 5,488 | medmcqa_train |
All are characteristics of Autism except | These are some of the characteristics of ASD: problems with social interaction with others. This may include problems talking back and foh, working, or playing with others. unusual interest in objects need for sameness great variation in abilities under or over reaction to one or more of the five senses: sight, touch, taste, smell, or hearing repeated actions or body movements unusual emotional reactions and expressions Children with ASD usually have difficulty with social interaction. Some parents have said that before their child's diagnosis of ASD, they thought their child was just very shy. Children with ASD may have an unusual interest in objects. They may play with toys in different or unusual ways. For example, they may be able to tell you everything you need to know about car engines. Or they may be able to sit for hours spinning the wheels on a toy vehicle. Children with ASD often have a need for sameness. They may have difficulty with changes in routines, clothes, food, caregivers, and other pas of their environment. Children with ASD may have great ability in one area and great difficulty in another. But not all children with ASD have the same abilities. For example: A child with ASD may have difficulty holding a pencil but have a strong memory for the words of songs or movies. On the other hand, they could be fabulous aists or have perfect pitch. A child may have difficulty knowing how to play a game with a peer but may have a very good understanding of how computers work. A child who does not speak may be able to build complex structures out of Lego. Children with ASD may also have unusually strong reactions to one or more of their five senses. For example, some children with ASD may react to bright sunlight. Others are excessively bothered by tags on their clothing or by loud noises. Many children may be bothered by these things, but children with ASD often have a stronger reaction to them. Children with ASD often have difficulty with the colour, smell, or texture of ceain foods. This may limit what they will eat to only a few foods. Children with ASD may also do the same thing over and over again. For example, they may repeatedly flap their hands, jump, or walk on tiptoes. This is common. It is something that many parents talk about when they describe their children. Your child may be doing these things to help calm themself during stressful situations or to help occupy or enteain themself. Children with ASD may also have unusually intense and prolonged emotional reactions. For example, they may get very angry when asked to stop playing and get ready for lunch. These emotions do not match the situation they find themselves in. These reactions may occur as a result of anxiety they feel when making changes in routine. Children with ASD may talk constantly about specific things that interest them and be unaware that other people might not have the same level of interest. Reference: GHAI Essential pediatrics, 8th edition | 5,489 | medmcqa_train |
Which apoprotein is the most impoant to activate lipoprotein lipase - | Ans. is 'c' i.e., Apo-C IIMajor activator of lipoprotein lipase is apo-CII | 5,490 | medmcqa_train |
Risk of the damage of fetus by maternal rubella is maximum if mother gets infected in | Congenital Rubella Syndrome (CRS):
CRS is said to have occurred if:
– Infant has IgM rubella antibodies shortly after birth, or
– IgG antibodies persist for more than 6 months
Major determinant of extent of fetal infection in CRS: Gestational age at which fetal transmission occurs,
– Infection in I trimester: MOST DISASTROUS TIME
1. Abortions
2. Still births
3. Skin lesions: blueberry muffin lesions
4. ‘Triad of Congenital Rubella Syndrome’
i. Sensorineural deafness
ii. Congenital heart defects (MC is PDA)
iii. Cataracts
– Infection in early part of II Trimester: Deafness (only)
– Infection after 16 weeks POG: No major abnormalities
Risk of fetal damage in CRS: | 5,491 | medmcqa_train |
TGF-β is involved in all of the process of angiogenesis except: | TGF-β stimulates fibroblast migration and proliferation, increases the synthesis of collagen and fibronectin, and decreases the degradation of ECM by inhibiting metalloproteinases. TGF-β is involved not only in scar formation after injury but also in the development of fibrosis in lung, liver, and kidneys that follows chronic inflammation.TGF-β also has anti-inflammatory effects that serve to limit and terminate inflammatory responses. It does this by inhibiting lymphocyte proliferation and the activity of other leukocytes.
