NurErtug/MNLP_M2_mcqa_dataset · Datasets at Hugging Face

question stringlengths 1 1.57k	options sequencelengths 4 4	answer stringclasses 5 values	correct_option stringlengths 1 287	explanation stringlengths 1 22.5k ⌀	dataset stringclasses 2 values
Hea failure cells are found in	[ "Myocardium", "Lungs", "Liver", "Spleen" ]	B	Lungs	It is seen characteristically found in lungs during left hea failure.The morphology of lung in LVH described by: Lungs. Rising pressure in the pulmonary veins is ultimately transmitted back to the capillaries and aeries of the lungs, resulting in congestion and edema as well as pleural effusion due to an increase in hydrostatic pressure in the venules of the visceral pleura. The lungs are heavy and boggy, and microscopically show perivascular and interstitial transudates, alveolar septal edema, and accumulation of edema fluid in the alveolar spaces. In addition, variable numbers of red cells extravasate from the leaky capillaries into alveolar spaces, where they are phagocytosed by macrophages The subsequent breakdown of red cells and hemoglobin leads to the appearance of hemosiderin-laden alveolar macrophages-- so-called hea failure cells--that reflect previous epi sodes of pulmonary edema. (Robbins Basic Pathology,9th edition,pg no.367)	medmcqa
bisferens pulse is seen in all except ?	[ "AS+ AR", "AR", "HYPEROPHIC CARDIOMYOPATHY", "TOF" ]	D	TOF	Pulsus Bisferiens It is single pulse wave with two peaks in systole * d/t ejection of rapid jet of blood through aoic valve * Best felt in brachial and femoral aery * AS + AR * Severe AR * HOCM(Hyperophic obstructive cardiomyopathy) . REF : harrisons 21st ed	medmcqa
True about MRI/CT appearance of lateral meningocele:	[ "Solid dural masses", "Usually outside the spinal canal", "Widened neural foramen", "Generally there is no spinal cord compression & deformity" ]	C	Widened neural foramen	C i.e. Widened neural foramen - Lateral meningocele is non solid, CSF containing leptomeningeal outpouching through widened neural foramen usually into paraspinal, intrathoracic spaceQ. And it is generally associated with spinal deformities like, posterior (dorsal) scalloping, erosion of pedicles, thinning of neural arch & ribs, widening of spinal canal & neural foramen and kyphoscoliosis.	medmcqa
Rapid infusion of insulin causes-	[ "Hyperkalemia", "Hypokalemia", "Hypernatremia", "Hyponatremia" ]	B	Hypokalemia	* Insulin, b2-adrenergic activity, thyroid hormone, and alkalosis promote Na+/K+-ATPase-mediated cellular uptake of K+, leading to hypokalemia. * stimulation of endogenous insulin can provoke hypokalemia, hypomagnesemia, and/or hypophosphatemia in malnourished patients given a carbohydrate load. (reference harrisons principles of internal medicine, 19E page-305)	medmcqa
Which occupation increases risk for silicosis:	[ "Mica worker", "Sugarcane worker", "Cotton industry workers", "Coal mine workers" ]	A	Mica worker	Ans. a. Mica workerSILICOSISDefinition: Silicosis is an occupational lung disease caused by inhalation of silica dust.Epidemiology: Silicosis is seen in individuals who work in mining, quarrying, tunneling, glass and pottery making, and sandblasting.Signs and Symptoms: Silicosis will cause similar symptoms to asbestosis (or any other pneumoconiosis) except the acute form of silicosis, which is caused by massive exposure that causes lung failure in months.Pathology: Silica causes inflammatory reactions with pathologic lesions being the hyaline nodule.Chest X-ray: In silicosis there are nodules (1-10 mm) seen throughout the lungs that are most prominent in the upper lobes. A characteristic finding is eggshell calcifications (rare). In progressive massive fibrosis, densities are 10 mm or more and coalesce in large masses.Diagnosis: A lung biopsy is usually necessary for the diagnosis of Silicosis.Treatment: fhere is no effective therapy for silicosis. Death occurs usually because of progressive respiratory insufficiency. There is an association of silicosis with pulmonary TB. Patients with silicosis should have yearly purified protein derivative (PPD) tuberculin testing; a patient with positive reactive PPD (> 10 mm) should get isoniazid (INH) prophylaxis for 9 months.Extra MileCauses of interstitial lung disease (ILD)CauseDiseaseAsbestosAsbestosisGlass workers, mining, sandblasting, brickyardsSilicosisCoal workerCoal worker's pneumoconiosisCottonByssinosisElectronics, ceramics, fluorescent light bulbsBerylliosisMercuryPulmonary fibrosis	medmcqa
The commonest tumour of parotid is	[ "Mucoepidermoid", "Mixed parotid tumour", "Adenolymphoma", "Squamous cell carcinoma" ]	B	Mixed parotid tumour	Pleomorphic adenomas are benign tumors that consist of a mixture of ductal (epithelial) and myoepithelial cells, and therefore they show both epithelial and mesenchymal differentiation. Because of their remarkable histologic diversity, these neoplasms have also been called mixed tumors. They represent about 60% of tumors in the parotid. Wahin tumor is the second most common. Both are benign. Robbins 9e pg: 745	medmcqa
Meibomian gland carcinoma may be mistaken for:	[ "Recurrent stye", "Recurrent chalazion", "Recurrent concretions", "Chronic conjunctivitis" ]	B	Recurrent chalazion	Ans. (b) Recurrent chalazion.	medmcqa
At what age does the child who knows his age, gender, name, can draw a circle and make a tower of 9 cubes?	[ "2 years", "3 years", "4 years", "5 years" ]	B	3 years	Ans. is 'b' i.e., 3 years Important milestones of a 3 years child* Rides tricycle* Knows his age and sex.* Stands momentarily on one foot* Repeat a sentence of 6 syllables* Draws a circle* Has a vocabulary of 250 words* Can dress or undress himself completely* Counts 3 objects correctly* Builds tower of 10 cubes* Can withhold and postpone bowel movement	medmcqa
A patient with cancer received extreme degree of radiation toxicity. Fuher history revealed that the dose adjustment of a paicular drug was missed during the course of radiotherapy. Which of the following drugs required a dose adjustment in that patient during radiotherapy in order to prevent radiation toxicity -	[ "Vincristine", "Dactinomycin", "Cyclophosphamide", "6-Mercaptopurine" ]	B	Dactinomycin	Ans. is 'b' i.e., Dactinomycin o The patient was most probably taking a radiosensitiser i.e., drugs which increases the toxicity due to radiotherpy. o The dose of these drugs should be decreased during radiotherapy o Among the drugs given in the question Actinomycin D or Dactinomycin is a radiosensitizer o Hypoxic cells are resistant to radiotherapy o Augmentation of oxygen is the basis of radiosensitization	medmcqa
True about cytokines are all except:	[ "It is polypeptide", "Have autocrine and paracrine effects", "Involve in leukocytic movements", "It takes pa in intrinsic enzymatic reaction" ]	D	It takes pa in intrinsic enzymatic reaction	D i.e It takes pa in intrinsic enzymatic reaction They are polypeptideQ in nature.Induced their effect in three ways: Autocrine, paracrine & endocrine effects.Q Mediates natural immunity Affects leucocytic movementQRegulate lymphocytic growth activation & differentiation.Activate inflammatory cells & stimulate hematopoesis.	medmcqa
Hydrocortisone acts as an anti–inflammatory agent because of induction of the synthesis of which of the following protein ?	[ "Heat shock protein 90", "Inhibin", "Transcortin", "Lipocortin" ]	D	Lipocortin	null	medmcqa
The operation of choice in ulcerative colitis	[ "Proctocolectomy with ileoanal anastomosis", "Subtotal colectomy and ileostomy", "Proctocolectomy and permanent end ileostomy", "Subtotal colectomy and ileorectal anastomosis" ]	A	Proctocolectomy with ileoanal anastomosis	The operation of choice in ulcerative colitis is proctocolectomy (with preservation of the anal sphincter complex) with ileoanal J pouch anastomosis (IPAA).Total proctocolectomy has the advantage of removing all diseased mucosa, thereby preventing fuher inflammation and the potential for progression to dysplasia or carcinoma. ie; Total colon and rectum are removed, ileal pouch is constructed (to function like rectum) and anastomosed to the anal canalRef: Sabiston 20e pg: 1372, Harrison 19e pg: 1962	medmcqa
