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Which of the following drug is an inverse agonist at H3 receptors used for Narcolepsy?
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Pitolisant (Tiprolisant) is a inverse agonist of H3 receptors approved for Narcolepsy. H3 receptors are presynaptic receptors and inverse agonist will lead to increased histamine release and promote wakefulness.
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Not true regarding Pectus excavatum?
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Ans DIn pectus excavatum the heart is shifted towards left side. As right heart border goes behind the sternum it is obscured and can thus mimic right middle lobe disease.
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Whip-lash' injury is caused due to
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B i.e. Acute hyperextension of the spine
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How to differentiate between staphylococci and micrococci?
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Micrococci:Micrococci are gram-positive cocci which occur mostly in pairs, tetrads or irregular clusters. They are catalase and modified oxidase positive and aerobic. They are ordinarily non-pathogenic. The resemble Staphylococci, but in general, they are large in size and tetrads. The common laboratory test used to differentiate between micrococci and staphylococci is modified oxidase test.Ref: Ananthanarayan 9th edition, p206
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Following are the factors for increased risk of wound infection EXCEPT
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Ans. (b) Good Blood Supply(Ref. Surgery Sixer 3rd Edition Page 33)Systemic Factors causing non healing of Wound:* Diabetes* Radiation* Extremes of age* Hypothermia* Hypoxemia* Hypocholesterolemia* Hyperglycemia (Even if transit)* Malnutrition* Vitamin C and A deficiency* Zinc and Iron deficiency* Drugs: Steroids and Doxorubicin* Jaundice, Uremia and Malignancy* Immunosuppressed State
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Therapeutic aboion was accepted by
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Ans. is 'b' i.e., Declaration of Oslo (1970)
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Which of the following is the Post - Chemotherapy based staging system used in Wilm's tumor?
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International Society of Pediatric Oncology-SIOP staging system is the post - chemotherapy based staging system used in Wilm'stumor. Protocol of SIOP consists of initial clinical staging by physical examination, radiologic examination and neoadjuvant chemotherapy. The tumor burden is reduced by preoperative chemotherapy, facilitating resection of the tumor and reducing the total amount of postoperative chemotherapy and radiotherapy. Ref: Pediatric Oncology (Surgical and Medical Aspects) By Devendra K. Gupta, Page 628
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Which of the following is TRUE regarding Neisseria meningitidis infection?
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For children >3 months old, the most common organisms are S. pneumoniae, Neisseria meningitidis, and Staphylococcus aureus, with a lower incidence of S. pneumoniae meningitis since routine vaccinations with the conjugate vaccine. Penicillin has long been the treatment of choice for meningococcal infections and sulfonamides are used only for chemoprophylaxis because of resistance. Serogroup A epidemics have been largely confined to tropical countries. Both MCV4 and MPSV4 can be given to individuals who are immunosuppressed. Ref: Ray C.G., Ryan K.J. (2010). Chapter 30. Neisseria. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
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All are true about Retained Antrum Syndrome except:
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Ans. (c) Positive Secretin Stimulation testRef: Internet SourcesRetained Antrum Syndrome:* A complication following Billroth 2 Reconstruction, in which part of antrum and pylorus is left along with the duodenum.* Characterized by excess secretion of Gastrin from retained antrum exposed to alkaline medium in Duodenum and hence continuous stimulus goes on for Gastrin from G cells in retained Antrum.* Increased Gastrin produces recurrent ulcer.* Billroth 1 operation will not have such complications.* Serum Gastrin levels increases to the extent of Zollinger Ellison Syndrome, the only way to differentiate from ZES is by Secretin Stimulation test will not cause increase in Gastrin in Retained Antrum Syndrome as seen in ZES.* The disease may respond to PPI, but definitive treatment is re resection of retained antrum.* Tc 99m Scan is the IOC to detect the retained Antrum* Secretin Stimulation test is positive for ZES but negative for Retained Antrum Syndrome.* Similarly, there is Calcium Provocation test is also positive only for ZES and negative for all other cases of Hypergastrinemia like Retained Antrum Syndrome, Gastric Outlet Obstruction and Chronic Renal failures.
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Most common adverse effect of colchicine -
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Ans. is 'a' i.e., diarrhoea "Nausea, vomiting, diarrhea and abdominal pain are the most common untoward effects of colchicine". - Goodman & Gilman
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Soft tick transmits:
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Among the given options soft tick transmits relapsing fever while the KFD, tularemia and Indian tick typhus are transmitted by hard ticks. Ref: Park Textbook of Preventive and Social Medicine, 19th Edition, Pages 622-23, 634-35
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Diagnosis of ABO incompatiability can be from all of the following except?
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Ans (d) CSF Ref Reddy , p 378 ABO group specific substances are found in high concentration in saliva, semen, vaginal secretion and gastric juice while in low concentration in sweat, tears and urine, so it is possible to determine blood group from an examination of these secretions. So for this question it can be said that, they are present in all tissues except CSF.
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A chronic alcoholic has an elevated serum alpha fetoprotein levels. Which of the following neoplasms is most likely -
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Elevated levels of serum α-fetoprotein are found in 50 to 75% of patients with HCC.
False-positive results are encountered with yolk-sac tumors and many non-neoplastic conditions, including cirrhosis, massive liver necrosis, chronic hepatitis, normal pregnancy, fetal distress or death, and fetal neural tube defects such as anencephaly and spina bifida.
Concept
The staining for Glypican-3 is used to distinguish early hepatocellular carcinoma from a dysplastic nodule. Other tests cannot be used because the levels of serum α-fetoprotein are inconclusive in this condition.
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Eaton agent is -
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Ans. is 'b' i.e., Mycoplasma pneumoniae
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True about primary angle closure glaucoma –a) More common in femalesb) Shallow anterior chamber is a risk factorc) Deep anterior chamber is a risk factord) Shorter diameter of cornea is a predisposing factore) Common in myopes
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PACG is more common in females.
Shallow anterior chamber, small diameter of cornea and hypermetropic eye (not myopia) are risk factors.
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Typically bilateral inferior subluxations of the lens is seen in –
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In Homocystinuria there is inferomedial (inferonasal) dislocation of lens.