VEGFs, mainly VEGF-A, stimulates both migration and proliferation of endothelial cells, thus initiating the process of capillary sprouting in angiogenesis. It promotes vasodilation by stimulating the production of NO and contributes to the formation of the vascular lumen.
Robin’s Textbook of pathology 10th ed Page 91 | 5,492 | medmcqa_train |
Cavallo's sign is seen in - | Ans. A. Tricuspid Regurgitation | 5,493 | medmcqa_train |
Sympathetic ophthalmitis usually results due to: | Ans. (c) Penetrating injury to Ciliary bodyRef.: A.K. Khurana 6th ed. /163, 437* Sympathetic ophthalmitis is a serious bilateral granulomatous panuveitis which usually occurs due to penetrating trauma to ciliary body.* The injured eye is called exciting eye.* Fellow eye which also develops uvieitis is called sympathizing eye.Features* Always follows a penetrating wound.* More common in children than in adults.* It doesn't occur when actual suppuration develops in the injured eyePathologies* Uveal pigment acts as allergen and excites plastic uveitis in the sound eye.* Dalen-Fuchs' nodules are formed due to proliferation of the pigment epithelium (of the iris, ciliary body and choroid) associated with invasion by the lymphocytes and epitheloid cells.Clinical Picture* Prodromal stage: Sensitivity to light (photophobia) transient indistinctness of near objects is the earliest symptoms.* First sign may be presence of retrolental flare or the presence of a keratic precipitates (KPs) at back of cornea. * Fully-developed stage: has typical signs and symptoms consistent with acute plastic iridocyclitis.* Dalen Fuch's Nodules are characteristic of SO.* Exciting (injured) eye: Keratic precipitates may be present at the back of cornea* Sympathizing (sound) eye: usually involved after 4-8 weeks of injury in the other eye.* Treatment - Early excision of the injured eye.# Topical cycloplegics + IV/oral steroids are also used for treatment. | 5,494 | medmcqa_train |
Wermer syndrome is - | Ans. is 'a' i.e., MEN 1 | 5,495 | medmcqa_train |
If hardness level of water is 50-150 mg/L, the water is defined as - | Ans. is 'b' i.e., Moderately hard Classification of hardness in waterClassificationLevel of hardness (mEq./litre)a) Soft waterb) Moderately hardc) Hard waterd) Very hard waterLess than 1 (< 50 mg/L)1 - 3 (50 - 150 mg/L)3 - 6 (150 - 300 mg/L)Over 6 (> 300 mg/L) | 5,496 | medmcqa_train |
Berson and yellow 1st described the following test | Berson and Yalow discovered RIA in 1959 by which we can quantify antigens or hormones upto picograms-v sensitive than ELISA RIA /ELISA-indirect immunofluorescence tests Ref: Textbook of Microbiology Baveja 5th ed Pg 115 | 5,497 | medmcqa_train |
Little&;s are is | The anteroinferior pa or vestibule of the septum contains anastomoses between the septal ramus of the superior labial branch of facial aery,branch of sphenopalatine aery,greater palatine and of anterior ethmoidal aery These form a large capillary network called kiesselbachs plexus. This is a common site of bleeding from nose or epistaxis and known as littles area. Ref BDC volume3,Sixth edition pg 241 | 5,498 | medmcqa_train |
Pyrimidine overproduction results in all except | Defective enzyme of pyrimidine metabolism Signs and symptoms Dihydropyrimidine dehydrogenase Can develop toxicity to 5-fluorouracil, also a substrate for this dehydrogenase Orotate phosphoribosyl transferase and orotidylic acid decarboxylase Orotic acid aciduria type 1, megaloblastic anemia Orotidylic acid decarboxylase Orotic acid aciduria type 2 Pyrimidine overproduction is not the causal factor in Reye's syndrome. Reye's syndrome results in secondary pyrimidine overproduction. Reference: Harpers illustrated biochemistry 30th edition | 5,499 | medmcqa_train |
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