Incised wounds on genitalia: AIIMS 09, 10	[ "Homicidal", "Suicidal", "Accidental", "Self-inflicted" ]	A	Homicidal	Ans. Homicidal	medmcqa
The pleural space into which lung tissue just above the cardiac notch would tend to expand during deep inspiration is the?	[ "Anterior mediastinum", "Costodiaphragmatic recess", "Costomediastinal recess", "Cupola" ]	C	Costomediastinal recess	The costomediastinal recess is an area right next to the cardiac notch, which is an indentation in the superior lobe of the left lung. This is where the medial area of the superior lobe of the left lung would tend to expand if it became very inflated. The lung would not enter the anterior mediastinum, which is an area between the two pleural sacs, bounded anteriorly by the sternum and posteriorly by the pericardium. The anterior mediastinum contains areolar tissue, sternopericardial ligaments, lymph vessels and nodes, but no lung tissue. The costodiaphragmatic recess is the recess at the inferior border of a lung. This is the space into which the inferior lobe of the lung would expand following deep inhalation. The cupola is the serous membrane lining the pleural cavity which extends above the level of the 1st rib into the root of the neck. The most superior poion of the superior lobe might expand into this space. The pulmonary ligament is the fold of pleura located below the root of the lung where the visceral pleura and the mediastinal parietal pleura are continuous with each other.	medmcqa
The co-factor for glycogen phosphorylase in glycogenolysis is:	[ "Thiamine pyrophosphate", "Pyridoxal phosphate", "Citrate", "FAD" ]	B	Pyridoxal phosphate	Glycogen phosphorylase catalyses the rate limiting step in glycogenolysis by catalyzing the phosphorolytic cleavage of glycogen to yield glucose 1-phosphate. Glycogen phosphorylase requires pyridoxal phosphate as its coenzyme.	medmcqa
In a patient with CSF otorrhea a cotton plug is kept in ear near Eustachian tube. A dye is injected in the sub- arachnoid space. The plug gets stained. Which of the following is most likely site of CSF leak?	[ "Temporal bone", "Ethmoid", "Sphenoid", "Cribriform plate" ]	A	Temporal bone	Ans. A. Temporal bone.CSF otorrhea# The most common cause of CSF otorrhea is trauma with fracture involving the tegmen tympani. Tegmen tympani which is formed in part by the petrous portion of the temporal bone, and the squamous portion of the temporal bone, forms the roof of the middle ear cavity. Other etiologies include perilymphatic fistula, surgeries involving the temporal bone, congenital anomalies, and destructive temporal bone tumors.# Fluid leaking from the nose or external auditory canal must first be positively identified as CSF. Drops of fluid from a CSF leak placed on absorbent filter paper may result in the double-ring sign, a central circle of blood and an outer clear ring of CSF. Serum glucose, chloride, and total protein tests of the fluid are not specific or conclusive for CSF.# Confirm or exclude the presence of CSF in leaking fluid by means of an immunoelectrophoretic study of the fluid for beta-2 transferrin or, beta-trace protein.# Methods for detecting CSF fistulas with intrathecal injections of dye pose a risk of chemical meningitis. Methylene blue, indigo carmine, and phenolsulfonphthalein (PSP) dyes are no longer in use. Some use a dilute solution of fluorescein to localize CSF fistulas both preoperatively and during surgery. Typically, is injected into the lumbar subarachnoid space over more than 1 minute. Cotton pledgets are placed in the nose. The dye reaches the skull base in 6 hours and is present over the cerebral convexities in 24 hours. The pledgets are examined for green fluorescence in a dark room with ultraviolet light 6 hours after the intrathecal PSP injection.# CT myelography is used in the detection of spinal CSF leak. CT cranial cisternography is performed with injection of 5-7 mL of nonionic myelographic contrast medium into the lumbar subarachnoid space. The patient is maintained in the prone position until a CT scan is performed. CT cistemographic findings in CSF leak include the concentration of contrast medium in portions of a paranasal sinus or within ethmoid or mastoid air cells. Occasionally, a stream of contrast medium is seen at the fistula site.Most common site for linear skull fracturesis the parietal bone, which is the thinnest of the cranial bones.Temporal bone fracturesclassified as transverse (extending across the petrous portion) or longitudinal (extending lateral to medial). Complication asso with transverse temporal bone fracture include CN VIII and CN VII injury, whereas longitudinal temporal fracture can cause hemotympanum, torn tympanic membrane, CSF leak, and conductive haering loss due to bony disruption.Basilar fracture of the temporal boneresults in "battle sign," which is postauricular ecchymoses and can be associated with CSF otorrhea.A frontal basilar farcture results in"raccoon's eyes", which is periorbital ecchymoses. CSF rhinorrhea can result due to frontal basilar fracture. The majority of CSF leaks resolve within 7 days without surgical intervention.	medmcqa
In pregnancy :	[ "Plasma fibrinogen levels are increased", "Fibrinogen levels are decreased", "Thyroglobulins are decreased", "IgD are markedly increased" ]	A	Plasma fibrinogen levels are increased	Plasma fibrinogen levels are increased	medmcqa
A 9-month-old girl is presented with PR bleed, vomiting, mass & colicky pain in Rt lumbar region with masked liver dullness. She is in shock like condition. Management should includes – a) Barium enema b) Saline reduction c) Give O2 d) Nasogastric tube d) IV fluid	[ "abc", "acd", "bcd", "abde" ]	D	abde	PR bleed, vomiting, mass in right lumbar region, colicky pain and masked liver dullness in a 9-month infant suggest the diagnosis of intussusception. Patient is also having shock, so she requires treatment of shock and intussusception. Diagnosis of intussusception The clinical history and physical findings are usually sufficiently typical for diagnosis. Plain abdominal radiographs may show a density in the area of the intussusception. A barium enema shows a filling defect or cupping in the head of barium where its advance is obstructed by the intussusceptum. A central linear column of barium may be visible in the compressed lumen of the intussusceptum, and a thin rim of barium may be seen traped around the invaginating intestine in the folds of mucosa within the intussuscipiens (coiled-spring sign), especially after evacuation. Retrogression of the intussusceptum under the pressure of the enema and gaseous distention of the small intestine from obstruction are also useful radiographic signs. Ileoileal intussusuception is usually not demonstrable by barium enema but is suspected because of gaseous distention of the intestine above the lesion. The use of "air" enemas in the diagnosis and treatment of intussusception has supplanted hydrostatic reduction. Reflux of air into the terminal ileum and the disappearance of the mass at the ileocecal valve document successful reduction. Air reduction is associated with fewer complications and lower radiation exposure than traditional hydrostatic techniques. Ultrasonography is a sensitive diagnostic tool in the diagnosis of intussusception. Treatment of Intussusception The child should be first stabilized. A tube should be passed into the stomach through nose (nasogastric tube). An intravenous line should be placed and fluids should be given to prevent dehydration. Reduction of an acute intussusception is an emergency procedure and performed immediately after diagnosis in preparation for possible surgery. The reduction can be achieved by installation of barium, saline or air. "In patients with prolonged intussusception with signs of shock, peritoneal irritation, intestinal perforation or pneumatosis intestinal, reduction (with barium, saline or air) should not be attempted". In the above cases and in cases where reduction by barium/saline/air fails, surgery is required, i.e., manual operative reduction. If the manual operative reduction is not possible or the bowel is not viable, resection of the intussusception is necessary, with an end to end anastomosis. Treatment of shock (e.g. O2 IV fluid etc) should be given first if it is present. About option a & b As the patient is in shock, reduction by air or barium is contraindicated. However, a barium enema can be used as a diagnostic modality.	medmcqa