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Treatment of severe intraoral infections in children
differs from that in adult because:
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Treatment of severe intraoral infections in children differs from that in adult because dehydration occurs more rapidly and severely in children.
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An 80-year-old patient presents with a midline tumor of the lower jaw, involving the alveolar margin. He is edentulous. Treatment of choice is:
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Mandibulectomy Marginal mandibulectomy Segmental mandibulectomy - Conservative mandibulectomy - Refers to paial excision of the superior poion of mandible in veical phase - Inner coical surface and a poion of underlying medullary cavity is excised - Preserve mandibular continuity - Indicated when tumor lies within I cm of the mandible or abuts the periosteum without evidence of direct bony invasion - Entire through and through segment of mandible is resected - Results in mandibular discontinuity - Require major reconstructive procedure for cosmetic and functional purposes - Indications: 1. Invasion of medullary space of mandible 2. Tumor fixation to occlusal surface of mandible in edentulous patients 3. Invasion of tumor into the mandible mandibular or mental foramen 4. Tumor fixed to the mandible.
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Which of the following is not sexually transmitted-
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Bacterial Diseases transmitted with sexual intercourse Neisseria gonorrhoeae Chlamydia trachomatis Treponema pallidum Haemophilus ducreyi Note the list does not include Haemophilus Vaginalis, the cause of bacterial vaginosis Viruses transmitted by sexual intercourse HIV (types 1 and 2) Human T-cell lymphotropic virus type I(HTLV) HSV type 2 HPV (multiple genotypes) Other infections like Trichomoniasis( Protozoal) , Candida and Phthirus pubis
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Which one of the following congenital heart diseases has cyanosis without cardiomegaly and/or congestive heart failure –
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Cardiomegaly and CHF do not occur in Fallot's tetrology.
No Cardiomegaly
First you should know the following facts : -
Pressure overload to ventricles causes concentric hypertrophy without dilatation.
Volume overload to ventricles causes hypertrophy with dilatation → Eccentric hypertrophy.
Due to pulmonary stenosis, there is pressure overload to right ventricle → Concentric hypertrophy of right ventricle without dilatation → No Cardiomegaly.
No CHF
The VSD of TOF is always large enough to allow free exit to the right to left shunt.
Since the right ventricle is effectively decompressed by the VSD, CHF never occurs in TOF.
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Which drug can be given in G6PD deficiency?
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Chloroquine rarely cause hemolysis in patients with G6PD deficiency. Drugs initiate hemolysis and should be avoided: Dapsone Methylthioninium chloride (methylene blue) Phenazopyridine Primaquine Rasburicase Tolonium chloride (toluidine blue) Nitrofurantoin, sulfonamides Aspirin, nonsteroidal anti-inflammatory drugs Quinidine Naphthalene Attacks can also be associated with infections (such as pneumonia, viral hepatitis, and Salmonella) and diabetic ketoacidosis. Finally, foods such as a beans have been implicated. Ref: Linker C.A., Damon L.E., Damon L.E., Andreadis C. (2013). Chapter 13. Blood Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow, T.G. Berger (Eds), CURRENT Medical Diagnosis & Treatment 2014.
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Which of the following is responsible for protection from ultraviolet rays: September 2011
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Ans. D: Melanocyte Structure involved in protection against ultraviolet radiation is melanin produced by melanocytes and transferred to keratinocytes
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All are useful in acute appendicitis except:
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Ans: d (Purgation)Ref: Bailey & Love, 24,hed, p. 1211 &23rded, p. 1085
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Prussak's space is seen in ?
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Ans. is 'a' i.e., EpitympanumPrussak's space is a small space between the shrapnel's membrane/pars flaccida laterally. neck of malleus medially, sho process of malleus below and lateral process of malleus above.Prussak's space communicates with epitympanum through a posterior gap.Prussak's space is impoant because it is a site for pars flaccida acquired cholesteatoma formation.
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Protein A of staphylococcus binds to -
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Ans. is 'b' i.e., IgG Virulence factors of staphylococcus aureuso Protein 'A' binds to Fc terminal of IgG (IgG 1,2 & 4 but not IgG3) and prevents opsonophagocytosis by PMNs . It is a B-cell mitogen. It is chemotactic, anti-complementory and antiphagocytico Heat stable nuclease (DNAase) is a characteristic feature of staph aureus.o Staphylococcus produces five cytolytic toxins, consisting of four hemolysins (alpha, beta, gamma and delta) and a leucocidin.o a - hemolysin is the most important hemolysin.o Beta - hemolysin is a sphingomyelinase. It exhibits a hot-cold phenomenon, the hemolysis being initiated at 37degC, but becoming evident only after chillingo Leucocidin is also called the Panton-valentine toxin.o Staphylococcal leucocidin and gamma lysin have been grouped as synergohymenotropic toxins.o Toxic shock syndrome toxin (TSST), exfoliative toxin and enterotoxins are superantigens which are potent activators of T lymphocytes and lead to an excessive and dysregulated immune response with release of cytokines IL-1, IL-2, TNF-a and IFN-g.o Enterotoxin is responsible for food poisoning, o Exfoliative (epidermolytic) toxin# Responsible for staphylococcal scalded skin syndrome (S.S.S.S.).# Severe form of SSSS is known as Ritter's disease in newborn and toxic epidermal necrolysis in older patients. Milder forms are pemphigus neonatorum and bullous impetigo.o Hyaluronidase is helpful in persistent skin infection.
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A farmer who is working in poultry developed acute onset of fever with chills. On physical examination, there is hepatosplenomegaly and lymphadenopathy. Blood culture shows Brucella abous. He must have got the infection through all the following ways, EXCEPT:
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The infection is transmitted from animals to humans. Brucella abous (cattle), B suis(hogs), and B melitensis (goats) are the main agents. Transmission to humans occurs by contact with infected meat (slaughterhouse workers), placentae of infected animals (farmers, veterinarians), or ingestion of infected unpasteurized milk or cheese. Ref: Schwaz B.S. (2014). Chapter 33. Bacterial & Chlamydial Infections. InPapadakis M.A., McPhee S.J., Rabow M.W. (Eds), CURRENT Medical Diagnosis & Treatment 2014.
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Malaria protection comes from all except ?
