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Most Imp. technical consideration at the time of doing below knee amputation is - | Ans. is 'a' ie. Post flap should be longer than the anterior flop Posterior flap should be longer than the anterior flap as the posterior skin has a good blood supply (and anterior skin has poor due to lack of muscle on anterior aspect). A good blood supply helps in easy healing of stump. - Equally sho anterior and posterior flaps are used only when the long post flap technique is not feasible because of previous wounds or extensive tissue ischemia. 'The longer (the stump) the better', is the general rule for amputation at all sites, but below knee amputation is an exception. The amputation level is kept proximal to the lower third of tibia, since the preponderance of tendinous structures in the lower third predispose to poor circulation and an unstable painful lump. The best level below the knee as, for, as prosthetic fitting is concerned is at the distal musculotendinous junction of the gastrocnemius muscle. Some other imp. points about BK amputation The fibula is transected slightly above the tibial level. No essential differences in healing rate is noted in pts. with or without popliteal pulses, but the absence of a femoral pulse is associated with a high failure rate for BK amputation. The nerves are pulled gently down, transected and then allowed to retract, and the vessels are ligated above the level of the end of tibia. | 6,000 | medmcqa_train |
Propey of acquiring antibiotic resistance from viral colony is by - | Ans. is 'c' i.e., Transduction Acquiring antibiotic resistance by viral colony (bacteriophage) is by transduction. . Drug resistance may be acquired in bacteria by Mutation Transduction (by bacteriophage ---> virus) Conjugation | 6,001 | medmcqa_train |
Major bacterial enzyme responsible for putrefaction: NEET 14 | Ans. Lecithinase | 6,002 | medmcqa_train |
A 5-year-old child presents with history of fever off- and-on for past 2 weeks and petechial spots all over the body and increasing pallor for past 1 month. Examination reveals splenomegaly of 2 cm below costal margin. The most likely diagnosis is: | - Pallor (anemia), petechial spot (thrombocytopenia), fever (infection due to neutropenia) with splenomegaly suggest the diagnosis of acute leukemia. - Splenomegaly eliminates aplastic anemia - Presence of anemia and recurrent infections, go against ITP | 6,003 | medmcqa_train |
Which of the following bacterium is non-motile? | (Refer: Anantha Narayanan and Paniker’s Textbook of Microbiology, 9th edition, pg no: 19-20)
Motility of Enterobacteriaceae members | 6,004 | medmcqa_train |
CSF on MRI appears: | Ans. Hypointense on T1 weighed image and hyperintense on T2 weighed image | 6,005 | medmcqa_train |
IQ level of intelligence 90-109 is: March 2013 (c, g) | Ans. B i.e. Normal | 6,006 | medmcqa_train |
The pH of vagina in adult women is : | 4.5 | 6,007 | medmcqa_train |
A patient presents with mental confusion, visual and auditory hallucinations, perceived changes of body shape, swelling of the tongue and a fear of impending death after he was treated for primary chancre of syphilis with an intramuscular injection. What is the likely diagnosis? | -Hoigne's syndrome is a pseudoanaphylactic or pseudoallergic reaction that occurs after the intramuscular administration of Penicillin G procaine or benzathine. These are usually embolic toxic reactions possibly due to vascular occlusion by large crystals of the Penicillin salts. It is not due to Penicillin allergy-Acute psychotic symptoms due to a pseudoanaphylactic or pseudoallergic reaction that occurs after the intramuscular administration of Penicillin G procaine or benzathine.-The patient presents with mental confusion, visual and auditory hallucinations, perceived changes of body shape, swelling of the tongue and a fear of impending death. | 6,008 | medmcqa_train |
Which of the following is not a feature of Tuberculosis of the spine: | Ans. C. Exaggerated lumbar lordosisTuberculosis of the spine usually involves vertebral bodies and is of paradiscal type. It results in kyphosis and not lordosis due to collapse of vertebrae. | 6,009 | medmcqa_train |
Absolute contraindication of IUCD is : | Ans. is d i.e. Pelvic tuberculosis | 6,010 | medmcqa_train |
Which of the following enzymes is stable at acidic pH? | Pepsin is an enzyme that breaks down proteins into smaller peptides (that is, a protease). It is produced in the stomach and is one of the main digestive enzymes in the digestive systems of humans and many other animals, where it helps digest the proteins in food. Pepsin exhibits maximal activity at pH 2.0 and is inactive at pH 6.5 and above, however, pepsin is not fully denatured or irreversibly inactivated. Therefore, pepsin in the solution of up to pH 8.0 can be reactivated upon re-acidification. Lowering pH does not denature many proteins. Unfolding, yes; denaturation, no. Hydrogen bonds play an impoant role in stabilizing pepsin. Lowering pH does not necessarily break the hydrogen bond network. At least one aspayl residue in the catalytic site needs to be protonated for catalytic action, hence the function at low pH. We do not completely understand the stability of aspayl proteases or pepsin | 6,011 | medmcqa_train |
The following virus can be grown only in suckling mice - | It is necessary to employ suckling mice for the isolation of coxsackie virus. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:491 | 6,012 | medmcqa_train |
Mantle cell lymphomas are positive for all of the following, except ? | Ans. is 'a' i.e., CD 23 Mantle cell lymphoma Mantle cell lymphoma is a type of non-hodgkin lymphoma characterized by presence of tumor cells which closely resemble the normal mantle zone of B-cells that surround germinal centers. Immunophenotype of mantle cell lymphoma Mantle cell lymphoma is neoplasm of B cells. Therefore it expresses B cell marker : CD19,CD20 Surface immunoglobulin heavy chain (IgM and IgD). Either /c or X light chain. As the tumor cells are derived from Mantle zone, they are positive for B cell marker of mantle zone i.e., CD-5. Mantle cell lymphoma is CD23 negative, this feature distinguish it from chronic lymphocytic leukemia (CLL) which is positive for both CD5 and CD23. The other characteristic marker of mantle cell lymphoma is cycline DI. Cytogenetic abnormalities. Mantle cell lymphoma is associated with an 11 : 14 translocation involving the IgH locus on chromosome 14 and the cyclin DI locus on chromosome 11. This leads to increased expression of cyclin D 1, which promotes GI to S phase progression during the cell cycle. 65 years old man with splenomegaly, lymphodenopathy CD-23 negative and CD-5 positive B-cell suggest the diagnosis of mantle cell lymphoma. Clinical features of mantle cell lymphoma It is usually present in fifth to sixth decade with male preponderance. The most common presentation is painless lymphodenopathy. Splenomegaly may occur. Occasionally, multifocal mucosal involvement of the small bowel and colon produces lymphomatoid polyposis- of all forms of NHL, mantle cell lymphoms is most likely to spread in this fashion. | 6,013 | medmcqa_train |
Which of the following does not contribute to the boundaries of facial recess? | Ans. b. Stapedius tendon (Ref: Dhingra 5/e p6)'Facial recess or the posterior sinus is a depression in the posterior wall lateral to the pyramid. It is bounded medially by the vertical part of Vllth nerve, laterally by the chorda tympani and above, by the fossa incudis. Surgically, facial recess is important, as direct access can be made through this into middle ear without disturbing posterior canal wall.'- Dhingra 5/e p6. Boundaries of Facial RecessMedially* Vertical part of Vllth nerveQLaterally* Chorda tympaniQAbove* Fossa incudisQ | 6,014 | medmcqa_train |
A 49-year-old woman has experienced increasing weakness and chest pain over the past 6 months. On physical examination, she is afebrile and normotensive. Motor strength is 5/5 in all extremities, but diminishes to 4/5 with repetitive movement. There is no muscle pain or tenderness. Laboratory studies show hemoglobin, 14 g/dL; hematocrit, 42%; platelet count, 246,000/mm3; and WBC count, 6480/mm3. A chest CT scan shows an irregular 10x12 cm anterior mediastinal mass. The surgeon has difficulty removing the mass because it infiltrates surrounding structures. Microscopically, the mass is composed of large, spindled, atypical epithelial cells mixed with lymphoid cells. Which of the following is the most likely cause of this mass lesion? | Thymomas are rare neoplasms that can be benign or malignant. In one third to one half of cases, thymomas are associated with myasthenia gravis as an initial presentation (as in this case). Benign thymomas have a mixed population of lymphocytes and epithelial cells and are circumscribed, whereas malignant thymomas are invasive and have atypical cells. Thymic carcinomas resemble squamous cell carcinomas. Granulomas can have epithelioid macrophages and lymphocytes, but the thymus is an unusual location for them. Hodgkin lymphoma involves lymph nodes in the middle or posterior mediastinum, with a component of Reed-Sternberg cells. Lymphoblastic lymphoma of the T-cell variety is seen in the mediastinal region, including thymus, in children, but it has no epithelial component. Metastases to the thymus are quite unusual. An organizing abscess could have granulation tissue at its edge, with a mixture of inflammatory cell types, but not atypical cells. | 6,015 | medmcqa_train |