Lower l/3rd of anal canal is derived from-	[ "Proctodaeum", "Cloaca", "Urogenital Sinus", "Midgut" ]	B	Cloaca	Ans. is 'b' i.e., Proctodaeum * 'The lower third of the anal canal is an ectodermal derivative and is derived from the proctodaeum.'* Part of anal canal above pectinate line develops from dorsal part of endodermal cloaca (primitive rectum) and part of anal canal below pectinate line develops from ectodermal proctodeum.	medmcqa
Injury caused to the pedestrian in a vehicular accident due to his/her striking onto the object on road is known as -	[ "Primary injury", "Secondary injury", "Acceleration injury", "Decceleration injury" ]	B	Secondary injury	Secondary injury is caused by person violently falling on ground (road) or on stationary object.	medmcqa
The area of the colon which is least visualized by barium studies -	[ "Sigmoid", "Hepatic flexure", "Splenic flexure", "Caecum" ]	A	Sigmoid	null	medmcqa
Transitional epithelium is seen in-	[ "Esophagus", "Vagina", "Urinary bladder", "Trachea" ]	C	Urinary bladder	Lining of urinary bladder is Transitional epithelium.	medmcqa
Strawberry berry gallbladder' is seen in	[ "Porcelain gall bladder", "Cholesterosis", "Necrosis of gall bladder", "Gall bladder carcinoma" ]	B	Cholesterosis	the strawberry gallbladder is seen in cholesterosis,i.e.abnormal deposition of cholestrol in gallbladder.In the freshstate,the interior of the gallbladder looks something like a strawberry,the yellow specks (submucous aggregations of cholesterol crystals and cholesterol esters )correspond to the seeds. It may be associated with cholesterol stones. Ref Bailey and love 27e p1188	medmcqa
Gabapentin has which mechanism of action for its antiepileptic effect ?	[ "Inhibits monoamine oxidase", "Blocks the re-uptake of neurotransmitters", "Increase the release of neurotransmitters", "Block Na+channels" ]	C	Increase the release of neurotransmitters	null	medmcqa
Criteria for a pancreas donor include:	[ "No history of diabetes", "No liver donation", "No replaced hepatic aery vessels arising from the superior mesenteric aery (SMA)", "No previous splenectomy" ]	A	No history of diabetes	- Combined liver-pancreas procurement should be routine, even if the right hepatic aery arises from the superior mesenteric aery. - In this situation, since the transplanted liver is the life-saving organ, the proximal superior mesenteric aery should remain with the liver and the distal superior mesenteric aery supplying the head of the pancreas can be reconstructed on a Y-graft of iliac aery with the splenic aery. - Successful pancreas transplantation can be performed using donors who have previously undergone splenectomy; however, there should be no significant pancreatitis and no history of diabetes in the donor.	medmcqa
In hyperventilation	[ "P50 and Hb affinity for O2 increases", "P50 and Hb affinity for O2 decreases", "P50 increases and affinity O2 decreases", "P50 decreases and affinity O2 increases" ]	C	P50 increases and affinity O2 decreases	Abnormally fast and deep breathing, the result of either an emotional state or a physiological condition. Emotional causes include acute anxiety and emotional tension, such as in nervous, anxious patients who may have other functional disturbances related to emotional problems. Physiological causes include a rapid decrease in intracranial pressure, other neurologic problems, and metabolic, pulmonary, and cardiovascular conditions.Ref: Ganong&;s Review of Medical Physiology; 24th edition; page no:647	medmcqa
Lacunar infarction is seen in:	[ "Large vessel stroke", "Small vessel stroke", "Artery to artery embolic stroke", "Temporal arteritis" ]	B	Small vessel stroke	(Small vessel stroke) (2378-H 16th) (864-66-CMDT-2009) (2519-H17th)(A) LACUNAR INFARCTION - refer to infarction following atherothrombotic or lipohyalinotic occlusion of a small artery (30 to 300 pm) in the brain. The term small vessel stroke denotes occlusion of such small penetrating artery and is now the preferred.* Lacunar infarctions are associated with poorly controlled hypertension or diabetes.(B) CEREBRAL INFARCTION - Thrombotic or embolic occlusion of a major vessels leads to cerebral infarction.* Causes include the disorders predisposing to transient ischemic attacks and atherosclerosis.	medmcqa
In papilledema, all the following are true except -	[ "Blurring of the disc", "Congestion of retinal veins", "Soft white exudates around the disc", "Sudden loss of vision" ]	D	Sudden loss of vision	Visual acuity and pupillary reactions usually remain fairly normal until late stages when optic atrophy sets. Even then, there is gradually progressive painless loss of vision.	medmcqa
Which of the following is the safest method of sterilization in immediate post paum period :	[ "Minilaparotomy", "Laparoscopy", "Hysteroscopic method", "None" ]	A	Minilaparotomy	Minilaparotomy	medmcqa
Meniscal tears usually result from which of the following circumstances?	[ "Hyperextension", "Flexion and rotation", "Simple hyperflexion", "Compression" ]	B	Flexion and rotation	Most meniscal tears are produced by flexion and rapid rotation. A classic example ("football knee") involves a player who is hit while running. The knee, supporting all the player's weight, usually is slightly flexed, and the foot is anchored to the ground by cleats. Impact from an opposing player usually causes rotation almost entirely restricted to the knee. The injury involves rapid rotation of the flexed femoral condyles about the tibial plateau, which most frequently tears the medial meniscus. (Less frequently, the lateral meniscus is torn.) A tear in the inner free border of the cartilage is also common whenever excessive rotation without flexion or extension occurs. Early surgical removal of the displaced menisci is usually recommended to prevent further damage to the cartilage or ligaments.	medmcqa