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Ans. is 'd' i.e., Acanthocytosis Types of anemia that have protective effect against P. falciparum malaria : ? G6PD deficiency, Sickle cell anemia, Thalassemia, HbC, Pyruvate kinase deficiency
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A 22-year old software engineer was brought in an unconscious state to the casualty. Clinical examination revealed features suggestive of shock, DIC and multisystem failure. CSF and petechial rashes yielded gram-negative diplococcic, which subsequently grew on modiefied Thayer-Martin medium. This isolation is known to be associated with-
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Ans- A Waterhouse-Friderichsen Syndrome This uncommon but catastrophic syndrome is characterized by the following:An overwhelming bacterial infection, which is classically associated with Neisseria meningitidis septicemia but occasionally is caused by other highly virulent organisms, such as Pseudomonas species, pneumococci, Haemophilus influenzae, or staphylococciRapidly progressive hypotension leading to shockDisseminated intravascular coagulation with widespread purpura, particularly of the skinRapidly developing adrenocortical insufficiency associated with massive bilateral adrenal hemorrhage Whatever the basis, the adrenals are converted to sacs of clotted blood virtually obscuring all underlying detail.
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MEN-1 include all except
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MEN 1 is characterised by the triad of tumours in the anterior pituitary gland, mostly presenting as prolactinomas or non-functioning tumours, hyperplasia of the parathyroids causing primary hyperparathyroidism (pHPT) and Pancreaticoduodenal endocrine tumours (PETs). also called Wermer's syndrome. It is caused by germline mutations in the menin gene, located on chromosome 11.MEN 2A is characterised by the combination of MTC, pHPT and mostly bilateral phaeochromocytomas. MTC combined with phaeochromocytoma alone is called Sipple's syndromeMEN 2B comprises MTC, phaeochromocytoma and characteristic facial and oral mucosal neurinomas and intestinal ganglioneuromatosis, accompanied by a Marfanoid habitus.Ref: Bailey and Love 27e pg: 856
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In which of the following conditions, MTP can be indicated -a) Pregnancy caused by rapeb) Husband is willing but mother is not agreeingc) If maternal health is in dangerd) Pregnancy after contraceptive failuree) Pregnant women have received cytotoxic drugs
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Pregnancy due to rape, danger to maternal health, receiving cytotoxic drugs (can cause fetal damage and risks of a born child with physical/mental abnormalities) and pregnancy due to contraceptive failure are indications for abortion under MTP act.
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Host related biological propeies of a disease agent are the following except
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Host related biological propeies of disease agent are Infectivity Pathogenicity Virulence Ref : parks textbook of PSM 24th edition page no : 41
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Huxley- Henley layers is a pa of
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Hair * Hair is derived from ectoderm, but dermal papilla is of mesoderm-derivation * Hair follicle is positioned at an angle; base of follicle typically within the subcutaneous fat Longitudinal anatomy * Infundibulum: upper poion of follicle extending from surface of epidermis to opening of sebaceous gland * Isthmus: middle poion extending from opening of sebaceous gland duct to inseion of arrector pili muscle (bulge), lined by outer root sheath (ORS), no inner root sheath (IRS) * Inferior segment or lower hair follicle: extending from base of isthmus to hair bulb; consists of matrix cells and envelops dermal papilla; lined by IRS; ORS present but not keratinized; widest diameter termed critical line of Auber (below this is where bulk of mitotic activity occurs); melanocytes in bulb provide melanosomes for hair color * Cross-sectional anatomy:- from outer to inner layer: * Glassy membrane - ORS - Henle's layer (IRS) - Huxley's layer (IRS) - cuticle (IRS) - hair shaft cuticle - coex --> Medulla. Ref:- Sima Jain; pg num:- 13,14
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A 37-year-old female presents to the emergency room with a fever. Chest x-ray shows multiple patchy infiltrates in both lungs. Echocardiography and blood cultures suggest a diagnosis of acute bacterial endocarditis limited to the tricuspid valve. Which of the following is the most probable etiology?
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The most probable etiology of bacterial endocarditis involving the tricuspid valve is illicit intravenous drug use, which can introduce skin organisms into the venous system that then attack the tricuspid valve. Staphylococcus aureus accounts for between 60% and 90% of cases of endocarditis in intravenous drug users. The endocarditis associated with congenital hea disease typically involves either damaged valves or atrial or ventricular septal defects. The tricuspid valve is not paicularly vulnerable. Rheumatic fever most commonly damages the mitral and aoic valves, and tricuspid damage is usually less severe and seen only when the mitral and aoic valves are heavily involved. Consequently, secondary bacterial endocarditis involving only the tricuspid valve in a patient with a history of rheumatic fever would be unusual. Rheumatoid ahritis is not associated with bacterial endocarditis. Ref: Brooks G.F. (2013). Chapter 14. The Streptococci, Enterococci, and Related Genera. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
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Karyotype of Complete mole is?
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ANSWER: (B) 46XXREF: Dutta 6th ed p. 201Repeat in December 2011See APPENDIX-63 for "COMPLETE AND PARTIAL HYDATIDIFORM MOLES" APPENDIX - 63Complete and Partial Hydatidiform Moles:FeaturePartial Hydatidiform MoleComplete Hydatidiform MoleKaryotype69XXY, Triploid, paternal and maternal origin46XX, Diploid, mostly paternal originImmunohistochemistryhCGWeakStrongPlacental alkaline phosphataseStrongWeakhPLvariableWeakPathology Fetus or amnion, fetal vessels Hydropic villiTrophoblastic proliferationPresentVariable, often focal FocalAbsentPronounced, generalizedVariable, often markedClinical Mole clinical diagnosisUterus large for datesMalignant sequelaeRareRare<5%Common30%-50%6%-36%
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Which of the following is an epiphyseal lesion?
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Ans. is 'a' i.e., Chondroblastoma
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Histologic examination of lung tissue reveals multiple suppurative, neutrophil-rich exudates that fill the bronchi and bronchioles and spill over into the adjacent alveolar spaces only. The majority of lung tissue is not involved in this inflammatory process. Hyaline membranes are not found. This histologic appearance best describes
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Pulmonary infections may be caused by bacteria, fungi, viruses, or mycoplasma. Bacterial infections generally result in a polymorphonuclear (neutrophil) response. Bacterial infection of the lung (pneumonia) results in consolidation of the lung, which may be patchy or diffuse. Patchy consolidation of the lung is seen in bronchopneumonia (lobular pneumonia), while diffuse involvement of an entire lobe is seen in lobar pneumonia. Histologically, bronchopneumonia is characterized by multiple, suppurative neutrophil-rich exudates that fill the bronchi and bronchioles and spill over into the adjacent alveolar spaces. In contrast, lobar pneumonia is characterized by four distinct stages: congestion, red hepatization, gray hepatization, and resolution Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.