All the following gives nerve supply to Parotid gland except | Nerve Supply of Parotid gland:1.Parasympathetic nerves are secretomotor. They reach the gland through the auriculotemporal nerve. The preganglionic fibers begin in the inferior salivatory nucleus; pass through the glossopharyngeal nerve, its tympanic branch, the tympanic plexus and the lesser petrosal nerve; and relay in the otic ganglion. The postganglionic fibers pass through the auriculotemporal nerve and reach the gland.2.Sympathetic nerves are vasomotor and are derived from the plexus around the external carotid aery.3.Sensory nerves to the gland come from the auriculotemporal nerve, but the parotid fascia is innervated by the sensory fibers of the great auricular nerve (C2).The facial nerve passes through gland but doesn&;t supply it.Reference: Chourasia; 6th edition; 110 and 111 pages | 6,016 | medmcqa_train |
Drug used for trabeculectomy | The main reason of failure of trabeculectomy surgery is scarring and closure of drainage site
Antimetabolites prevent scarring and can be used to increase the success rate of trabeculectomy
The most commony used antimetabolites are mitomycin-C and 5-fluorouracil. | 6,017 | medmcqa_train |
Mycetoma is caused by the following agents except?Allescheria boydii | Ans. is 'c' i.e., Trichosporum beigelli | 6,018 | medmcqa_train |
35 year old lady with post coital bleeding, Management is : | Post coital bleeding is the typical symptom of Cervical cancer It is managed by colposcopy and abnormal areas are biopsied Reference : Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Pg no: 299, 302 | 6,019 | medmcqa_train |
Tetralogy of Fallot classically consists of the combination of ail except - | Ans. is 'd' i.e., Left ventricular hypertrophy Tetralogy of Falloto TOF is the commonest congenital heart disease.o Constituents of TOF# Ventricular septal defect# Overriding or dextroposed aorta# Pulmonic stenosis# Right ventricular hypertrophy. Hemodynamics of Tetralogy of Falloto The severity of obstruction to the right ventricular outflow determines the direction of blood flow. Pulmonary stenosis SevereMild(Ejection Systolic murmur- Greater resistance to rightThe abnormality resembles anand delay in P2) ventricular outflow throughisolated VSD and the shunt may be pulmonary valveleft to right without cyanosis | As this resistance approaches the level of systemic vascular resistance Absence of shunt murmur because-(Right to left shunt predominates) the pressure difference at which this | shunt operates is low Reduced flowr of blood into pulmonary' artery i.e. pulmonary artery pressure is reduced | Cyanosis and soft P2 Clinical features of TOF:o Dvsnea on exertion and exercise intolerance - Most common,o Cyanosis usually presents after neonatal periodo Hypoxemic or cyanotic spells (Tet spells)o Commonest congenital lesion with which squatting is usedo Clubbingo Ausculatory findings:# S1-Normal# S2-Single predominantly Aortic# Muimur-Ejection systolic o TOF patients are RARELY CYANOTIC AT BIRTH*X-ray findings in TOF# Boot shaped heart (Cour en sabot)# Oligemic pulmonary fields# Normal sized heart (no cardiomegaly) | 6,020 | medmcqa_train |
The drug having higher concentration in the bone: | Poor bone penetration. - B lactams - Vancomycin - Aminoglycoside Good bone penetration (Higher concentration in Bone) * Tetracycline * Macrolide * Clindamycin | 6,021 | medmcqa_train |
All are complication of formula fed baby over human milk fed baby except: | Formula feeds contain a host of vitamin and minerals, as well as trace elements (zinc, mangnese, copper, iodine) and electrolytes.
In formula feeds vitamin K is added in higher levels than in breast milk to reduce the risk of hemorrhagic diseases in new born. So, vitamin K deficiency can never be a complication of formula fed babies.
Now let’s see what Ghai 6/e, p 164, 331, 177 has to say on the rest of options.
Option “a” i.e. Necrotizing enterocolitis
“Almost all patients of neonatal necrotizing enterocolitis (NEC) are artificially fed prior to the onset of illness. Breast milk is protective for NEC.”
—Ghai 6/e, p 164
Option “b” i.e. Otitis media
“Otitis media is one of the most common infections of early childhood. Anatomic features which make this age group particularly susceptible to ear infection include shorter, more horizontally
placed and compliant eustachian tube, which permits reflux of nasopharyngeal secretions into the middle year. A high incidence of bacterial carriage in the adenoids may also contribute to the frequency of otitis media in children. Other risk factors include exposure to cigarette smoke, over crowding, bottle feeding, cleft palate, allergic rhinitis, Down’s syndrome and disorders of mucocilliary transport.”
—Ghai 6/e, p 331
Option “c” i.e. Hypocalcemia
“In the neonatal period there is transient hypoparathyroidism. As a result, less phosphate is excreted in the urine. Human milk is low in phosphate, but cow’s milk is rich in phosphate. Immature parathyroid in the neonates can not easily cope with excess phosphate in cow’s milk leading to hypocalcemia in top fed babies”.
—Ghai 6/e, p 177 | 6,022 | medmcqa_train |
Local anesthetics depress transmission first in | Local anesthetics depress transmission in the group C fibre before they affect group A touch fibres. Ref: Ganong&;s Review of medical physiology;25th edition; pg: 95. | 6,023 | medmcqa_train |
Which of the following is the reason for the development of a simple lentigo? | Ans. B. Increased melanocytesSimple lentigo occurs due to an increase in melanocytes at dermal-epidermal junction.* Simple Lentigo also known as Lentigo simplex is a light- to dark-brown or black macule that does not fade away once it appears.* They usually appear during childhood and increase in number until the age of 40.* It is more common in individuals with red hair and fair skin.Lentigo simplex: Hyperpigmentation is evident in the basal and squamous epidermal cells. There is a slight increase in non-atypical melanocytes between the epidermal basal cells. Magnification 40x(H&E). | 6,024 | medmcqa_train |
Which drug is given in delayed vomiting after chemotherapy - | Ans. is 'd' i.e., Aprepitant o Cisplatin can induce vomiting within 24 hours or after 2 days. DOC for the early vomiting is ondensetron while for delayed vomiting is aprepitant (substant P antagonist). | 6,025 | medmcqa_train |
Fried Egg Colonies are produced by? | ANSWER: (B) MycoplasmaREF: Jawetz 24th edition Section III. Bacteriology Chapter 26Mycoplasma Cultures:1. The material is inoculated onto special solid media and incubated for 3-10 days at 37degC with 5% CO2 (under microaerophilic conditions), or into special broth and incubated aerobically. One or two transfers of media may be necessary before growth appears that is suitable for microscopic examination by staining or immunofluorescence. Colonies may have a "Fried Egg" appearance on agar. | 6,026 | medmcqa_train |
Bacteroides are often implicated in the causation of: September 2004 | Ans. B i.e. Empyema | 6,027 | medmcqa_train |
Which of the following is the most common presenting symptom of non-cirrhotic poal hypeension? | Clinical assessment Haematemesis is red with clots when bleeding is rapid and profuse, or black ('coffee grounds') when less severe. Syncope may occur and is caused by hypotension from intravascular volume depletion. Symptoms of anaemia suggest chronic bleeding. Melaena is the passage of black, tarry stools containing altered blood; it is usually caused by bleeding from the upper gastrointestinal tract, although haemorrhage from the right side of the colon is occasionally responsible. The characteristic colour and smell are the result of the action of digestive enzymes and of bacteria on haemoglobin. Severe acute upper gastrointestinal bleeding can sometimes cause maroon or bright red stool . Ref Davidson edition23rd pg780 | 6,028 | medmcqa_train |
All are true about minimal change G.N. except – | There is no deposition of immune reactants. | 6,029 | medmcqa_train |
Median weight of 100 children was 12 kgs. The Standard Detion was 3.Calculate the percentage coefficient of variance - | Ans. is 'a' i.e., 25% o We cannot calculate cofficient of variance here, because value of mean has not been provided (value of median is given). o Only in standard normal curve mean = median. o But in that case both are '0' (In standard normal normal curve mean = median = mode = 0) o I am clueless here. o It you take, value of median as mean than the answer will be 25%. | 6,030 | medmcqa_train |