Antidote used in methyl alcohol poisoning is?	[ "EDTA", "Alpha methyl dopa", "Acetyl cysteine", "Fomepizole" ]	D	Fomepizole	ANSWER; (D) FomepizoleREF: APPENDIX-42 below for list of "Antidotes" APPENDIX - 42AntidotesAntidotePoison/drug/toxinN-AcetylcysteineAcetaminophenCarbon tetrachlorideOther hepatotoxinsAmyl nitrite, sodium nitrite and sodium thiosulfate (Cyanide antidote kit)NitrilesBromatesChloratesCyanide (e.g., HCN, KCX and NaCN)Mustard agentsNitroprussideSmoke inhalation (combustion of synthetic materials)Antivenin, Crotalidae Polyvalent (Equine Origin)Pit viper envenomation (e.g. rattlesnakes, cottonmouths, timber rattlers and copperheads)Antivenin, Crotalidae Polyvalent Immune Fab - Ovine (CroFab)Pit viper envenomation (e.g.. rattlesnakes, cottonmouths, timber rattlers and copperheads)Atropine sulfateAlpba2 agonists (e.g., clonidine)Alzheimer drugs (e.g., donepezil, galantamine, rivastigmine, tacrine)Antimyesthenk agents (e.g., pyridostigmine)Bradyarrhythmia-producing agents (e.g., beta blockers, calcium channel blockers and digitalis glycosides)Cholinergic agonists (e.g., bethanechol) .Muscarine-containing mushrooms Nerve agents (sarin, soman, tabun and VX)Organophosphate and carbamate insecticidesDigoxin immune FabCardiac glycoside-containing plants (foxglove and oleander)Digitoxin, DigoxinEthanolEthylene glycolMethanolFlumazenilBenzodiazepinesZaleplonZolpidemFolic acid and Folinic acid (Leucovorin)Formaldehyde/Formie AcidMethanolMethotrexate, trimetrexatePyrimethamineTrimethoprimFomepizoleEthylene glycolMethanolGlucagonBeta blockersCalcium channel blockersHypoglycemiaHypoglycemic agentsHydroxocobalaminNitrilesBromatesChloratesCyanide (e.g., HCN, KCN and NaCN)Mustard agents NitroprussideSmoke inhalation (combustion of synthetic materials)Hyperbaric oxygen (HBO)Carbon monoxideCarbon tetrachlorideCyanideHydrogen sulfideMethemoglobinemiaMethylene blueMethemoglobin-inducing agents including;Aniline dyesDapsoneLocal anesthetics (e.g., benzocaine)MetoclopramideNaphthaleneNitrates and nitritesNitrobenzenePhenazopyridineNalmefene and NaloxoneACE inhibitorsAlpha2 agonists (e.g., clonidine)Imidazoline decongestants (e.g., oxymetazoline and tetrahydrozoline) LoperamideOpioids (e.g., codeine, fentanyl, heroin, meperidine, morphine)Physostigmine salicylateAntihistaminesAtropine and other anticholinergic agentsDhatura poisoningIntrathecal baclofenPhytonadione (Vitamin Kl)Long-acting anticoagulant rodenticides (e.g., brodifacoum and bromadiolone) WarfarinPralidoxime chloride (2-PAM)Antimyesthenic agents (e.g., pyridostigmine)Nerve agents (sarin, soman, tabun and VX)Organophosphate insecticidesTacrineProtamine sulfateEnoxaparinHeparinPyridoxine hydrochloride (Vitamin B6)Acrylamide Ethylene glycol Hydrazine Isoniazid (INH)Sodium bicarbonateChlorine gasHyperkalemiaSerum Alkalinization:Agents producing a quinidine-like effect as noted by widened QRS complex on EKG (e.g., amantadine, carbamazepine, chloroquine,cocaine, diphenhydramine, flecainide,tricyclic antidepressants, quinidine)Urine Alkalinization:Weakly acidic agents (chlorpropamide, methotrexate, phenobarbital and salicylates)Deferoxamine and DeferasiroxAcute iron poisoningDimercaprol (BAL in oil)Hydrofluoric acid (HF)Hyperkalemia (not digoxin-induced)HypermagnesemiaCalcium disodium EDTA (Versenate)Acute arsenic poisoning,Acute mercury poisoning,Lead poisoning (in addition to EDTA)Dicobalt EDTACyanide poisoningSucdmer/ Dimercaptosuccinic acid (DMSA)Lead poisoning,Arsenic poisoning,Mercury poisoningDimercapto-propane sulfonate (DMPS)Severe acute arsenic poisoning,Severe acute mercury poisoningD-Penicillamine (Cuprimine)Mainly in: copper toxicityOccasionally adjunctive therapy in: Gold toxicity, Arsenic poisoning, Lead poisoning, Rheumatoid arthritisBotulinum antitoxin * Bivalent (types AB)<< Trivalent (types ABE)Food-borne botulismWound botulismBotulism as a biological weaponNote: Not currently recommended for infant botulismL-CarnitineValproic acidCyproheptadine HCLMedications causing serotonin symdromeDantrolene sodiumMedications causing neuroleptic malignant symdrome (NMS)Medications causing malignant hyperthermiaInsulin and dextroseBeta blockersCalcium channel blockers (diltiazem, nifedipine, verapamil)Octreotide acetateSulfonylurea hypoglycemic agents (e.g., glipizide, glyburide)Sodium thiosulfateBromatesChloratesMustard agentsNitroprussideThiamineEthanolEthylene glycolPrussian blue, ferric hexacyan ofer rateRadioactive cesium (Cs-137), radioactive thallium (Tl-201), and nonradioactive thallium	medmcqa
In a child with respiratory distress, failure to thrive. His sweat chloride leveles were estimated 35 meq/L and 41 meq/L. What is next best test to do cystic fibrosis for diagnosis aEUR'	[ "Nasal transmembrane potential difference", "DNA analysis AF 508 mutation", "CT chest", "72 hour fecal fat estimation" ]	C	CT chest	Trans epithelial nasal potential difference Diagnosis of cystic fibrosis Sweat chloride testing The sweat test is the standard approach to diagnosis. The diagnosis is made by elevated sodium and chloride level in the sweat > 60 meoll. Two tests on different days are required .for accurate diagnosis. A normal sweat chloride dose not exclude the diagnosis. Genotyping and other tests such as measurement of nasal membrane potential difference, pancreatic .function should be done if there is high clinical suspicion of cystic fibrosis. Nasal potential difference Measurement of nasal transepithelial potential difference in vivo can be useful adjunct in the diagnosis of cystic fibrosis. Individuals with cystic fibrosis demonstrate a significantly more negative baseline nasal potential difference, with the topical application of amiloride there is loss of this potential difference. Nasal potential difference is a sensitive test of electrolyte transpo (CFTR) function that can be used to suppo or refute a diagnosis of cystic fibrosis. Genetic analysis Cystic .fibrosis is an autosomal recessive disorder. It is caused due to defect in CFTR (Cystic fibrosis transmembrane conductance regulator) protein. Cystic fibrosis is associated with large number of mutations. More than 1500 CFTR polymoiphisms are associated with cystic fibrosis syndrome. The most prevalent mutation of CFTR is the deletion of single phenylalanine residue at amino acid 4.508 This mutation is responsible for high incidence of cystic fibrosis in nohern European populations. Approximately 50% of individuals with CF who are of nohern European ancestry are homozygous for 4.508 and > 70% carry at least one 4.508 gene. The remainder of patients has an extensive array of mutation, none of which has prevalence of more than several percent. Testing for cystic .fibrosis mutation was not possible because of the large no. of mutations associated with the disease. Now days commercial laboratories test for 30-80 of the most common CFTR mutations. This testing identifies > 90% individuals who carry 2 CF mutations. No where it is mentioned in the texts that testing only for 4508 is enough for diagnosis. Detection of atleast 2 CF mutations are necessary for making the diagnosis of cystic fibrosis. The patient has features of cystic fibrosis but sweat chloride levels are normal. - To diagnose cystic .fibrosis in this patient, another laboratory evidence demonstrating CFTR dysfunction is required. This can be done by two methods:? - Demonstrating abnormal potential difference - Demonstrating abnormal CF mutations. But the diagnostic criteria for cystic fibrosis requires. - Demonstration of two CF mutations (demonstration of single abnormal F508 mutation is not enough) So we are left with abnormal nasal potential difference. - It is an established laboratory evidence for CFTR dysfunction and is accepted as a diagnostic criteria to establish the diagnosis of cystic fibrosis. Diagnostic criteria for cystic fibrosis Presence of typical clinical features (respiratory, G.LT, genitourinary) OR A history of CF in a sibling OR A positive newborn screening test PLUS Laboratory evidence for CFTR Dysfunction Two elevated sweat chloride concentrations obtained on separate days OR Identification of two CF mutations OR An abnormal nasal potential difference	medmcqa
Child attains a height of 100 cm at the age of: March 2011	[ "1 year", "2 years", "3 years", "4 years" ]	D	4 years	Ans. D: 4 years A normal Indian child is 100 cm tall at the age of 4.5 years	medmcqa