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Tissue suturing glue contains:
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Most tissue adhesives or glue are cyanoacrylate polymers, such as n-butyl-2-cyanoacrylate (eg, Histoacryl®, PeriAcryl®) or 2-octyl cyanoacrylate (eg, Dermabond®, Surgiseal).
Cyanoacrylate tissue adhesives are liquid monomers that undergo an exothermic reaction on exposure to moisture (eg, on the skin surface), changing to polymers that form a strong tissue bond. When applied to a laceration, the polymer binds the wound edges together to allow normal healing of the underlying tissue.
Compared with wounds closed with sutures, the tensile strength of wounds closed by tissue adhesives is less at the time of initial application, but equalizes by one week post-repair.
Advantages:
Less painful application, and sometimes no need for local anesthetic injection
More rapid application and repair time
Cosmetically similar results at 12 months post-repair
Waterproof barrier
Antimicrobial properties
Better acceptance by patients
No need for suture removal or follow-up
Indications and contraindications:
For use of tissue adhesives the wound needs to be clean, dry with near perfect hemostasis and under no tension.
Complex stellate lesions or crush injuries should not be closed with tissue adhesives since good wound approximation is difficult to achieve.
Tissue adhesives are not recommended for lacerations of the hands, feet, or joints, since repetitive movements could cause the adhesive bond to break before sufficient tensile strength is achieved.
Tissue adhesives are not recommended for the oral mucosa or other mucosal surfaces or areas of high moisture such as the axillae and perineum.
Lacerations involving the hairline or vermilion border require more precision, and should be repaired with traditional sutures.
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Pain in early labor is transmitted through
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.
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Snake that causes paralysis with convulsions: NEET 14
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Ans. Cobra
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A female patient has adenocarcinoma uterus along with sarcoma of uterus. It is known as -
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Of the Uterine Sarcomas Almost 50% of are Mixed and are called the Mixed Mesodermal tumors (Synonymously called Mixed mullerian tumors). These mixed tumors can be Homologous 25% Heterologous 20% Adencarcinomas in 5% cases. The other Uterine sarcomas are Leiomyosarcoma in 33% cases and Stromal sarcoma in 16% cases
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A patient presented to you after an assault and penetrating knife injury to the abdomen. X-Ray shows gas under the diaphragm. Most common organ damaged in this case:
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Ans.B intestine X-Ray shows gas under the diaphragm suggests perforating injury . Most common organ damaged in Penetrating or stab injury : Liver Most common organ damaged in Perforating injury : Small Intestine Most common organ damaged in Blunt abdominal injury : Spleen Most common organ damaged in Seat belt injury : Mesentry Most common organ damaged in Blast injury : Head above water : TM Below water : GIT Most common organ damaged in Deceleration injury- Dudodenojejunal flexure
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Which of the following is not a feature of juvenile CML?
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Philedelphia chromosome positivity is a feature of adult CML. Juvenile CML is commonly seen in children between 1-2 years of age. It is characterised by enlarged lymphnodes, spleen and liver. Lab findings includes thrombocytopenia, leukocyte count lower than classic CML, and in increase in propoion of fetal hemoglobin.
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Maximum cones are seen in
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Optic disc, 1.5 mm in size, is responsible for blind spot of Mariotte Rods and cones are sensory end organs of vision Rods are absent in the foveal region. Ganglion cell layer is thickest in the macular region. Foveola is the most sensitive pa of retina. It contains only cones and their nuclei covered by a thin internal limiting membrane. There are 3 types of cones Red (maximum number) 65% Green Blue (least number) Cones are packed and tight mosaic hexagonal cells Visual acuity depends upon the density of cone mosaic
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Hypoglycemic unawareness that occurs in diabetic patients when transferred from oral hypoglycemics to insulin, is due to :
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Answer is A (Autonomic neuropathy): Hypoglycemic unawareness refers to a loss of warning symptoms that ale individuals to the presence of hypoglycemia and prompt them to eat and'abo the episode. Hypoglycemic unawareness can be attributed to two factors : Autonomic neuropathy Loss of catecholamine response to hypoglycemia : This means that patients with repeated attacks of hypoglycemia lose their capacity to release epinephrine and norepinephrine in response to hypoglycemia. (increase release of glucogon in response to hypoglycemia is lost very early in type I Diabetes Thus type I patients overeated with insulin may be unaware of critically low levels of blood glucose because of an adaptive blunting of their alarm systems owing to repeated episodes of hypoglycemia.
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True about Epidural anesthesia – a) Effects start immediatelyb) C/I in coagulopathiesc) Given in subarachnoid spaced) Venous return decreases
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Epidural anesthesia is given outside the dura in epidural (extradural) space (not in subarachnoid space).
Onset of effect takes place in 15-30 minutes (not immediately). In contrast, spinal anesthesia has immediate effect (approximately 5 minutes).
Neuraxial block (spinal & epidural) anesthesia is contraindicated in coagulopathy or bleeding diasthesis.
Neuraxial block (spinal & epidural) can cause venous pooling and decreased venous return.
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A boil is due to staphylococcal infection of -
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• Folliculitis, carbuncles and furuncles are all types of localized (superficial) skin infections that fall under the category of boils.
• Hair follicles serve as portals for a number of bacteria, although S. aureus is the MC cause of localized folliculitis.
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A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from
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Specific Learning Disability (SLD) in youth is a neurodevelopmental disorderproduced by the interaction of heritable and environmental factors that influence the brain's ability to effeciently perceive or process verbal and non verbal information. It is characterised by persistent difficulty learning academic skills reading, written expression, that is inconsistent with the overall intellectual ability of a child. They find difficulty to keep up with their peers in ceain academic subjects. SLD is associated with an increased risk of comorbid disorders, including ADHD, Communication disorders, Conduct disorders and Depressive disorders. Ref: Synopsis of Psychiatry, 11e, pg 1181.