Paraxial mesoderm develops into | Human embryology Tenth edition Inderbier Singh Page no 62At first, the cells of paraxial mesoderm are homogeneously arranged later the mesoderm get segmented The segment are two categories somitomeres and somites | 6,031 | medmcqa_train |
Acute infection of hepatitis B virus is diagnosed by: | Ans. is 'b' IgM antibody of HBcAg (Ref. November 2001, Micro, Harrison 17/e p 1943-44,1933-34 & 16/e, p 1823-24). | 6,032 | medmcqa_train |
Testicular feminisation syndrome is associated with : | Primary amenorrhea | 6,033 | medmcqa_train |
The prognosis of rhabdomyosarcoma is likely to be poor if the site of the tumour is | Rhandomyosarcoma Rhabdomyosarcoma Arises from Mesenchymal tissues MC sites of origin : Head and neck (Parameningeal) > Extremities > Genitourinary tract > Trunk MC pediatric soft tissue sarcoma : Rhabdomyosarcoma Associated with : NF, Beckwith- Weidman syndrome, Li-Fraumeni and fetal alcohol syndrome Prognosis of Rhabdomyosarcoma Favourable primary sites Unourable primary sites Orbit Nonparameningeal head and neck Paratestis Vagina Extremity Parameningeal Ref: Devita 9th edition Pgno : 1780-1784 | 6,034 | medmcqa_train |
Intrauterine exposure of diethylstiboesterol is associated with - | Ans. is 'c' i.e., Clear cell adenocarcinoma of vagina | 6,035 | medmcqa_train |
The lateral pterygoid muscle attaches to which of the following? | The inferior head of the lateral pterygoid muscle attaches to the lateral surface of the lateral pterygoid plate of sphenoid bone. Its superior head attaches to the infratemporal crest of the greater wing of sphenoid bone. The deep fibers of the medial pterygoid muscle attaches to the medial surface of the lateral pterygoid plate. | 6,036 | medmcqa_train |
A 30-year-old male is diagnosed with Peutz-Jeghers syndrome. What findings is consistent with the diagnosis? | Peutz-Jeghers syndrome is rare but should be considered if pigmented spots are found on the lips, mouth, or hands. Hamartomas are not neoplasms; the name is derived from the Greek hamartos, which refers to the misfiring of a javelin. The tissues appropriate to the site misfire and are arranged in an irregular order. | 6,037 | medmcqa_train |
Ebstein anomaly is due to maternal intake of: | a. Lithium(Ref: Nelson's 20/e p 2211-2217, Ghai 8/e p 420-423)Maternal drugCongenital heart diseasePhenytoinVSD, ASD, coarctation of aorta, PDAValproateCoarctation of aorta, aortic stenosis, pulmonary atresia, VSDLithiumEbstein anomaly, Tricuspid atresiaAlcoholASD. VSD | 6,038 | medmcqa_train |
The most common anomaly seen in the fetus of a mother taking lithum carbonate is - | Ans. is 'a' i.e., Cardiac deformities o It causes Ebstein anomaly. | 6,039 | medmcqa_train |
D Tubocurarine acts by | Refer Katzung 10/e p 429 D-Tubocurarine is a skeletal muscle relaxant that acts by competitive inhibition of NM receptors at neuron muscular junction | 6,040 | medmcqa_train |
All of the following are true about the Herd Immunity for infectious diseases except: | Occurrence of clinical and subclinical infection in a community is responsible for herd immunity. Herd immunity; * It is the level of resistance of a community or group of people to a paicular disease. * Herd immunity provides an immunological barrier to the spread of disease in the human herd. * The epidemic wave declined with a build-up of herd immunity following natural infection. * It is neither possible nor necessary to achieve 100 per cent herd immunity in a population to halt an epidemic or control disease, as seen in SMALL POX eradication. * Herd immunity implies group protection beyond that afforded by the protection of immunized individuals. It provides an immunological barrier to the spread of disease in the human herd. * It may lead to elimination of the disease in due course (Eg. Poliomyelitis and Diphtheria). * In the case of tetanus, however, herd immunity does not protect the individual. | 6,041 | medmcqa_train |
Malaria is transmitted in Rural areas by ? | Ans. is 'c' i.e., Anopheles culicifacies | 6,042 | medmcqa_train |
A chest physician performs bronchoscopy in the procedure room of the out patient department. To make the instrument safe for use in the next patient waiting outside, the most appropriate method to disinfect the endoscope is by : | 2% Glutaraldehyde is knows as cidex (Aldehyde disinfectant) specially effective against tubercle bacilli, fungi and viruses. It is most commonly used for cystoscope, endoscope, bronchoscopes etc., which can’t be disinfected by heat.
Also used to treat corrugated rubber anesthetic tubes and face masks, plastic endotracheal tubes, metal instruments and polythene tubing.
Other choice:
70% alcohol is used as skin antiseptic. It acts by denaturing bacterial proteins.
Methylated ethyl alcohol is MC alcohol used for skin disinfection and hand washing.
2 - 3 percent formaldehyde (20 - 30 ml of 40% formalin in one litre of water) is used for spraying rooms, walls, furnitures and disinfecting blankets, beds and books. It is most effective at high temperature and relative humidity of 80-90%.
Sodium hypochlorite is recommended for sterilizing infant’s feeding bottles. It acts in the same way as bleaching powder and is more strong. | 6,043 | medmcqa_train |
In cap stage, the cell in the centre of enamel organ secrete glycosaminoglycans, which are: | The cells in the centre of enamel organ synthesize and secrete glycosaminoglycans into the extracellular compartment between the epithelial cells. Glycosaminoglycans are hydrophilic and so pull water into the enamel organ. The increasing amount of fluid increases the volume of the compartment of the enamel organ, and the central cells are forced apart. Because they retain connections with each other through desmosomal contacts, they become star-shaped. The center of the enamel organ thus is termed the stellate reticulum. | 6,044 | medmcqa_train |
A 56 year old female presented with breast carcinoma and she was prescribed herceptin (trastuzumab). Which of the following statement regarding this drug is true ? | It is a monoclonal antibody produced by injecting HER-2 antigen; 'cl' i.e., The protein HER2/NEU is expressed in increased amount by breast cancer cells Cancer cells express ceain antigen on their surface. These antigens can be made the target of chemotherapies. Specific antibodies have been developed against these cell surface receptors. Because the antibodies were produced from one cell that was grown into a clone of identical cells it is called monoclonal antibody. These antibodies were originally developed as mice antibody but because human have immune reactions to mouse proteins, these antibodies are usually chimerized or humanized when used as therapeutic reagents. i.e., the antibodies have both human and mouse component. These antibodies kill the cells by following mechanism :? - Antibody dependent cellular toxicity - Complement dependent cytotoxicity - Diret induction of apoptosis However, the clinically relevant mechanism still remains unceain. Herceptin (Trastuzumab) Herceptin is a humanized antibody and is used in breast cancers which are HER2 positive. (Major poion of it is composed of human component and a small pa is composed of mouse protein). HER2 stands for --4 human epidermal growth factor receptor. HER2 gene produces HER2 protein also called HER2 receptor. The HER2 protein is found on the surface of some normal cells in the body. In normal cells HER2 protein help send growth signals from outside the cell to the inside of the cell. These signals tell the cell to grow and divide. In HER2 (+ve) breast cancer the cancer cells have abnormally high number of HER2 genes per cell when this happens too much HER2 protein appears on the surface of these cancer cells. This is called HER2 protein over expression. Too much HER2 protein is thought to cause cancer cells to grow and divide uncontrollably. Herceptin acts in two ways a) Herceptin attaches to HER2+ cancer cells and stimulates the bodys immune system to target the HER2+ cancer cells b) Herceptin attaches itself to the HER2 receptors on the surface and blocks them from receiving the signals. Herceptin also acts by antibody dependent cell c) mediated cytotoxicity. We are not sure if it is increased antibody response Uses of Herceptin (trastuzumab) Currently transtuzumab is approved for HER2/ neu overexpressing metastatic breast cancer in combination with paclitaxel as initial treatment or as monotherapy following chemotherapy. | 6,045 | medmcqa_train |
Which IUCD acts for 10 yrs - | Ans. is 'c' i.e., Cu-T 380A "The Cu-T 380A is approved for use for 10 years. However, the Cu-T 380A has been demonstrated to maintain its efficacy over at least 12 years of use" . --Park Intra-uterine devices o An intrauterine device is a long acting reversible contraceptive bih control device placed in the uterus. o There are two basic types of IUD --> Non-medicated and medicated. | 6,046 | medmcqa_train |