Breast conservation surgery is contraindicated in	[ "Tumor > 4 cm", "Multicentric tumor", "Axillary LN involvement", "All of the above" ]	D	All of the above	.Contraindications * Tumour > 4 cm * Positive axillary nodes > N1 * Tumour margin is not free of tumour after breast conservative surgery needs MRM * Poorly differentiated tumour * Multicentric tumour * Tumour/breast size ratio is more (centeral tumour) * Tumour beneath the nipple * Extensive intraductal carcinoma Ref; (page no;553 ) 5th edition of SRB&;S manual of Surgery	medmcqa
ECG changes in hyperkalemia are all except -	[ "Prolonged PR interval", "Depressed ST-segment", "Inverted T wave", "Wide QRS" ]	C	Inverted T wave	Ans. is 'c' i.e., Inverted T wave HypokalemiaHyperkalemiao Prominent U wave (earliest change)o Sine wave configurationo Flattening and inversion of T-waveo Tall, tented T-wave (peaked & narrow)o Prolonged PR-interval, QRS widening (in severe H~) o Prolonged PR-interval, QRS widening and(But PR & QRS constant when K+ +- 3.5 mEq/L)o \|HR (Complete heart block or ventricularo Prolonged QT intervalasystole may occur)o Depressed / sagging of ST-segmento Depressed ST-segment	medmcqa
Fructose intolerance is due to deficiency of?	[ "Aldolase B", "Fructokinase", "Triokinase", "Aldolase A" ]	A	Aldolase B	Ans. is 'a' i.e., Aldolase B DiseaseDificient enzymesEssential fructosuriaFructokinaseHereditary fructose intoleranceAldolase-BGalactosemiaGalactose-1-phosphate uridyl transferase (most common), Galactokinase UDP-galactose-4-epimeraseLactose intoleranceLactase (b-galactosidase)Essential pentosuriaL-xylulose dehydrogenase (xylulose reductase)	medmcqa
All of the following statements are true regarding anterior axillary lymph nodes EXCEPT-	[ "Present on anterior wall of axilla on pectoral muscle", "Present along the lateral thoracic vein", "Drains into central axillary lymph nodes", "Drains the medial aspect of mammary gland" ]	D	Drains the medial aspect of mammary gland	Anterior axillary / pectoral lymph nodes are present along the lateral thoracic vein on the anterior wall of axilla on pectoral muscle. These drains the lateral aspect of mammary gland. And finally drains into central axillary lymph nodes.	medmcqa
Inheritence of Familial hypophosphatemic Rickets is	[ "Autosomal recessive", "X-linked dominant", "X-linked recessive", "Autosomal dominant" ]	B	X-linked dominant	null	medmcqa
Paranasal sinuses presents at bih are	[ "Frontal and maxillary", "Ethmoid and maxillary", "Frontal and ethmoid", "Sphenoid and ethmoid" ]	B	Ethmoid and maxillary	Paranasal sinuses develop as outpouchings from the mucous membrane of a lateral wall of the nose. The growth of sinuses continues during childhood and into early adult life. Radiologically maxillary sinuses can be identified at 4-5 months, ethmoids at 1 year, sphenoid at 4 years and frontals at 6 years. Reference: Diseases of ear, nose and throat; PL Dhingra; 6th edition; Pg no.189	medmcqa
In children, the most common lesion in anterior teeth are due to	[ "Nursing bottle caries", "Dental trauma", "Malformation of tooth", "Discolouration" ]	A	Nursing bottle caries	- In children, the most common lesion in anterior teeth are due to nursing bottle caries. - These lesions begin on the labial surface of all anterior and they progress rapidly as diffused demineralization of the entire surface of all existing teeth.	medmcqa
Ketone bodies are used by all except ?	[ "Brain", "RBCs", "Skeletal muscles", "Hepatocytes" ]	D	Hepatocytes	Ans. is 'd' i.e., Hepatocytes Ketone bodies are synthesized by liver and are utilized by extrahepatic tissues like hea, muscles, renal coex and brain (in starvation). Liver cannot utilize ketone bodies because it lacks enzyme succinyl-CoA-acetoacetate CoA transferase, which is required for the activation of ketone bodies. The first reaction in use of ketone bodies is activation of acetoacetate. CoA-transferase Succinyl CoA + acetoacetate ___________________ Acetoacetyl CoA + succinate	medmcqa
Bevelling of inner table of skull is found in	[ "Fire arm entry wound", "Fire arm exit wound", "Drowning", "Infanticide" ]	A	Fire arm entry wound	A i.e. Firearm entry wound When a bullet traverses the skull, the apeure in the bone differs in relation to the outer & inner tables; the defect is larger in the I direction in which the bullet travelsQ	medmcqa
A patient comes with history of unresponsive fever and cough. X-ray revealed pneumonia. Sputum examination showed gram positive, paially acid fast bacteria with branching filaments that grows on sheep blood agar. The most likely etiologic agents is:	[ "Actinomycetes", "Nocardia", "Aspergillosis", "Pneumococci" ]	B	Nocardia	Ans. (b) i.e. Nocardia	medmcqa
Most sensitive test for sanguinarine is :	[ "Paper chromatography", "HCL", "Fecl3", "Nitric acid" ]	B	HCL	Can be detected by both Nitric acid test and paper chromatography test (Most sensitive test).	medmcqa
Budd - Chiari Syndrome occurs in:	[ "Antithrombin deficiency", "Protein C deficiency", "Oral contraceptive use", "All of the above" ]	D	All of the above	(All of the above) (336, 627, 1862, 1874-H 16th) (612-13-CMDT-09) (362, 661, 733,1945, 1990-Hl7th)BUDD-CHIAR1 SYNDROME (Hepatic vein obstruction)* Many cases associated with polycythemia vera or other proliferative diseases* Predisposition to thrombosis (e.g. - hyperprothrombinemia) factor II G20210 A mutation) activated protein C resistance (Factor V Leiden mutation) Protein C or S or antithrombin deficiency, the methylenetetrahydro folate reductase mutation, antiphospholipid antibodies can be identified.* Right sided heart failure or constrictive pericarditis, neoplasm.* Paroxysmal nocturnal hemoglobinuria, Behcet's syndrome blunt abdominal trauma, use of oral contraceptives and pregnancy.* Cytotoxic agents and pyrrolizidine alkaloids ("bush teas")The screening test of choice is colour or pulsed Doppler ultrasonography	medmcqa
Osteoblastic secondaries are most commonly seen from which primary malignancy?	[ "Lung", "Prostate", "Adrenal", "Breast" ]	B	Prostate	Ans is 'b' i.e. Prostate	medmcqa
Most common type of hypospadias is: September 2011	[ "Glandular", "Penile", "Coronal", "Perineal" ]	A	Glandular	Ans. A: Glandular Glandular hypospadias is common and does not usually require treatment Hypospadias: The external meatus opens on the underside of the penis or the perineum, and the inferior aspect of the prepuce is poorly developed (hooded prepuce) Meatal stenosis occurs Bifid scrotum 6 - 10 months of age is the best time for surgery	medmcqa
Which of the following is the most common location of hypertensive haemorrhage -	[ "Pons", "Thalamus", "Putamen/external capsule", "Subcortical white matter" ]	C	Putamen/external capsule	null	medmcqa
A 32-year old male with no past medical history is brought to the emergency department after being injured in a bomb blast. On examination he is suspected to have a splenic injury and is supposed to undergo an emergency laparotomy. Which of the following is the ideal anaesthetic agent of choice?	[ "Remifentanil", "Morphine", "Etomidate", "Halothane" ]	C	Etomidate	Ans. c. Etomidate (Ref: Morgan 4/e p167, 194, 199)A 32-year -old male with no past medical history is brought to the emergency department after being injured in a bomb blast. On examination he is suspected to have a splenic injury and is supposed to undergo an emergency laparotomy. The ideal anaesthetic agent of choice would be etomidate, as it has minimal effects on the cardiovascular system."Abdominal trauma patient especially with splenic injury are at high risk of hypotension, etomidate is agent of choice as it has minimal effects on the cardiovascular system.""Etomidate has minimal effects on the cardiovascular system. A mild reduction in peripheral vascular resistance is responsible for a slight decline in arterial blood pressure. Myocardial contractility and cardiac output are usually unchanged. Etomidate does not release histamine.""Opioids: In general, opioids do not seriously impair cardiovascular function. Meperidine tends to increase heart rate (it is structurally similar to atropine). Ramifentanyl, and alfentanyl are associated with vagus-mediated bradycardia With the exception of meperidine, the opioids do not depress cardiac contractility. Nonetheless, arterial blood pressure often falls as a result of bradycardia, venodilation, and decreased sympathetic reflexes, sometimes requiring vasopressor (eg., ephedrine) support. Meperidine and morphine evoke histamine release in some individuals that can lead to profound drops in systemic vascular resistance and arterial blood pressure.""Halothane: A dose-dependent reduction of arterial blood pressure is due to direct myocardial depression. 