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The cone of tissue removed in the operation of conization consists of :
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A+B
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Which is not transmitted through blood -
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Ans. is 'b' i.e., CholeraInfections transmitted by bloodViralBacterialParasiteso HCVo Pseudomonaso Taxoplasmao HBVo Yersiniao Malariao HIVo Coagulase negative stapho Babesiao CMVo Borrefia burgdorferio Chagas dis.o HTL V - Type 1(Lyme dis) o Hepatitis G virus (GBV-C) o Parvovirus B-19 o Hepatitis A (rarely) o West Nile virus o Creutzfeld - Jakob dis.
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A 29year old primigravida at 36weeks with Rh negative pregnancy came to labor room with complaints of bleeding per vaginum followed by abdominal trauma. Which of the following test is advised to estimate the size of fetomaternal haemorrhage?
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* kliehauer Betke test is the procedure of choice to assess the volume of the fetal maternal bleeding * It should be done as soon as possible (within 2hours) after delivery in women with suspected large feto maternal haemorrhage who need larger amounts of anti D * This method is based on the fact that an acid solution elutes the adult but not the fetal hemoglobin from the red cells. * Fetal erythrocytes appear in a smear stained dark red and surrounded by colourless ghosts that are adult erythrocytes without hemoglobin. * This test can detect as little as 0.2ml of fetal blood diluted in 5litres of maternal blood. * Following clinical scenarios are associated with large feto maternal bleeding: 1. Traumatic deliveries including cesarean 2. Manual removal of placenta 3. Still bihs and intrauterine deaths 4. Abdominal trauma during the third trimester 4. Twin pregnancies at delivery 5. unexplained hydrops fetalis Reference: Greentop guidelines no: 22
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A hemodynamically stable patient with blunt abdominal trauma, the best investigation is ?
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CT Scan of Abdomen: It is most commonly used and better investigation for abdominal trauma. It is useful in blunt/penetrating trauma, suspected pancreas, spleen, liver, duodenal, retroperitoneal injuries. Smaller injuries, early haemoperitoneum are better detected. It is noninvasive, highly specifi c, highly accurate (96%), with low false-positive/low false-negative, noninvasive. Diagnostic Peritoneal Lavage (DPL) (by Perry) It is useful in blunt injury abdomen. It is not very useful in penetrating injury, bowel injury, retroperitoneal and pelvic injuries. Focused abdominal sonar trauma (FAST): It is rapid, noninvasive, poable bedside method of investigation focusing on pericardium, splenic, hepatic and pelvic areas. It is not reliable for bowel or penetrating injuries. It often needs to be repeated. SRB's Manual of Surgery, 4th Edition, pg. no. 150
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Which of the following radio of Iodine is used for thyroid scan: September 2008
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Ans. A: 1-123 The radionuclides that are used in thyroid scans are two isotopes of iodine, 1-131 and 1-123, and an isotope of technetium known as 99m Tc. Technetium scanning is preferred for some diagnostic workups because it is relatively fast and does not require the patient to fast beforehand. Many prefer to reserve 1-131 for follow-up evaluations of cancer patients, and use 1-123 for thyroid uptake tests and routine thyroid scans. The reason for the distinction is the higher radiation burden of 1-131.
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Which of the following is not a suprahyoid space?
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Ans. is'c'i.e., Anterior visceral spaceRef: Ballenger's Otorhinolaryngology: Heat and Neck Surgery 1//e by james Byron Snow, Phillip A. Wackym, John lacob Ballenger p. 1021, Cummings Otolaryngology- Head and Neck Surgery Sh/e, Ch. 14Suprahyoid neckThese spaces are :-Peritonsillar spaceSubmandibular 6 sublingual spacesPrestyloid parapharyngeal spaceMasticator spaceParotid space
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Doxycycline is used in the treatment of following disease except:
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TETRACYCLINES These are a class of antibiotics having a nucleus of four cyclic rings. The tetracyclines still available in India for clinical use are: Tetracycline Oxytetracycline Demeclocycline Doxycycline Minocycline Uses: Although tetracyclines are broad-spectrum antibiotics, they should be employed only for those infections for which a more selective and less toxic AMA is not available. Clinical use of tetracyclines has very much declined due to availability of fluoroquinolones and other efficacious AMAs. USES: >Mild leptospirosis is treated with doxycycline, ampicillin, or amoxicillin. For severe leptospirosis, intravenous penicillin G has long been the drug of choice, although the third-generation cephalosporins cefotaxime and ceftriaxone have become widely used. >Rickettsial infections: typhus, rocky mountain spotted fever, Q fever, etc. respond dramatically. Chloramphenicol is an alternative. >Relapsing fever* due to Borrelia recurrentis responds adequately ESSENTIALS OF MEDICAL PHARMACOLOGY, www.medscape.com K.D.TRIPATHI SIXTH EDITION PAGE NO:715
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External cephalic version is contraindicated in all except: March 2012
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Ans: D i.e. Breech presentation Indications for external cephalic version are breech presentation & transverse lie.
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Which of the following is/are the side effect/s of using argon laser -
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argon gases causes all d side effects. REF:khurana,pg no 461
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Number of amino acids in A chain and B chain of insulin is:
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Ans: d (21 and 30) Ref: Vasudevan,4th ed, p. 108Insulin is a protein hormone with 2 polypeptide chains; the A chain with 21 amino acids and B chain with 30 amino acids.Insulin:T 1/2 of insulin is 5 minutes.Normal daily insulin secretion is 50 units.Tissues independant of insulin - RBC, brain, renal medullary cells, placenta.Amino acids stimulating insulin secretion - leucine and arginine.Pork insulin differs from human insulin by only one amino acid residue.