Most common rheumatic disease in children is ________ | The most common rheumatic disease in children is Juvenile idiopathic ahritis (JIA), Juvenile idiopathic ahritis represents a homogenous group of chronic disorders charcterized by Ahritis in >/= 1 joint Age at onset: <16 years Duration of disease: >/=6 weeks Ahritis is clinically defined as: Swelling or effusion, or the presence of 2 or more of the followin signs: Limitation of range of motion Tenderness or pain on motion Increased heat Ref: Nelson textbook of pediatrics 21st edition pgno: 1258 | 6,047 | medmcqa_train |
In which of the following form of imaging, Harmonic imaging is related- | Harmonic imaging is a newer technique in ultrasonography. Harmonic imaging exploits non-linear propagation of ultrasound through the body tissues. The high-pressure poion of the wave travels faster than low pressure resulting in distoion of the shape of the wave. This change in waveform leads to the generation of harmonics Advantages over conventional ultrasound * decreased aifacts * increased axial and lateral resolution * improved resolution in patients with large body habitus | 6,048 | medmcqa_train |
What is the net amount of ATP's formed in aerobic glycolysis? | During aerobic glycolysis the number of net ATPs formed are 8. Steps involved in the formation of ATP during glycolysis are: Conversion of 2 molecules of glyceraldehyde 3 phosphate to 1,3 bisphoglycerate release 2 molecules of NADH which yield 6 ATP. Conversion of 2 molecules of 1,3 BPG to 3 phosphoglycerate yield 2 ATP. Conversion of 2 molecules of phosphoenol pyruvate to pyruvate yield 2 ATP. Steps involved in the consumption of ATP during glycolysis are: Conversion of glucose to glucose 6 phosphate Conversion of fructose 6 phosphate to fructose 6 bis phosphate Total ATP formed during glycolysis : 10 ATP utilised during glycolysis : 2 Net ATP formed during glycolysis : 8 Net ATP produced during anaerobic glycolysis is only 2. Ref: Medical Biochemistry By N. Mallikarjuna Rao page 160. | 6,049 | medmcqa_train |
Anchovy sauce pus is a feature of ? | Ans. is 'a' i.e., Amebic liver abscess In amebic liver abscesses the liquified material within the abscess cavity is a mixture of RBCs, leucocytes and broken down liver cells. This looks chocolate or reddish brown in colour and is k/a 'chocolate' or 'anchovy' sauce. | 6,050 | medmcqa_train |
Aerial blood Gas analysis in a bottle contaiing heparin causes a decrease in value of : | Answer is D (All of the above) Dilution of a sample with heparin can cause erroneously low value for pH, pCO2 and HCO3-. Heparin and Blood Gas Measurements Heparin is the preferred anticoagulant for blood gas specimens Heparin is used in blood gas syringes to avoid coagulation of the blood sample, as clots interfere with the function of the blood gas analyzer. Heparinization of blood sample also limits the deposition of proteins on the electrodes. However excess heparin can affect blood gas analysis by lowering the PaCO2 and calulcated HCO3- by dilutional effect and the pH as heparin is acidic. | 6,051 | medmcqa_train |
A 25-year-old woman rushes to an emergency depament because she is afraid she is dying. She is experiencing chest pain, a sensation of choking, nausea, and tingling sensations up and down her arms. When the screening nurse examines the patient, her face is flushed and sweating. Her pulse is 140/min and respirations are 25/min. When the emergency depament physician examines her 15 minutes later, her symptoms are dissipating; her pulse is 100/min, and respirations are 20/min. The ECG is normal, except for some residual tachycardia. Which of the following is the most likely diagnosis? | This woman had a panic attack. These are common, affecting more than one third of the general population each year. The etiology appears to be a combination of both biological and psychological dysfunction. The sensations and physiologic changes can be very dramatic and, in addition to the features cited in the question stem, can include dizziness, fear of going crazy, feelings of unreality, chills, abdominal distress, palpitations, shoness of breath, and trembling or shaking. Many patients who experience a panic attack are concerned that they may have a dangerous hea, lung, or brain disorder. Although the diagnosis is fairly straightforward in a younger individual with no known serious disease, the diagnostic dilemma is more difficult in an older patient, who may potentially have a true disease of these organ systems. Whereas isolated panic attacks are common, less than 1% of the population has "panic disorder," characterized by frequent panic attacks, severe anticipation anxiety about recurrent attacks, and avoidance of places in which attacks had previously been experienced. Individuals with isolated panic attacks usually need no more therapy than reassurance; those with panic disorder may be helped with antidepressants, benzodiazepines, and behavior therapy.Angina and myocardial infarction would not be expected in a 25-year-old woman, and the ischemic changes would be apparent on the ECG. Heaburn can produce chest pain, but does not usually produce increased pulse and respiratory rate. Ref: Lee T.H. (2012). Chapter 12. Chest Discomfo. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. | 6,052 | medmcqa_train |
Lallo, 25 yr old man, presented with h/o of pain, redness & watering of left eye for last 1 day. There is also intolerance to light. Most probable diagnosis is- | Ans- B. | 6,053 | medmcqa_train |
Which of the following hormone is secreted by the kidney? | All hormones are produced from kidneyRef: Ganong&;s review of medical physiology; 24th edition; page no; 702 | 6,054 | medmcqa_train |
Treatment of whooping cough is : | Ans. is 'c' Erythromycin DOC for pertussis infection - ErythromycinDOC is one of the favorites of all paper setters. Below given list will be helpful to tackle these type of questions.Drug of choice for suspected or proved microbial pathogens (according to Harrison's 16th/e)Infective organismDrugs of choiceReferenceCommentsGram-Positive CocciPenicillinP.822AlternativeStaphylococcal inf.- Sensitive to penicillinNafcillin, cefazolin, Vancomycin- Sensitive to methicillinNafcillin or oxacillinP.822Cefazolin, Vancomycin- Resistant to methicillinVancomycinP.822TMP-SMX, Minocycline-Resistant to methicillin with intermediate or complete resistance to vancomycinUncertainP.822 * Streptococcal inf. Group A - PharyngitisBenzathine Penicillin GP.825 - ImpetigoBenzathine Penicillin GP.825 - Erysipelas/cellulitisSevere - Penicillin G mild to moderate - Procaine Penicillin GP.825 - Necrotizing Fascitis/myositisSurgical debridement + Penicillin G + ClindamycinP.825 - Pneumonia/empyemaPenicillin G + Drainage of empyemaP.825 - Streptococcal toxic shock syndromePenicillin G + Clindamycin + intravenous immunoglobulinP.825 Group BPenicillinP.829Penicillin is the t/t of choice for all group B streptococcal infectionGroup DEnterococci and non enterococcalCombination therapyIf penicillin allergicPenicillin or Ampicillin + Gentamycin Vancomycin in combination with GentamycinP.830Enterococci are resistant to all cephalosporins therefore this class of antibiotic should not be used for t/t of enterococcal infections.Viridans streptococciPenicillinP.831In neutropenic pts the t/t is first started with vancomycin (as they are often resistant to penicillin)* Streptococcus pneumoniaeFor otitis mediaAmoxicillin812,813Second line - Amoxicillin Third line - ceftriaxoneFor PneumococcalPneumoniaOral therapy - amoxicillin, quinolone eg. GatifloxacinParenteral - Penicillin, Ampicillin, therapy Ceftriaxone, cefotaxime, Quinolone * Streptococcus meningitis - Antibiotic susceptibility unknownT/t with ceftriaxone + vancomycin812, 813 - Susceptibility results availableSusceptible - Ceftriaxone Resistant - T/t with both ceftriaxone & Vancomycin - Life threating penicillin allergyT/t with imipenem Gram - negative Cocci * Meningococcus (Neisseria Meningitis)Penicillin for confirmed invasin meningococcal diseaseP.853Alternatives - Chloramphenicol, Meropenem* Moraxella CatarrhalisPenicillin/Clavulanic acid is highly appropriateP.863Alternatives - Cephalosporins (2nd or 3rd generation) Tetracyclines, Macrolides, Ketolide, Trimethoprim - Sulfamethoxazole* Gonococcal infectionCervix, urethra, pharynx RectumFirst line-Ceftriaxone, Ciprofloxacin ofloxacin861Alternative- Spectinomycin, Ceftizoxime, CefotetanGonococcal conjunctivitisCeftriaxone861 Ophthalmia neonatorumCeftriaxone861 Disseminated gonococcal infectionPatient tolerant of b lactam drugsCeftriaxone, Cefotaxime, Ceftizoxime Patient allergic to b lactam drugsCiprofloxacin, Ofloxacin, Spectinomycin Continuation therapyCiprofloxacin, Ofloxacin, Levofloxacin Gonorrhoeae EpididymitisCeftriaxone followed by doxycycline765 Gonococcal urethritisCefpodoxime or ceftriaxone or fluoroquinolones765 P1DORALRegimen A - Ofloxacin or levofloxacin Plus metronidazoleRegimen B - Ceftriaxone plus doxycycline plus metronidazolePARENTERALRegimen A - Cefotetan or cefoxitin plus GentamycinRegimen B - Clindamycin Plus gentamycin771 Gram-Positive bacilli:Ciprofloxacin or doxycycline +Rifampicin, penicillin or ChloramphenicolP. 710 Bacillus Anthrax ClostridiumGas gangrenePenicillin (i.v.) + clindamycinP.761 Clostridial sepsisPenicillin (i.v.) + ClindamycinP. 