2.0 MAC of halothane results in a 50% decrease in blood pressure and cardiac output."EtomidateEtomidate is a carboxylated imidazole compound that is a selective positive allosteric modulator at GABA-A receptorQUnlike thiopental does not appear to affect other pentameric ion channels.It is structurally unrelated to other agents.Mechanism of Action:Selective positive allosteric modulator at GABA-A receptorQPharmacokinetics:It is rapidly acting general anesthetic agent with a short duration of action (2-3 min), resulting predominantly from redistribution, although it is also eliminated rapidly from bodyQ.Characteristic Features:It is characterized by hemodynamic stability, minimal respiratory depression and cerebroprotective effectQ.It is a sedative hypnotic but lacks analgesic propertiesQAs with thiopental, cerebral blood flow and metabolism, intracranial and intraocular pressure all fall with etomidateQAs with methohexital, excitatory phenomenon (on induction) may be seen which can be prevented by benzodiazepine premedication or concomitant use of opioid.Central sympathetic out flow is stimulated, which maintains hemodynamics. Because of minimal cardiovascular effect, CPP is well maintained.It enhances somatosensory evoked potentials on EEG.Side-Effects:It causes adrenocortical suppressionQ by inhibiting enzymes 11-beta hydroxylase (mainly) and 17-alpha hydroxylase involved in cortisol and aldosterone (mineralocorticoid) productionQ. Vitamin C supplementation restores cortisol level.Excitatory phenomenon causing myoclonus, hiccups and other involuntary movements (40%); emergence phenomenon causing restlessness and delirium during recoveryQHigh incidence of nausea and vomiting (highest among all IV anesthetics i.e. ~40%)Pain on injection; Vitamin C deficiency; ThrombophlebitisQ	medmcqa
A 30-year-old multiparous female complains of a painless ulcer in vulva. She has several sexual partners. Her previous pregnancy has ended in a still birth at 24 weeks. What is the first test, which should be performed in this case:	[ "ELISA for HIV", "VDRL Test", "Culture of scraping from the ulcer", "Election microscopy of scraping from the ulcer" ]	B	VDRL Test	Ans is b, i.e. VDRL TestRef: Dutta Gynae 6th/ed, p262The female is presenting with a single painless ulcer, she has multiple sex partners and her pregnancy resulted in still birth at 24 weeks. All this points towards syphilis as the diagnosis.The first test to be performed in this case is VDRL test (screening test).Confirmatory test = specific treponemal test like Treponema haemaggluteration test or fluorescent treponemal antibody test.InfectionDiagnosisChlamydiaNAAT or PCRGonorrheaNAATChancroidCulture of scrapings from ulcerGenital herpesElectron microscopy of scrapings from ulcerLGVELISA test	medmcqa
The treatment for CNS leukaemia is	[ "Intrathecal methotrexate", "Vincristine and prednisolone", "Intrathecal vincristine", "IV prednisolone" ]	A	Intrathecal methotrexate	Intrathecal methotrexate is a chemotherapy drug which is given to prevent leukaemia cells entering the cerebrospinal fluid (CSF) around the spine and brain. This drug is also used to treat leukaemia found in the CSF for CNS leukemias Ref Davidson 23rd edition pg 788	medmcqa
A young girl presented with swelling of right thigh with history of trauma 2 months back. Now she presents with swelling at mid shaft of femur and low grade fever. ESR is midly raised. X ray shows a laminated Periosteal reaction, next line of investigation would be	[ "MRI", "Biopsy", "Bone scan", "Blood count and CRP" ]	A	MRI	Next best investigation is MRI Extent of soft tissue involvement Skip lesions in the same compament Relationship if neurovascular bundle to the tumor Intramedulary extent of tumor Refer Campbell 13th/e	medmcqa
Fatty acid synthase complex result in formation of	[ "14 carbon chain", "16 carbon chain", "18 carbon chain", "20 carbon chain" ]	B	16 carbon chain	Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 136-138	medmcqa
Arthritis mutilans is a feature of?	[ "Lichen planus", "Psoriasis", "Staphylococcal scalded skin syndrome", "Eczema" ]	B	Psoriasis	Ans. b (Psoriasis). (Ref. Harrison' sprinciples of medicine -18th/Chapter 52.)PSORIASIS# Classical features:- White scaly plaques with specific distribution over the body.- Pitting (thimble) of nails.- Onychodystrophy, Subungual hypertrophy.- Arthritis mutilans, rare and late feature {pencil in cup sign, pestle in mortar sign). (MH 2008)# Treatment:- Unstable psoriasis = liberal application of topical bland emollient & supportive therapy.- PUVA therapy is used in severe cases.- Oral methotrexate, retinoids, cylosporin can be used, however systemic steroids are usually avoided for the fear of precipitating pustular psoriasis upon withdrawal.	medmcqa
Sine wave pattern in E.C.G. is seen in-	[ "Hypokalemia", "Hyperkalemia", "Hyponatremia", "Hypermatremia" ]	B	Hyperkalemia	null	medmcqa
Maximum recommended external beam radiation therapy dose for a case of Carcinoma cervix is?	[ "80 Gy", "70 Gy", "50 Gy", "35 Gy" ]	C	50 Gy	Ans. C. 50 Gy."External-beam doses of more than 40 to 45 Gy to the central pelvis tend to compromise the dose deliverable to paracentral tissues and increase the risk of late complications. However, recently IMRT (Intensity Modulated Radiotherapy) allows delivery of doses exceeding 60 Gy with relative sparing of adjacent critical structures"Discussion:RADIATION THERAPY IN CERVICAL CANCERAs with radical surgery, the goal of radical radiotherapy is to sterilize disease in the cervix, paracervical tissues, and regional lymph nodes in the pelvis. Patients are usually treated with a combination of external-beam irradiation to the pelvis and brachytherapy. Brachytherapy is a critical element in the curative radiation Rx of all carcinomas of the cervix. Even relatively small tumors that involve multiple quadrants of the cervix are usually treated with total doses of 80 to 85 Gy to point A.Teletherapy dose rates:# An initial dose of 40 to 45 Gy to the whole pelvis, is believed to deliver a homogeneous distribution to the entire region at risk for microscopic disease and the additional tumor shrinkage achieved before brachytherapy outweigh other considerations.# External-beam doses of more than 40 to 45 Gy to the central pelvis tend to compromise the dose deliverable to paracentral tissues and increase the risk of late complications.# Recently, there has been considerable interest in the use of IMRT to treat the pelvis in patients with endometrial and cervical cancer. Unlike standard two-field and four-field techniques, IMRT makes it possible to deliver a lower daily dose to the intrapelvic contents than to surrounding pelvic lymph nodes. IMRT allows delivery of doses exceeding 60 Gy with relative sparing of adjacent critical structures.Brachytherapy dose rates:# An effort should always be made to deliver at least 85 Gy (with LDR brachytherapy-csl37) to Point A for patients with bulky central disease.# If the intracavitary placement has been optimized, this can usually be accomplished without exceeding a dose of 75 Gy to the bladder reference point or 70 Gy to the rectal reference point.# The dose to the surface of the lateral wall of the apical vagina should not usually exceed 120 to 140 Gy.# A total dose (external-beam and intracavitary) of 50 to 55 Gy appears to be sufficient to sterilize microscopic disease in the pelvic nodes in most patients. It is customary to treat lymph nodes known to contain gross disease and heavily involved parametria to a total dose of 60 to 65 Gy (including the contribution from brachytherapy Rxs).	medmcqa