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The macrophage to epitheliod conversion in Mycobacterium tuberculosis infection is mediated by:
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Ref: Robbins Pathologic Basis of Disease, 8th edition, Pg: 183Explanation:T Cell-Mediated (Type IV) HypersensitivityThe cell-mediated type of hypersensitivity is initiated by antigen-activated (sensitized T lymphocytes, including CD4+ and CD8+ Tcells.Tubercle bacilli colonizing the lungs are persistent or nondegradable antigensThe perivascular infiltrate is dominated by macrophages over a period of 2 or 3 weeks.The activated macrophages often undergo a morphologic transformation into epithelium-like cells and are then referred to as epithelioid cells.A microscopic aggregation of epithelioid cells, usually surrounded by a collar of lymphocytes, is referred to as a granuloma.This pattern of inflammation, called granulomatous inflammation is typically associated with strong T-cell activation with cytokine production.M. tuberculosis enters macrophages by endocytosis mediated by several macrophage receptors: mannose receptors bind lipoarabino- mannan. a glvcolipid in the bacterial cell wall, and complement receptors bind opsonized mycobacteria.M. tuberculosis organisms replicate within the phagosome by blocking fusion of the phagosome and lysosomeAbout 3 weeks after infection, a T-helper 1 (TH1) response is mounted that activates macrophages to become bactericidal.Differentiation of TH1 cells depends on IL-12, which is produced by antigen-presenting cells that have encountered the mycobacteria.Mature TH1 cells, both in lymph nodes and in the lung, produce IFN-g.INF-g is the critical mediator that enables macrophages to contain the M. tuberculosis infection.IFN-g stimulates formation of the phagolysosome in infected macrophages, exposing the bacteria to an inhospitable acidic environment.Macrophages activated by IFN-y differentiate into the "epithelioid histiocytes" that characterize the granulomatous response, and may fuse to form giant cells.Activated macrophages also secrete TNF. which promotes recruitment of more monocytes.
| 7,357 |
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An 18-year-old girl presents with amenorrhoea, milk discharge, weight loss. Diagnosis is
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Its tempting here to go for Hypothyroidism but that is usually associated with weight gain. However, pituitary tumors and craniopharyngiomas can cause increase in PRL and consequent galactorrhea , weight loss attributed then to the malignant process. Ref - Harrison 20e pg2673
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Clavipectoral fascia is derived from which ligament
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CLAVIPECTORAL FASCIAStrong fascial sheet deep to clavicular head of pectoralis major muscle.Fills space between clavicle and pectoralis major.Extend:-Verically-clavicle above to axillary fascia below.Medially-first rib and costoclavicular ligament.Laterally- coracoid process and blends with coracoclavicular ligament.The thick upper pa of fascia extending from first rib near costochondral junction to the coracoid process is called costocoracoid ligament.Clavipectoral fascia encloses two muscles- subclavius and pectoralis major.Structures piercing:-1. Thoracoacromial aery 2. Apical group of axillary lymph nodes.3. Lateral pectoral nerve.4. Cephalic vein{Reference: Vishram Singh, pg no.43}
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The following are indications for assisted ventilation in acute severe asthma EXCEPT?
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PEFR of 50-60% indicates moderate asthma. Indication for intubation in asthma exacerbation is a poor response to oxygen with salbutamol nebulisation and oral steroids. The definition of poor response is: 1. FEV1< 40%. 2. PaCO2> 45mmHg. 3. Features of carbon dioxide narcosis. 4. Hypoxia defined as PaO2<60 mm Hg.
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All of the following are causes of vasogenic type of cerebral edema except
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Vasogenic edema occurs due to a breakdown of the tight endothelial junctions that make up the blood-brain barrier. This allows intravascular proteins and fluid to penetrate into the parenchymal extracellular space. Some premature babies have bleeding in the brain, which can block the flow of CSF andcause hydrocephalus. Other possible causesof congenital hydrocephalus include: X-linked hydrocephalus - caused by a mutation of the X chromosome Ref ganong's review of medical physiology 25e p277
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The ovarian cycle is initiated by:
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Ans. is a i.e. FSHRef: Shaw 14th/ed, p41, Dutta Gynae 5th/ed, p82Ovarian cycle is initiated by FSHRemember: Following questions asked, previously on FSHFSHi. It is the hormone which initiates ovarian cycleii. In menopausal females- Since primordial follicles are decreased so levels of estrogen is decreased, so negative feedback on FSH is decreased, hence levels of FSH are increased and increased FSH levels are a sine qua non of menopause.iii. Human menopausal gonadotropin (HMG) is FSH and LH obtained from the urine of postmenopausal femalesiv. FSH levels can help in differentiating the causes of male infertility vizIn pretesticular cause of male infertility = FSH decreasesIn testicular cause = FSH levels increaseIn post testicular cause = FSH is normal
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All of the following cephalosporins have good activity against Pseudomonas aeruginosa except ?
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Ans. is 'a' i.e., Cephadroxil o Cephalosporins with antipseudomonal activity :- Ceftazidime, Cefoperazone, Cefepime
| 7,363 |
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Structure damaged most commonly during Surgery on Ranula is?
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Submandibular duct REF: Clinical surgery: Volume 9 Head and neck edited by Charles Rob, Rodney, Smith page 56 "The treatment of ranula constitutes a problem, owing to the technical difficulty of complete excision without damage to adjacent structures such as the submandibular duct"
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Puppe's rule deals with?
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Ans. is `b' i.e., Multiple impact injuries
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NOT a content of carpal tunnel
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Carpal tunnel Contents - 1. 4 tendons of Flexor Digitorum Profundus (FDP) 2. 4 tendons of Flexor Digitorum Superficialis (FDS) 3. 4 tendons of Flexor Pollicis Longus (FPL) 4. Median nerve Structure passing anterior to carpal tunnel: 1. Ulnar nerve 2. Ulnar aery 3. Palmaris longus tendon. Structure embedded into flexor retinaculum Flexor carpi radialis tendon.