761 Suppurative deep tissue infectionsPenicillin (i.v.) + Gentamycin or third generation cephalosporinP. 761 Clostridium difficile (diarrhoea)Metronidazole and vancomycinP. 761use of vancomycin in first episodes is discouraged because of possible drug resistanceClostridium tetaniI.V. PenicillinP.841Some prefer metronidazoleDiphtheria (Respiratory)Erythromycin or Procaine penicillin834, 835Administration of diptheria antitoxin is the most important element in the t/t of respiratory diphtheriaListeria monocytogenesI.V. ampicillin or PenicillinP.839 Enteric Gram-negative bacilliCefotaxime, Ceftizoxime, Ceftriaxone ceftazidime, CefepimeFluoroquinolones, nitrofurantoinC.M.D.T. 2004 1487- 881. (37.1) Escherichia Coli SepsisUrinary infection Klebsiella infectionsCarbapenemsP.883Imipenem remain the most active antibiotic class against KlebsiellaSalmonellaCiprofloxacin, ceftriaxoneP.900Alternative-Azithromycin, ciprofloxacinShigellaIn developing countries In U.S.A.Nalidixic acid Ampicillin,Cotrimoxazole Ciprofloxacin, Azithromycin CefiximeP.906 CampylobacterErythromycinP.909 Yersinia pestis (Plague)StreptomycinP.925Gentamycin is considered as effectiveAlternative-Tetracycline & chloramphenicolOther Gram-Negative bacilliInitial t/t consists of cephalosporins such as Ceftriaxone or cefotaximeP.865Alternative - Penicillin + ChloramphenicolHaemophilus infectionsHaemophilus influenzae 'b' Haemophilus ducreyiThe recommended t/t is a single 1 gm oral dose of azithromycinP.867Alternative - Ceftriaxone ciprofloxacin, ErythromycinPertussisMacrolides Antibiotics - Erythromycin, clarithromycin, AzithromycinP.877Trimethoprim and sulfamethoxazole can be given to macrolide allergic patientsLegionellaNewer Macrolides - Azithromycin, clarithromycin, Respiratory Quinolones - levofloxacin, moxifloxacin GemifloxacinP.873 DonovanosisAzithromycin, Erythromycin, Tetracycline, DoxycyclineP. 933Azithromycin begin increasingly used as first choiceBrucellaMonotherapy - Streptomycin Dual therapy - Streptomycin & Tetracycline917, 916The gold standard is Ultra muscular streptomycin together with doxycyclineTularemiaStreptomycin (i.m.) for both adult & childrenP.921 Gardnerella VaginosisMetronidazoleP. 767 ChlamydiaChlamydia trachomatisAzithromycin1015-18Erythromycin is D.O.C. is pregnant womenChlamydia psittaci Chlamydia pneumoniaeTetracyclineErythromycin, Tetracycline, AzithromycinP. 1018Alternatives - FluoroquinolonesChlamydia urethritisAzithromycin or DoxycyclineP. 765 Rickettsial infections Rocky mountain spotted feverDoxycycline1001-02 Rickettsial PoxDoxycycline or Ciprofloxacin1001-02 Endemic typhusDoxycycline or Chloramphenicol1001-02 Epidemic typhusDoxycycline1001-02 Scrub typhusDoxycycline or Chloramphenicol1001-02 * Spirochetes P.983 Syphilis Primary, Secondary>> or early latentPenicillin G benzathine Late Latent cardiovascular or benign tertiaryNormal C.S.F. - Penicillin benzathine Abnormal C.S.F. T/T as neurosyphilis Neuro syphilisAqueous Penicillin G or Aqueous Penicillin G Procaine Syphilis in pregnancyAccording to stage LeptospirosisMild - Doxycycline, Ampicillin or AmoxicillinModerate/Severe - Penicillin G, Ampicillin,Amoxicillin, ErythromycinP.911 BorreliaRelapsing fever Lyme diseaseDoxycycline (or other tetracyclines) Erythromycin, ChloramphenicolP.995 Oral therapy - Adult - Doxycycline < 9 year AmoxicillinIntravenous therapy - Ceftriaxone Second choice - Amoxicillin Third choice - cefuroxime Second choice - Cefotaxime Third choice - Na PenicillinMycoplasmaErythromycin or doxycyclineCMDT 2004 P. 1489Alternatives - Clarithromycin Azithromycin, Fluoroquinolone Third generation cephalosporins or cefotaxime in the initial therapy as it also covers meningitis causing bacteriaActinomycetesActinomycosisNocardiaPenicillinP.939 Sulfonamides minocycline is an acceptable alternativeP.937Some believe that cotrimoxazole may be more effective but it poses a greater risk of hematological toxicityHelminthic infections * Cestodes H. NanaPraziquantelP. 1276 Taenia saginataPraziquantelP. 1273 Taenia SoliumPraziquantelP. 1274 * TrematodeSchistosomiasisPraziquantelP. 1271 Liver flukes Lung flukesPraziquantelPraziquantelP. 1271 * Nematodes (tissues) TrichinellaEnteric stage - Mebendazole & AlbendazoleP. 1254Trichinella larva in muscle (Drugs ineffective)* Intestinal Nematodes AscariasisAlbendazole, Mebendazole, Pyrantel Pamoate (used in Pregnant women)P. 1257 Hook wormAlbendazole, Mebendazole, Pyrantel PamoateP. 1258 StrongyloidiasisIvermectin,P. 1259Alternative - AlbendazoleTrichuriasis (Whipworm)Mebendazole or albendazoleP. 1259 Enterobiasis (Pinworm)Mebendazole, Albendazole, Pyrantel pamoateP. 1259 Extraintestinal Nematodes FilariaFilariasisTropical Pulmonary EosinophilaDiethyl carbimazole Diethyl carbimazoleP. 1262 P. 1263 OnchocerciasisIvermectin is the D.O.C.P. 1264 Dracunculiasis (Guinea worm)Metronidazole may relieve symptoms but has no proven activity against the wormP. 1265 Protozoal infections AmoebaAsymptomatic carrier Acute Colitis Amoebic liver abscessIodoquinol Paromomycin Metronidazole + Luminal agent MetronidazoleP. 1217 TrichomoniasisMetronidazoleP. 1252 GiardiasisMetronidazoleP. 1250 Toxoplasma infection Congenital infection Immunocompetent patients Immunocompromised patientsOral pyrimethamine and sulfadiazine usually do not require t/tTrimethoprim sulfamethoxazole (Alternative is dapsone - pyrimethamine)P. 1247 ANTIVIRAL Influenza A and B Prophylaxis TreatmentAmantadine or rimantadine Oseltamivir, Zanamivir, AmantadineP. 1028 t (162.1)Amantadine is used for influenza A onlyRSV InfectionRibavirin99 CMV-retinitis in immunocompromised host (AIDS)Ganciclovir Valganciclovir, Foscarnet, CidofovirVaricellaImmunocompetent host Immunocompromised hostAcyclovirAcyclovir" Herpes simplex EncephalitisAcyclovir" NeonatalAcyclovir GenitalPrimary (treatment) Recurrent (treatment)AcyclovirAcyclovir: KeratitisTrifluridineP. 10291 (162.1) Herpes zoster Immunocompromised host Immunocompetent hostAcyclovirValacyclovir>> Herpes zoster ophthalmicusAcyclovir" Condyloma acuminatumIFN-a2bIFN-a n3" Chronic hepatitis BIFN- a 2bLamivudineAdefovir Chronic hepatitis CIFN- a 2a or a 2b IFN- a 2b/ribavirin Pegylated-IFN- a 2b Pegylated-EFN- a 2b/ribavirin Pegylated-IFN- a 2a/ribavirin IFN ala conP. 10301 (162.1) Chronic hepatitis DIFN-a2a or -a2b" Antifungal"Intravenous amphotericin B is the drug of choice for the treatment of patient with disseminated histoplasmosis who are severely ill or immunosuppressed or whose infection involves the C.N.S."P. 1180 Histoplasmosis Acute pulmonaryNone" Chronic pulmonaryItraconazole"Alternatives - Amphotericin BDisseminated Immunocompetent patient less severeItraconazole Alternatives - Amphotericin BRapid progressive severe illness CNS involvement, HIV infectionAmphotericin B Alternatives - ItraconazoleCoccidioidomycosisPatients with ever or rapid progressive disseminated coccidioidomycosis are first given intravenous Amphotericin B patients whose condition improves or who have more indolent disseminated infection are given itraconazole1181-82 No risk factorsItraconazole or Fluconazole"Alternatives-ObservationRisk factors, severe illness, rapid progression or diffuse pulmonary infiltratesAmphotericin B Alternatives-Switch to Itraconazole or fluconazoleChronic dissemination (no CNS disease)Itraconazole or Fluconazole Alternatives-Amphotericin BMeningitisFluconazole"Alternatives-intrathecalAmphotericin BBlastomycosisI.V. Amphotericin B is the drug of choice for patients with rapidly progressive infections, severe illness or CNS lesions.1183-83 Rapid progressing or severe illnessAmphotericin B"Alternatives-Switch to nasale when condition stabilizeCNS diseaseAmphotericin B for 10-12 weeks Alternatives-Give fluconazole if patient improvesIndolent infectionItraconazole CryptococcosisDiseases in AIDS patientsAmphotericin BP. 1185Alternatives-itraconazoleDisease of Non AIDS patientsMeningitis - Amphotericin BPulmonary disease -Treatment immunosuppressed patients as for meningitis"Alternatives-Switch to fluconazoleAlternatives-itraconazoleCandidiasisCutaneousTopical Azole1187 VulvovaginalAzole cream or suppository or oral fluconazole"Alternatives-NystatinOropharyngealClotrimazole or fluconazole"Alternatives-NystatinEsophagealFluconazole tablet Alternatives-For azole Unresponsive diseaseDeeply invasiveNon neutropenic - Fluconazole or Amphotericin caspofungin Neutropenic - Amphotericin B AspergillosisFungus base of the lungSurgical resectionP. 1189Alternatives-Bead embolization for hemoptysisAllergic bronchopulmonary aspergillosisShort course of Glucocorticoids Alternatives-itraconazole prophylaxisInvasive aspergillosisVoriconazole liposomal or conventional Amphotericin B Alternatives-Amphotericin B colloidal dispersion or lipid complex itraconazole or caspofunginMucormycosisIntravenous amphotericin B is usefulP. 1190 Pityriasis versicolorAzole creams, Application of Selenium itraconazole is also effectiveP. 1192 SporotrichosisItraconazole is the drug of choiceP. 1193 MycetomaActinomycetomaEumycetomaStreptomycin Dapsone and Cotrimoxazole Rarely responds to chemotherapyP. 1192 PneumocystosisPneumocystis cariniiTrimethoprim, SulfamethoxazoleP. 1195These are D.O.C. for all forms of Pneumocystosis | 6,055 | medmcqa_train |