During skeletal muscle contraction:	[ "A band shorten", "Both H and I band shorten", "Both A and I band shorten", "Both A and H band shorten" ]	B	Both H and I band shorten	During muscle contraction, two Z lines come closer; the length of the ‘A band’ remains constant whereas the length of H and I band decreases. The M line becomes more prominent.	medmcqa
ln &;V&;-Exotropia amount of detion	[ "Decreases in upward gaze and increases in downward gaze", "Decreases in upward as well as downward gaze", "Increases in upward as well as downward gaze", "Increases in upward gaze and decreases in downward gaze" ]	D	Increases in upward gaze and decreases in downward gaze	A' AND 'V' PATTERN HETEROTROPIA The terms 'A' or 'V' pattern squint are labelled when the amount of detion in squinting eye varies by more than 10deg and 15deg, respectively, between upward and downward gaze. 'A' and 'V' esotropia. In 'A' esotropia the amount of detion increases in upward gaze and decreases in downward gaze. The reverse occurs in 'V' esotropia. 'A' and 'V' exotropia. In 'A' exotropia the amount of detion decreases in upward gaze and increases in downward gaze. The reverse occurs in 'V' exotropia. Ref:- A K KHURANA; pg num:-334	medmcqa
Late metabolic acidosis in newborns are caused due to feeding of which formula:	[ "Whey predominant", "Casein predominant", "Both of the above", "None of the above" ]	B	Casein predominant	Casein dominant formulas or cow's milk has higher concentration of aromatic acids like tyrosine and phenylalanine that may lead to late metabolic acidosis. Ref: Nutrition and Child Development, K.E. Elizabeth, 4th edition pg: 26	medmcqa
Commonest cutaneous eruption in SLE is:	[ "Palmar erythema", "Discoid lesions", "Erythema of light exposed area", "Diffuse morbiliform erythema" ]	C	Erythema of light exposed area	Erythema of light exposed area	medmcqa
"Sub-mucosal glands" are present in?	[ "Duodenum", "Colon", "Anal canal", "Stomach" ]	A	Duodenum	Duodenum and oesophagus have submucosal glands. The submucosa of the duodenum is densely packed with mucous Brunner&;s glands.The oesophagus has occasional submucosal mucous glands.Reference: Chaurasia; 6th edition	medmcqa
Coenzyme A in TCA contains which of the following?	[ "Thiamine", "Riboflavin", "Panthothenic acid", "Nicotinic acid" ]	C	Panthothenic acid	Co-enzyme Activity of Pantothenic Acid - i. The beta mercaptoethanol amine (NH2-CH2- CH2-SH) contains one thiol or sulfhydryl (-SH) group. It is the active site where acyl groups are carried. Therefore the co-enzyme A is sometimes abbreted as CoA-SH to denote this active site. ii. The thio ester bond in acyl-CoA is a high energy bond. These acyl groups are transferred to other acceptors, for example: Acetyl CoA + Choline - Acetyl choline + CoA (enzyme is acetyl choline synthase) iii. Acyl groups are also accepted by the CoA molecule during the metabolism of other substrates, for example: Pyruvate+CoA+NAD+ - AcetylCoA+CO2+NADH (Enzyme is pyruvate dehydrogenase). iv. The impoant CoA derivatives are: Acetyl CoA Succinyl CoA HMG CoA Acyl CoA. v. Co-enzyme A is an impoant component of fatty acid synthase complex. The ACP (acyl carrier protein) also contains pantothenic acid. Ref: DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY, EIGHTH EDITION,PG.NO.,472.	medmcqa
Test normally undeaken to demonstrate the presence of collateral circulation of hand is NOT RELATED-SURGERY	[ "Kety Schmidt test", "Allen's test", "Sellick's test", "Swan Ganz test" ]	B	Allen's test	Allen's test is done to determine the presence of collateral circulation of hand before cannulating radial aery.	medmcqa
Pudendal canal is a pa of -	[ "Colle's fascia", "Obturator fascia", "Scarpa's fascia", "None" ]	B	Obturator fascia	Ans. is'b'i.e., Obturator fasciaPudendal canal (Alcock's canal) is a fascial canal in the lateral wall of ischeorectal (ischeo-anal) fossa.It is a space between obturator fascia and lunate fascia. Other believe that it is formed by splitting of the obturator fascia.Contents of pudendal canal are -Pudendal nerve,Internal pudendal aery, andInternal pudendal vein.	medmcqa
The most common complication of hypermature sclerotic cataract is	[ "Dislocation of the lens", "Phacomorphic glaucoma", "Uveitis", "Neovascularization of retina" ]	A	Dislocation of the lens	Subluxation of the lens is the most common complication of nuclear sclerotic hypermature cataract refer Khurana 6th edition page number 184	medmcqa
True regarding 10-0 sutures is/are?	[ "Thicker than 1-0 sutures", "Synthetic sutures", "Diameter is 0.9 mm", "Stronger than 1-0" ]	B	Synthetic sutures	Answer- B. Synthetic suturesThe larger the size ascribed to the suture, the smaller the diameter be.10-0 sutures- 0.2 (0.020-0.029)	medmcqa
Eye examination of a 48-year-old man showed a golden brown ring around the cornea. You suspect a Kayser Fleisher ring, which is characteristically seen in which of the following conditions?	[ "Hemosiderosis", "Wilson's disease", "Tyrosinemia", "Hereditary cataract" ]	B	Wilson's disease	Kayser Fleisher Ring is seen in Wilson's disease. KF ring is a golden brown ring which occur due to deposition of copper under the peripheral pas of the Descement's membrane of the cornea. Wilson's disease is a rare autosomal recessive disease of young adults characterized by abnormal copper metabolism which inturn causes changes in the basal nuclei, liver cirrhosis, and corneal pigmentation. Abnormal copper metabolism can result in deposition of copper in the posterior capsule of the lens resulting in sunflower cataract. Ref: Comprehensive Ophthalmology by A K Khurana, 4th edn, page 410	medmcqa
Lisch nodules are seen in: March 2009	[ "Retinoblastoma", "Neurofibromatosis", "Retiniitis pigmentosa", "Neuroblastoma" ]	B	Neurofibromatosis	Ans. B: Neurofibromatosis	medmcqa
Postnatally when is the growth velocity maximum	[ "In the first year of life", "In the second year of life", "In the seventh year of life", "In adolescence" ]	A	In the first year of life	Postnatally there are 2 periods of accelerated growth, they are: 1st yr of growth Growth spu during pubey Ref: Nelson's, 20th edition, Page-84	medmcqa
A Down syndrome child is mentally retarded. All cytogenetic abnormalities may occur except?	[ "Deleted chromosome 21", "Trisomy 21", "Robertsonian translocation", "Mosaic" ]	A	Deleted chromosome 21	a. Deleted chromosome 21(Ref: Nelson's 20/e p 610-615, Ghai 8/e p 637-639)An extra copy of chr 21 is required to cause trisomy 21 (Down syndrome), so deletion of chr 21 will not cause it.	medmcqa
Which of the following is a fungus -	[ "Klebsiella", "Clostridia", "Pneumocystis jerovecii", "Listeria" ]	C	Pneumocystis jerovecii	Pneumocystis jerovecii is considered to be fungus based on following points: It takes fungal stains like Gomori’s methanamine silver stain It possesses chitin at all stages of development (component of fungal cell wall) Based on molecular study of 5S –rRNA.	medmcqa
If a child's teeth do not form, this would primarily affect the growth of the:	[ "Maxilla", "Mandible", "Whole face", "Alveolar bone" ]	D	Alveolar bone	Key Concept: If teeth do not form, this would primarily aﬀect the growth of the alveolar bone.	medmcqa