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Sensitivity is a measure of
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(A) True positive # Term Sensitivity was introduced by Yarushalmy in 1940s as a statistical index of diagnostic accuracy.> It has been defined as the ability of a test to identify correctly all those who have the disease, that is "True positive".> A 90% sensitivity means that 90% of the diseased people screened by the test will give a "true positive" result and remaining 10% a "false negative" result.> Sensitivity has been defined as the ability of a test to identify correctly all those who have the disease, that is "true positive".> Sensitivity: the ability of a test to identify correctly all those who have the disease, i.e. true positive ... a/a + c x 100> Specificity: The ability of a test to identify correctly those who do not have the disease i.e. true negative ...d/(b+d) x 100
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OPV Bivalent vaccine contain:
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b. P1 & P3(Ref: Nelson's 20/e p 1561, 3212, Ghai 8/e p 190-194)Monovalent OPVs (mOPVs) & bivalent OPV (bOPV) are 2.5-3 times more efficacious than trivalent OPVIn bivalent OPV, the type 2 component is removed
| 7,368 |
medmcqa_train
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Which of the following enzymes does NOT contain Zn? (NOT RELATED)
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Zinc is required for the activity of > 300 enzymes, covering all six classes of enzymes. alcohol dehydrogenase; superoxide dismutase; transferases like RNA polymerase and aspaate transcarbamoylase; hydrolases like carboxypeptidase A and thermolysin; lyases like carbonic anhydrase and fructose-1,6-bisphosphate aldolase; isomerases like phosphomannose isomerase; and ligases like pyruvate carboxylase and aminoacyl-tRNA synthases
| 7,369 |
medmcqa_train
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A patient presents with vomiting and severe colicky abdominal pain. He underwent bariatric surgery 5 years ago. He is advised to undergo an emergency reoperation. Which of the following procedures did he most likely undergo 5 years ago?
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Patient must have underwent Laparoscopic Roux-en-Y gastric bypass 5 years ago Now presented with internal hernia- late complication of gastric bypass surgery Closure of hernia defects at the time of gastric bypass surgery reduces the incidence of symptomatic internal hernias in future.
| 7,370 |
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Reese-Ellsworth classification is used for?
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ANSWER: (B) RetinoblastomaREF: Decision Making in Radiation Oncology, Volume 2 by Jiade J. Lu page 1041Repeat from June 2008Reese-Ellsworth classification of Retinoblastoma:TypeDescriptionGroup I"Very favourable"ASolitary tumor, less than 4 dd in size, at or posterior to the equatorBMultiple tumors, none over 4 dd in size, all at or posterior to the equatorGroup II"Favourable"ASolitary tumor, 4-10 dd in size, at or posterior to the equatorBMultiple tumors, 4-10 dd in size, all posterior to the equatorGroup III"Doubtful"AAny lesion anterior to the equatorBSolitary tumors larger than 10 dd posterior to the equatorGroup IV"Unfavorable"AMultiple tumors, some larger than 10 ddBAny lesion extending to the ora serrataGroup V"Very unfavourable"AMassive tumors involving over half the retinaBVitreous seeding*dd= disc diameter (approximately 1.5 mm)
| 7,371 |
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Which of the following is an indication for the use of folinic acid?
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Prophylaxis of neural tube defects require treatment with folic acid. Methotrexate toxicity can be prevented by 5'-formyltetrahydrofolate (folinic acid). Pernicious anemia requires the therapy with vitamin B12. Anemia associated with chronic renal failure is treated with erythropoietin.
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Patient presents with varicose vein with sapheno-femoral incompetence and normal perforator. Management options include all of the following except
|
Ans. b. Sclerotherapy
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Neuro surgical intervention may be necessitated in all of the following Except
|
Diffuse axonal injury (DAI) is a form of traumatic brain injury. It happens when the brain rapidly shifts inside the skull as an injury is occurring. The long connecting fibers in the brain called axons are sheared as the brain rapidly accelerates and decelerates inside the hard bone of the skull. DAI typically causes injury to many pa of the brain, and people who suffer a DAI are usually left in a coma. The changes in the brain are often very tiny and can be difficult to detect using CT or MRI scans. It is one of the most common types of traumatic brain injury and also one of the most devastating. The prevailing symptom of DAI is loss of consciousness. This typically lasts six or more hours. If the DAI is mild, then people might remain conscious but display other signs of brain damage. These symptoms can be extremely varied, as they depend upon which area of the brain has been damaged. They can include: disorientation or confusion headache nausea or vomiting drowsiness or fatigue trouble sleeping sleeping longer than normal loss of balance or dizziness Ref:
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Subclan aery is divided by which muscle ?
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Ans. is 'c' i.e., Scaleneus anterior Scaleneus anterior muscle divides subclan aery into three pas :?A) First pa :This pa is medial (proximal) to scaleneus anterior. Branches from first pa are :?Veebral aeryInternal thoracic aeryThyrocervical trunk:Costocervical trunk (on left side only).B) Second pa :This pa lies posterior to scalenus anterior. It gives origin to Costocervical trunk on right side. Costocervical trunk gives following branches:Deep cervical aerysuperior intercostal aery.C) Third pa :This pa lies lateral (distal) to scalenus anterior. It gives dorsal scapular aery (sometimes dorsal scapular aery arises from transverse cervical aery, a branch of thyrocervical trunk).
| 7,375 |
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NICE project is associated with:
|
National Institute of Social Defence has launched NICE project (National Initiative on Care for Elderly) in 2000. Ref: National Health Programmes in India, J.Kishore, 10th edition pg: 795
| 7,376 |
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Commonest feature of hypothyroidism in children is
|
Ans. is 'c' i.e., Cold extremities o Amongst the given options cold extremities is the best answer. o Prolongation of physiological jaundice is the earliest sign.
| 7,377 |
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Left medial sector contains segment
|
Left medial sector contains segment III and IV Left lateral sector contains only one segment II Ref: Sabiston 20th edition Pgno : 1421-1422
| 7,378 |
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The medicolegal importance of postmortem lividity is all except -
|
Medicolegal importance of postmortem staining are :-
It is a sign of death.
Helps to know time since death.
Helps to know the position or posture of dead body.