Which is false regarding HCG? | Ref: Text book of Obstetrics by D. C.Dutta. 7th, ed. Pg. 58Explanation:Human chorionic Gonadotrophin (HCG)HCG is a glycoprotein, it consists of a and b subunits, a subunit of HCG is biochemically similar to LH.FSH and TSH.HCG is synthesized by syncitiotrophoblast.Half life of HCG is 24 hrs and Doubling time is 1.4 to 2 daysHCG is responsible for rescue and maintenance of corpus luteum till 6 wk of pregnancy.Maximum level is reached between 60 to 70 days of pregnancy.High levels of HCG are seen inMultiple pregnancyHydatidifom moleChoriocarcinomaDown's syndrome fetusREMEMBER:Protein hormones produced by placenta are:HCGHuman placental lactogenPAPP-A (pregnancy associated placental protein A)Steroid hormones produced by placenta areEstrogenProgesterone | 6,056 | medmcqa_train |
Which of the following anticancer drug can result in "disulfiram reaction" | Procarbazine is a type of alkylating agent which can result in "Disulfiram reaction". Other side effects include cheese reaction, serotonin syndrome, behavioral and personality changes. | 6,057 | medmcqa_train |
All are branches of coeliac trunk except: | Ans. D. Right gastric arteryThe celiac trunk is the first major branch of the abdominal aorta. It is 1.25 cm in length. Branching from the aorta opposite disc between T12 & L1, it is one of three anterior branches of the abdominal aorta (the others^ are the superior and inferior mesenteric arteries).The three main branches of the celiac artery are left gastric artery, splenic artery & common hepatic artery | 6,058 | medmcqa_train |
In a patient with cervical disc prolapse the management includes | (C) Immediate surgery to prevent neurological complications # Cervical disc prolapse the management includes:> Heat and analgesics are soothing but, as with lumbar disc prolapse, there are only three satisfactory ways of treating the prolapse itself.> Rest: A collar will prevent unguarded movement; it may be made of felt, sponge-rubber or plastic. It seldom needs to be worn for more than a week or two.> Reduce: Traction may enlarge the disc space, permitting the prolapse to subside. The head of the couch is raised and weights (up to 8 kg) are tied to a harness fitting under the chin and occiput. Traction is applied intermittently for no more than 30 minutes at a time.> Remove: If symptoms are refractory and severe enough, if there is a progressive neurological deficit or if there are signs of an acute myelopathy then surgery is indicated The disc may be removed through an anterior approach; bone grafts are inserted to fuse the affected area and to restore the normal intervertebral height. If only one level is affected, and there is no bony encroachment on the intervertebral foramen, anterior decompression can be expected to give good long-term relief from radicular symptoms. | 6,059 | medmcqa_train |
Which one of the following does not represent the submerged portion of the iceberg? | Ans. (a) Diagnosed cases under treatment* Iceberg Phenomenon of disease: Disease in a community may be compared to an iceberg- Floating tip is what physician sees in community, i.e., clinical cases- Vast submerged portion of iceberg represents hidden mass of disease i.e., latent, inapparent, pre-symptomatic and undiagnosed cases and carriers in community- Line of demarcation (water surface): Is between apparent and inapparent infections- Water surrounding iceberg: Healthy populationALSO REMEMBER* 'Epidemiologist is concerned with Hidden portion of iceberg' whereas Clinician is concerned with Tip of iceberg* 'Screening is done for Hidden portion of Iceberg' whereas diagnosis is done for tip of iceberg* Iceberg phenomenon of disease is not shown by:- Rabies- Tetanus- Measles- Rubella | 6,060 | medmcqa_train |
Insulin causes ? | Ans. is 'c' i.e., Induction of lipogenesis ACTIONS OF INSULIN Insulin affects the metabolism of carbohydrates, lipids and proteins. Effects on carbohydrate metabolism The overall effect of insulin is to decrease blood glucose level. Insulin increases the utilization of glucose and decreases its production by its following actions : - i) Stimulation of oxidation of glucose by glycolysis especially in the liver and skeletal muscle. ii) Stimulation of glycogenesis i.e., insulin ours conversion of glucose into its storage form, glycogen. This action is seen in both liver and muscles. iii) Inhibition of gluconeogenesis. Insulin stimulates the uptake of glucose by myocytes (skeletal muscle, cardiac muscles), adipocytes (adipose tissue) and hepatocytes. Tissues that do not depend on insulin for glucose uptake include brain, erythrocytes (RBC), the epithelial cells of kidney & intestine, Liver, and Cornea & lens of eye. The mechanism through which insulin increases glucose uptake is different in different tissues. In the muscle and adipose tissues, insulin increase facilitated diffusion by increasing glucose transpoer (GLUT4 ) on the cell membrane. In the liver, insulin stimulates glucose entry into hepatocytes indirectly by induction of glucokinase so that the glucose entering the liver cells is promptly conveed to glucose - 6 - phosphate (glucose trapping). This keeps the intracellular glucose concentration low and ours entry of glucose into the liver. Thus, though the liver do not depend on insulin for glucose uptake, insulin stimulates glucose entry into hepatocytes. That means glucose entery can occur in liver without the action of insulin, but this is facilitated by insulin. On the other hand, myocytes (skeletal and cardiac muslces) and adipocytes (adipose tissue) are dependent on insulin for glucose uptake. Increased uptake of glucose in the glucose has following effects :- i) T Glycolysis :- It is due to induction of key enzymes of glycolysis by insulin. These key enzymes are glucokinase, phosphofructokinase and pyruvate kinase. ii) Increased glycogen synthesis (glycogenesis) :- It is due to induction of glycogen synthase. iii) Decreased glycogen break-down (Glycogenolysis) : - It is due to inhibition of enzyme phosphorylase. iv) Decreased gluconeogenesis :- It is due to inhibition of enzymes Pyruvate carboxylase, PEP carboxykinase, fructose 1, 6-bisphosphatase, glucose - 6 - phosphates. Effects on lipid metabolism Insulin induces lipogenesis by inducing enzyme acetyl CoA carboxylase, the rate limiting enzyme in fatty acid synthesis. Triglyceride synthesis is increased by induction of lipoprotein lipase. Lipolysis (13-oxidation) is decreased due to inhibition of hormone sensitive lipase, so that the fat in the adipose tissue is not broken down. Thus free fatty acid and glycerol are decreased. Because of antilipolytic action insulin decreases ketogenesis. There are two impoant lipases : - i) Lipoprotein lipase : - It hydrolysis the triglycerides of chylomicrons and VLDL into free fatty acid and glycerol in the vessels of skeletal muscles, cardiac muscles and adipose tissue. There FFA is taken up by the cells of these tissue and is conveed back into the triglyceride and the FFA is stored as triglyceride. So, lipoprotein lipase is involved in the synthesis of triglyceride. Lipoprotein lipase is stimulated by insulin, therefore insulin stimulates triglyceride synthesis. ii) Hormone sensitive lipase : - It is involved in lipolysis and cause degradation of stored triglyceride of adipose tissue into FFA and glycerol. FFA comes out into the blood raising the FFA levels of blood. Insulin inhibits hormone sensitive lipase therefore decreases FFA levels of blood. Effects on protein metabolism Insulin stimulates synthesis of protein (anabolism) and inhibits protein breakdown (catabolism). Insulin increases the active transpo of many amino acids into the tissue. In addition insulin increases protein synthesis by increasing the rate of synthesis of mRNA. | 6,061 | medmcqa_train |
Which of the following is best diagnosis of this neonate who is excessively hungry, warm with flushed skin? | Ans. (a) Neonatal thyrotoxicosis.Notice the lid retraction and presence of stare sign. This coupled with history proves that the child has increased sympathetic drive and increased BMR. This is caused by transfer of thyroid stimulating immunoglobulin across the placenta. Image source .. style="font-size: 1.04761904761905em; color: rgba(0, 0, 0, 1); font-family: Times New Roman, Times, serif; margin: 0 0 0 8px; text-indent: 0"> | 6,062 | medmcqa_train |
Colorado tick fever is the only known human infection caused by | Coltiviruses form another species within the Reoviridae. The virus paicle is 80 nm in diameter with a genome consisting of 12 segments of double-stranded RNA, totaling about 29 kbp. Colorado tick fever virus, transmitted by ticks, is able to infect humans.Reference:Jawetz, Melnick, & Adelberg's Medical Microbiology; 27th edition; Chapter 37; Reoviruses, Rotaviruses, and Caliciviruses | 6,063 | medmcqa_train |
Number of t-RNA present in cells is | The number of tRNAs in most cells is more than the number of amino acids used in protein synthesis (20) and also differs from the number of amino acid codons in the genetic code (61)Ref: DM Vasudevan, 7th edition, page no: 596, 597 | 6,064 | medmcqa_train |
Which of the following characteristics is not of much impoance in a screening test- | ref: ref: Park&;s 23rd edition pg 137 Screening test must satisfy the criteria of acceptability, repeatablity and validity, desides others like yield, simplicity, safety, rapidity, ease of administration and cost. Specificity: defined as the ability of a test to correctly identify those who do not have the diesase, that is "true negatives". A screening test need not have high specificity. | 6,065 | medmcqa_train |
A 50 year old female presents to the OPD with shoness of breath. On examination she is hypotensive, has soft hea sounds and elevated JVP. Her ECG shows reduction in the amplitude of QRS complexes. Which of the following is the investigation of choice for diagnosing her condition? | Patient in the question is showing features of cardiac tamponade. 2D echo is the investigation of choice in diagnosing tamponade. It shows reduced right ventricular cavity diameter and collapse of right ventricular free wall and right atrium. M - mode echocardiography is used to study valvular functions. Ref: Harrison's Principles of Internal Medicine 18e chapter 239. | 6,066 | medmcqa_train |
Not a posterior mediastinal tumor : | Ans is 'c' ie Thymoma Mediastinum- is situated b/w the lungs in the center of the thorax.It is divided into 3 compartmentsAnterior or Anterosuperior it lies in front of the anterior pericardium & tracheaMiddle mediastinum or Visceral compartment it lies within the pericardial cavity including the tracheaPosterior mediastinum or paravertebral sulci it lies posterior to the post pericardium & tracheaLocations of the common Mediastinal MassesAnterior mediastinumMiddle MediastinumPost. MediastinumThymoma (most common in Ant med.)LymphomaGerm cell tumorsMesenchymal tumorsThyroid & parathyroid massesThymic cystCysts (MC in Mid. Med.)pleuropericardialbronchogenicenterogenousneuroentericVascular masses (aneurysm)Lymph node enlargement (including lymphoma)Mesenchymal tumorsPheochromocytomaMC tumor in middle Mediastinum- LymphomaNeurogenic tumors (MC overall)MeningoceleGastroenteric cystMesenchymal tumorsPheochromocytomaLymphoma | 6,067 | medmcqa_train |
A 35-year-old woman develops an itchy rash over her back, legs, and trunk several hours after swimming in a lake. Erythematous, edematous papules are noted. The wheals vary in size. There are no mucosal lesions and no swelling of the lips. The most likely diagnosis is | (a) Source: (Braunwald, 15/e, pp 318, 323, 822, 1061, 1917-1918.) Urticaria, or hives, is a common dermatologic problem characterized by pruritic, edematous papules and plaques that vary in size and come and go, often within hours. Mast cells may be stimulated by heat, cold, pressure, water, or exercise. Immunologic mechanisms can also cause mast cell degranulation. Folliculitis caused by Pseudomonas aeruginosa can cause a rash, often after exposure to hot tubs. The lesions would not be as diffuse, with a line of demarcation depending on the water level. These lesions are pustular and occur 8 to 48 h after soaking. Erythema multiforme produces target-like lesions and oral blisters often secondary to medications. Erythema chronicum migrans usually presents with a large, solitary annular lesion. | 6,068 | medmcqa_train |
Alpha-1- antitrypsin deficiency presents as? | Ans. (a) EmphysemaRef: Robbins 8thEdn /684y 685, Harrison 18,hed chapter 309, Nelson Textbook of Pediatrics, 18th ed chapter 390 | 6,069 | medmcqa_train |
A 35-year-old male presents with bald patches and with no scars. The patches are well demarcated with broken hair at the edges. Diagnosis is: | Ans. a. Alopecia areataAlopecia areata is a form of non-scarring alopecia with the edges showing coudability sign and exclamation hairsAndrogenic alopecia presents with diffuse involvement of frontotemporal regions and vertex, sparing occiputTelogen effluvium presents with diffuse involvement of scalp, with a history of a precipitating factor 3-4 months earlier, e.g. severe febrile illness, crash dieting, mental stress etc. | 6,070 | medmcqa_train |
Several antiviral compounds have been developed during the last decade. One such compound is ribavirin, a synthetic nucleoside structurally related to guanosine. Ribavirin therapy has been successfully used against | Ribavirin is effective to varying degrees against several RNA- and DNA-containing viruses in vitro. It has been approved for aerosol treatment of respiratory syncytial virus infections in infants. Intravenous administration has proved effective in treating Lassa fever. | 6,071 | medmcqa_train |
Commonest site for extranodal lymphoma is | Ans. (b) Stomach(Ref: Wintrobe's 12th/pg 2177)Commonest site for extranodal lymphoma is StomachGastrointestinal tract is the most common site for extranodal NHL (10 to 15% of all NHL).Stomach accounts for 50% of gastrointestinal lymphomas | 6,072 | medmcqa_train |
Enlargement of pituitary tumor after adrenalectomy is called as? | ANSWER: (A) Nelson s syndromeREF: Schwartzs Principles of Surgery 9th edition chapter 38. Thyroid, Parathyroid, and Adrenal "Nelson's syndrome is the rapid enlargement of a pituitary adenoma that occurs after the removal of both adrenal glands"Approximately 30% of patients who undergo bilateral adrenalectomy for Cushings disease are at risk of developing Nelson s syndromefrom progressive growth of the pre-existing pituitary tumor. This leads to increased ACTH levels, hyperpigmentation, visual field defects, headaches, and extraocular muscle palsies. | 6,073 | medmcqa_train |
Drug not used for Pseudomembranous colitis | All except streptogramins are used. Drug of choice for pseudomembranous colitis is metronidazole,in resistant cases vancomycin given orally. Fidaxomycin is newer class of macrolide type of antibiotic used specially for PMC Ref:KDT 6/e p799 | 6,074 | medmcqa_train |
False about xenon anesthesia | It has been shown that, compared to other anesthetic regimens, Xenon anesthesia produces the highest regional blood flow in the brain, liver, kidney and intestine. In conclusion, the most impoant positive effectsof Xenon are cardiovascular stability, cerebral protection and ourable pharmacokinetics. Ref ganong's review of medical physiology 25e 976 | 6,075 | medmcqa_train |
Which of the following is the most common congenital cardiac defect? | VSD is the most common congenital hea diseaseTOF is the commonest cyanotic congenital hea disease(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2194 - 2195) | 6,076 | medmcqa_train |
All of the following are Light's criteria for exudative I pleural effusion: | Answer is D (Pleural fluid ADA and Serum ADA <16): Ratio of Pleural fluid ADA and Serum ADA <16 is not pa of Light's Criteria. Light's criteria, rely on a comparison of the chemistries in the pleural fluid to those in the blood, to establish the cause of the effusion as transudate or exudates. According to Light's criteria a pleural effusion is likely exudative if at least one of the following exists The ratio of pleural fluid protein to serum protein is greater than 0.5 The ratio of pleural fluid LDH and serum LDH is greater than 0.6 Pleural fluid LDH is greater than 0.6 or Y3 times the normal upper limit for serum. Note: Exudative Pleural Effusions meet at least one of the above criteria while transudative effusions meet None These criteria misidentify around 25 percent of transudates as exudates | 6,077 | medmcqa_train |
Pulsus bisiferiens is seen in all, except - | pulsus bisferiens, , is a sign where, on palpation of the pulse, a double peak per cardiac cycle can be appreciated. Bisferious means striking twice. Classically, it is detected when aoic insufficiency exists in association with aoic stenosis, but may also be found in isolated but severe aoic insufficiency and hyperophic obstructive cardiomyopathy. Normally, aerial pulses are best felt in radial aeries but character is better assessed in carotid aery. Pulsus bisferiens is best felt in brachial and femoral aeries. Ref Harrison 20th edition pg 1432 | 6,078 | medmcqa_train |
WHO defi nes adolescent age between - | Ans. is 'a' i.e., 10-19 years o Adolescence is usually the period 10 to 20 yr. | 6,079 | medmcqa_train |
All of the following can be administrated in acute hypertension during labour EXCEPT | Nitroprusside can cause severe hypotension. It is powerful arteriolar and venodilator. It is contraindicated in eclampsia. | 6,080 | medmcqa_train |
Difference between neurosis and psychosis is | B i.e. Insight | 6,081 | medmcqa_train |
Which of the following is / are autoimmune disease: | Rheumatoid arthritis is reported in about 15 percent cases of Sjogren’s syndrome. | 6,082 | medmcqa_train |