Sometimes cause of death can be known by peculiar distribution, e.g. in hanging or drowning.
| 7,379 |
medmcqa_train
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Saffron coloured meconium is seen in:
|
Postmaturity syndrome is the description of a clinical syndrome in which fetus experiences placental insufficiency and resultant growth restrictions.The classical syndrome describes a neonate with wrinkled ,peeling skin coated with meconium,overgrown nails ,well developed palm and sole creases ,reduced subcutaneous fat and a wizened old man appearance (refer pgno:218 sheila textbooks of obstetrics 2 nd edition)
| 7,380 |
medmcqa_train
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First change of improvement noted after iron therapy is initiated
|
First change of improvement noted after iron therapy is decreased irritability followed by increased reticulocyte count. Reference: GHAI Essential pediatrics, 8th edition
| 7,381 |
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Expectant management of placenta pre includes all except
|
The regimen advocated by Macafee Carried out in a teiary care Complete bed rest with bedside toilet facilities Anaemia has to be looked for and corrected by blood transfusion Iron ,vitamins,calcium should be continued Antenatal steroids can be given to promote lung maturity Anti -D should be given (refer pgno: 132 sheila 2 nd nd edition)
| 7,382 |
medmcqa_train
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Which of the following enzyme leads to release of free glucose from glycogen during glycogenolysis in muscle?
|
Debranching enzyme Has 2 catalytic sites in a single polypeptide chain. Glucan transferase and debranching enzyme are the two separate activities of the same enzyme. Glucan transferase 1,6-glycosidase transfers a trisaccharide unit from one branch to the other, exposing the 1 - 6 branch point. Breaks a (1- 6) bond, which is present at the staing of a branched-chain releasing glucose **Glucose-6-phosphatase also release free glucose but only in liver and not in muscle.
| 7,383 |
medmcqa_train
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Which of the following tumours present with proptosis?
|
PROPTOSIS It is defined as forward displacement of the eyeball beyond the orbital margins. Causes of bilateral proptosis include: Tumours: These include symmetrical lymphoma or lymphosarcoma, secondaries from neuroblastoma, nephroblastoma, Ewing's sarcoma and leukaemic infiltration. Ref:- A K KHURANA; pg num:-379,381
| 7,384 |
medmcqa_train
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Macula is stimulated by
|
Macula senses the position of the head in response to gravity and linear acceleration. Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 6th edition; page no.16
| 7,385 |
medmcqa_train
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Skin scrapings from a patient with tinea corporis were taken and cultured on SDA. Figure shows the LCB mount. Likely identity of the causative dermatophyte is-
|
M. gypseum-numerous fusiform (spindle) shaped macroconida M. audouinii- racquet shaped macroconidia E. floccosum- club shaped macroconidia T. rubrum- arrangement of microconida has been described as "birds on a wire" where the pyriform (teardrop shaped) microconidia are attached to the hyphae at the narrow end
| 7,386 |
medmcqa_train
|
Karsakoff's Psychosis is diagnosed by
|
C i.e. Impairment of long term memory
| 7,387 |
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Toxicity of leigonella is due to:
|
Toxin
| 7,388 |
medmcqa_train
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Best method of treatment of Methyl alcohol -
|
Among the given options only ethyl alcohol is used.
| 7,389 |
medmcqa_train
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Carcinoma cervix extends to the lateral pelvic wall in which stage
|
Stage III B more precisely. Ref mudaliar textbook of obstetrics 6e p561
| 7,390 |
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Most common site of curling's ulcer?
|
Ans. (a) Proximal duodenum(Ref: Robbins 9th/pg 762)Curling ulcers-Ulcers occurring in the proximal duodenum and associated with severe burns or trauma
| 7,391 |
medmcqa_train
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Parenchymatous xerosis of conjunctivitis is caused by
|
A i.e. Trachoma Vit A deficiency causes epithelial xerosisQ. Parenchymal xerosis is caused by widespread destructive interstitial conjunctivitis as seen in trachoma Q, diptheria, Steven Jonson Syndrome, pemphigus or pemphigoid conjunctivitis, thermal, chemical or radiational burns of conjunctiva Q and exposure of conjunctiva.
| 7,392 |
medmcqa_train
|
Treatment for impetigo ?
|
Ans. is 'a' i.e., Dicloxacillin Treatment of impetigo is either dicloxacillin or cephalexin can be given at a dose of 250 mg four times daily for 10 days. Topical mupirocin ointment is also effective.
| 7,393 |
medmcqa_train
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A patient operated for thyroid surgery for a thyroid swelling, later in the evening developed difficulty in breathing. There was swelling in the neck. The immediate management would be
|
Haemorrhage is the most frequent life-threatening complication of thyroidectomy. Around 1 in 50 patients will develop a haematoma, and in almost all cases this will develop in the first 24 hours. If an aerial bleed occurs, the tension in the central compament pressure can rise until it exceeds venous pressure. Venous oedema of the larynx can then develop and cause airway obstruction leading to death. If a haematoma develops, clinical staff should know to remove skin sutures in order to release some pressure and seek senior advice immediately. Endotracheal intubation should be used to secure the airway while the haematoma is evacuated and the bleeding point controlled.Ref: Bailey and Love, page no: 815
| 7,394 |
medmcqa_train
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Developmental Quotient is calculated as:
|
Ans. A. Average age at attainment/observed age at attainment x100Significant delays on screening is an indication for a detailed formal assessment of developmental status. By assessment, one can assign developmental quotient (DQ) for any developmental sphere. A DQ below 70 is taken as delay
| 7,395 |
medmcqa_train
|
Temperomandibular joint is:
|
Temporo-mandibular joint is weight-bearing joint though not covered by hyaline cartilage like sterno-clavicular joint. Clavicle ossifies at five weeks followed by mandible at six weeks. Absence of hyaline cartilage is because no cartilaginous precursor exists at that time. This does not mean that the joint is non-weight bearing, it is the early ossification which has made the joint free of hyaline cartilage.
| 7,396 |
medmcqa_train
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Which of the following ranges of haemoglobin O2 saturation from systemic venous to systemic aerial blood represents a normal resting condition?
|
In a normal res ng condition, the blood leaving the lungs is 98% saturated with oxygen, and the blood returning to the lungs is 75% saturated with oxygen. With vigorous exercise, blood leaving the lungs is still 98% saturated, but blood returning is usually less than 75% saturated because more oxygen is unloaded from hemoglobin in exercising muscles
| 7,397 |
medmcqa_train
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Early deceleration pattern on cardiotocography indicates :
|
Head compression
| 7,398 |
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False about Gaucher's disease
|
Three biochemical markers of gaucher disease Angiotensin-conveing enzyme ( ACE ) Tarate-resistant acid phosphate ( TRAP ) Chitotriosidase ( CHITO ) These marker are elevated in active disease, these are useful indicators of disease progress and response to enzyme replacement therapy So gaucher disease is basically Tarate-resistant acid phosphatase positive as the disease is being treated the levels of TRAP gradually declines
| 7,399 |
medmcqa_train
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