Fatty change is seen in? | * Fatty change is particularly common in the liver but may occur in other non - fatty tissues as well e.g. in the heart, skeletal muscle, kidneys (lipoid nephrosis or minimum change disease) and other organs.* Fatty change, steatosis or fatty metamorphosis is the intracellular accumulation of neutral fat within parenchymal cells.* It includes, now abandoned, terms of fatty degeneration and fatty infiltration because fatty change neither necessarily involves degeneration nor an infiltration. The deposit is in the cytosol and represents and absolute increase in the intracellular lipids. | 6,083 | medmcqa_train |
All are structures passing between base of skull and superior constrictor except (Repeat Q 2008 ) | Ans: a (Glossopharyngeal nerve) Ref: Chaurasia 4th ed pg 223 fig. 14.18, pg 225The structures passing between the superior constrictor and the base of skull (sinus of morgagni):A-L-A-auditory tubelevator veli palateascending palatine artery"Auditory tube is about 3.6 cm long and is divided into an outer bony part which is 12 mm long and an inner cartilagenous part which is 24 mm long.The levator veli palati is attatched to its inferior surface. Ascending palatine artery is a branch of facial artery"Also note:Structures passing through the superior orbital fissureupper part:middle part:R/c meningeal branch of the ophthalmic artery lacrimal nerve frontal nerve superior ophthalmic vein trochlear nerve lower part:inferior ophthalmic veinoculomotor nerve naso ciliary nerve abducent nerveThe structures passing between superior and middle constrictors-stylopharyngeusglossopharyngeal nerveBetween middle and inferior constrictors:internal laryngeal nerve-Superior laryngeal vesselsBetween lower border of inferior constrictor and esophagusRecurrent laryngeal nerveInferior laryngeal vessels | 6,084 | medmcqa_train |
A 45 year old male presented with palpitations, tachycardia & anxiety. His BP is 158/90 mmHg. The patient also has mild depression and is presently taking citalopram, labetalol & amlodipine to control his blood pressure. 24-hour urine total metanephrines are ordered and show an elevation of 1.5 times the upper limit of normal. What is the next best step? | Investigations done in pheochromocytoma 24 hour urinary fractionated metanephrine 24 hour urinary catecholamines 24 hour urinary vanillylmandelic acid level IOC- Plasma fractionated metanephrine levels 24-hour urine total metanephrines has high sensitivity & value of three times the upper limit of normal is highly suggestive of pheochromocytoma. Borderline elevation- likely to be false positives. Drugs related- include levodopa, sympathomimetics, diuretics, TCA, and a- and b-blockers (Labetalol) Therefore, hold labetalol for 1 week and repeat testing is the best next step | 6,085 | medmcqa_train |
Area number for Motor area include | 4 & 6 {Description: Bradman's areas of Cerebral cortex) | 6,086 | medmcqa_train |
First sound by child is: | Most children are able to produce the bilabial sounds (made with the lips) of “b, p, m, w” first, since these are sounds visible on the lips.
They may also produce sounds (linguo-alveolar) such as “d, n, t” early on as well.
These sounds are called linguo-alveolar, since they are produced with the tongue behind the teeth against the alveolar ridge in the mouth. | 6,087 | medmcqa_train |
Function of coenzyme is to | Enzymes may be simple proteins , or complex enzymes, containing a non -protein pa, called the prosthetic group. The prosthetic group is called the co-enzyme.It is heat stable. The protein pa is named as apoenzyme.It is heat labile.The two poions combined together are called the HOLOENZYME. First group of co-enzymes: In the first group , the change occuring in the substrate is counter balanced by the co-enzymes.Therefore,such co-enzymes may be called as co-substrates or secondary substrates. These takes pa in reactions catalyzed by oxido-reductases by donating or accepting hydrogen atoms or electrons. Second group of coenzymes : These coenzymes take pa in reactions transferring groups other than hydrogen. A paicular group or radical is transferred from the substrate to another substrate. REFERENCE :DM VASUDEVAN TEXTBOOK EIGHTH EDITION , Page no :54 | 6,088 | medmcqa_train |
Auto antibody in Sjogrens syndrome is? | Robbins basic pathology 9th edition page no 131,(green box=Pathogenesis) Most patients with primary sjogren syndrome have auto antibodies to the ribo-nucleoprotien (RNP) antigensSS-A(RO) and SS-B(la). | 6,089 | medmcqa_train |
An 85-year old male cigar smoker with no notable medical history presented with black discoloration and hairy appearance ofthe tongue, which had lasted several years. He said he did not use bismuth- containing compounds. This condition could be treated with all of the following except - | Treatment is by reassurance, as the condition is benign, and then by correction of any predisposing factors.This may be cessation of smoking or cessation/substitution of implicated medications or mouthwashes, applying topical retinoids. Generally direct measures to return the tongue to its normal appearance involve improving oral hygiene, especially scraping or brushing the tongue before sleep.This promotes desquamation of the hyperparakeratotic papillae.Keratolytic agents (chemicals to remove keratin) such as podophyllin are successful, but carry safety concerns. Other repoed successful measures include sodium bicarbonate mouthrinses, eating pineapple, sucking on a peach stone and chewing gum Ref Davidson 23rd edition pg 714 | 6,090 | medmcqa_train |
Politzer bag maneuver used to test: | Politzer bag maneuver used to test Eustachian tube Designed for those who can`t perform Valsalva test Politzer bag is connected to rubber tube- Tube is placed in one nostril and other is closed-Air is blown with pressure by pressing the bulb-Air enters nasopharynx - opens eustachian tube & enters middle ear- pops out TM | 6,091 | medmcqa_train |
Poisoning by irritants may be mistaken for : | C i.e. Gastroenteritis | 6,092 | medmcqa_train |
Argon laser trabeculoplasty is done in: | In Argon Laser Trabeculoplasty (ALT) Laser beam is focused on trabecular meshwork Opens up the pores of trabecular meshwork. So that more Aqueous can flow through it in faster time Lowers Intra ocular pressure Typically done in open angle glaucoma Trabecular meshwork After ALT | 6,093 | medmcqa_train |
PANDAS are associated with which of the following infection? | PANDAS is sho for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. A child may be diagnosed with PANDAS when: Obsessive-compulsive disorder (OCD), tic disorder, or both suddenly appear following a streptococcal (strep) infection, such as strep throat or scarlet fever. Reference: GHAI Essential pediatrics, 8th edition | 6,094 | medmcqa_train |
Which of the following is absolutely essential for wound healing | refrobbins 7/e p 114;9/e p106 synthesis of collagen. It is also a highly effective antioxidant protecting cells from damage by free radicals. Studies have shown that the vitamin can help speed thehealing process of wounds. | 6,095 | medmcqa_train |
Binocular single vision is tested by ? | Ans. is 'b' i.e., Synoptophore Grades of binocular single vision There are three grades of binocular single vision, which are best tested with the help of a synoptophore. 1. Grade-I - Simultaneous perception It is the power to see two dissimilar objects stimultaneously. It is tested by projecting two dissimilar objects (which can be joined or superimposed to form a complete picture) in front of the two eyes. For example, when a picture of a bird is projected onto the right eye and that of a cage onto the left eye, an individual with presence of simultaneous perception will see the bird in the cage. 2. Grade-II - Fusion It consists of the power to superimpose two incomplete but similar images to from one complete image. The ability of the subject to continue to see one complete picture when his eyes are made to converge or diverge a few degrees, gives the positive and negative fusion range, respectively. 3. Grade-III - Stereopsis It consists of the ability to perceive the third dimension (depth perception). It can be tested with stereopsis slides in synoptophore. | 6,096 | medmcqa_train |
Final centre for horizontal movement of eye is: | Ans. Abducent nucleus | 6,097 | medmcqa_train |
ACRTI-RADS scan for thyroid nodule characteristics include all except: | Ans: (c) VascularityColl Radiol 2017 May, 14(5), Page 587-595ACR TI-RADS is a reporting system for thyroid nodules on ultrasound proposed by the American College of Radiology.It is based on the following characteristic of the lesion:CompositionEchogenicityShapeMarginEchogenic fociRecommendationsTR1: No FNAC requiredTR2: No FNAC requiredTR3: >=1.5 cm follow up, >=2.5 cm FNACFollow up: 1, 3 and 5 yearsTR4: >=1.0 cm follow up, >=1.5 cm FNACFollow up: 1,2,3 and 5 yearsTR5: >=0.5 cm follow up, >=1.0 cm FNACAnnual follow up for up to 5 years | 6,098 | medmcqa_train |
For cephalometric projection, what should be the distance between source and the subject? | Distance between source and the subject = 5 feet.
Distance between film and the subject = 15 cm. | 6,099 | medmcqa_train |
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