In cholangiography CBD stone appears as	[ "Meniscus sign", "Cutoff sign", "Slight flow of dye from the sides", "Ability to absorb water" ]	A	Meniscus sign	Mr cholangiography : provides excellent anatomic detail, with sensitivity and specificity of 95 %and 98 %respectively for CBD stones Typical meniscus sign is seen when the CBD stone is wedged at the level of the papilla Ref: Sutton 6th edition Pgno : 971	medmcqa
Which of the following is the first bone to ossify in human body	[ "Mandible", "Maxilla", "Clavicle", "Humerus" ]	C	Clavicle	The mandible is the second bone, next to the clavicle, to ossify in the body.	medmcqa
All of the following are features of Mobiz type I block except -	[ "Constant PR interval", "Normal QRS morphology", "Regular atrial rhythm", "Atrial rate - ventricular rate" ]	A	Constant PR interval	null	medmcqa
Differential diagnosis of rosacea includes all of the following except?	[ "Acne vulgaris", "Lupus erythematosus", "BCC", "Melasma" ]	D	Melasma	Ans. is 'd' i.e., Melasma ACNE ROSACEA* Acne rosacea, commonly called rosacea, is a chronic non-curable skin disease with periodic ups and down. It occurs in middle age (30-50 years). It is more common in females, but is more severe in males. Rosacea is a centrofacial disease, i.e., it involves the central face - Cheeks, Chin, Forehead, Nose, making typical cruciate pattern of involvement. Periorbital 8c perioral areas are spared.* Clinical features are intermittant flushing followed by more permanent erythma and telangiectasia. On this back-ground, erythmatous papules, papulo pustules and rarely nodules develop. Lesions may be exacerbated by light (photosensitive) and spicy foods.Complications are: -1. Rhinophyma: - Rhinophyma is large, bulbous, ruddy appearance of nose caused by granulomatous infiltration of skin. It is slowly progressive condition due to hypertrophy of sebaceous gland on the tip of nose. It is also known as Potato nose.2. Ophthalmologic: - Blephritis, Conjuctivits, Keratitis.3. Lymphedema : - Infra-orbital and on forehead.Differential diagnosis1. Erythematous and telengiectatic phase - carcinoid syndrome, LE2. Popular and pustular phase - acne vulgaris, lupus milliaris, seborrheic dermatitis, demodicidosis3. Rhinophyma - BCC	medmcqa
All are features of familial hemolytic uremic syndromes except:	[ "Characterized by microangiopathic hemolytic anemia", "Hemolysis results from an inherited intrinsic red cell abnormalities", "Atypical HUS is a severe disease with up to 15% moality in the acute phase", "50% of cases progressing to end-stage renal disease" ]	B	Hemolysis results from an inherited intrinsic red cell abnormalities	Familial HUS mostly affecting children, characterized by microangiopathic hemolytic anemia (HA) with presence of fragmented erythrocytes in the peripheral blood smear, thrombocytopenia and acute renal failure. The hemolysis results from an inherited defect external to red cells. Atypical HUS is a severe disease with up to 15% moality in the acute phase and up to 50% of cases progressing to end-stage renal disease. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 880	medmcqa
The behaviour therapeutic falls in management of enuresis, The pharmacological drug of choice for this case is –	[ "Phenytoin", "Diazepalm", "Imipramine", "AlPrax" ]	C	Imipramine	Desmopressin is best answer. But it is not given in options. Amongst the given options only imipramine is used in enuresis.	medmcqa
Earliest symptom of glomus tumor is:	[ "Pulsatile tinnitus", "Deafness", "Headache", "Veigo" ]	A	Pulsatile tinnitus	Ans. A Pulsatile tinnitus "The two most common presenting symptoms of paraganglioma of temporal bone (Glomus tumor) are conductive hearing losso and pulsatile tinnnus" Hearing loss is conductive and slowly progressive Tinnitus is pulsatile and of swishing character", synchronous with pulse", and can be temporarily stopped by carotid pressure", Thus, both pulsatile tinnitus and deafness are seen in glomus tumor.	medmcqa
Dorsal root ganglion contains -	[ "Dendrides of motor neuron", "Dendrides of sensory neuron", "Body of motor neuron", "Body of sensory neuron" ]	D	Body of sensory neuron	Ans. is 'd' i.e., Body of sensory neuron o The various sensations from the sensory receptors are carried to the spinal cord through the spinal nerves. As thespinal nerve approaches the spinal cord, it divides into the dorsal (sensory) roots and ventral (motor roots). Ganglion for dorsal root (Le. dorsal root ganglion - DRG) contains the cell body (soma) of sensory neuron, coming from the receptors. The axon of the sensory neuron enter the spinal cord (in dorsal root of spinal nerve) and terminates in the dorsal horn of spinal cord. The axons of DRG neuron (sensory neuron) may follow any of the following three routesi) First, A few branches synapses with motor neuron in the ventral horn of spinal cord either directly or through intemeurons, and motor neuron leaves through ventral root in same spinal nerve to complete the reflex arcs for spinal reflexes.ii) Second, they ascend up in the spinal cord towards the brainstem in specific tracts, resulting in conscious perception.iii) Third, they relay in reticular formation and nonspecific thalamic nuclei, resulting in general arousal.	medmcqa
All of the following bones are pneumatic, except:	[ "Maxillary", "Parietal", "Frontal", "Ethmoidal" ]	B	Parietal	Pneumatic bones are those bones which contain an air filled cavity within them. In humans, they are seen in relation to the the nasal cavity – they enclose the paranasal sinuses. Pneumatic bones are – maxilla, frontal bone, sphenoid and ethmoid.	medmcqa
Battle's sign is associated with:	[ "Orbital cellulitis", "Head injury", "Conjunctivitis", "Liver failure" ]	B	Head injury	Extravasation of blood results in ecchymosis behind the ear, known as Battle's sign. A fracture of the anterior skull base can result in anosmia (loss of smell from damage to the olfactory nerve), CSF drainage from the nose (rhinorrhea), or periorbital ecchymoses, known as raccoon eyes. Ref: Schwaz's principle of surgery 9th edition, chapter 42.	medmcqa
Line I in International Death Certificate is	[ "Disease leading directly to death", "Interval between onset and death", "Antecedent causes", "Other conditions not related to disease" ]	A	Disease leading directly to death	Ans. is 'a' i.e., Disease leading directly to death International Death Cetificate* The certificate has two parts (Part I and Part II) and a section to record the time interval between the onset of each codition and the date of death.* Part I - To record diseases or conditions related to the sequence of events leading directly to the death.* Part II - To record conditions that have no direct connection with the events leading to death but which, by their nature, contributed to the death.INTERNATIONAL FORM OF THE MEDICAL CERTIFICATE FOR CAUSE OF DEATHINTERNATIONAL FORM OF MEDICAL CERTIFICATE OF DEATHCause of deathApproximate interval between onset and deathIDisease or condition directly leading to death a) .................................due to (or as a consequence of)...............Antecedent causesMorbid conditions, if any, giving rise to the above cause, stating the underlying condition last.b)..................................due to (or as a consequence of)...............c) ..................................due to (or as a consequence of)...............d) .................................................IIOther significant conditions contributing to the death, but not related to the disease or conditions causing it .................................................."this does not mean the mode of dying, e.g. heart failure, respiratory failure, it means the disease, injury, or complication that caused death.	medmcqa
Which of the following is a feature of pernicious anaemia	[ "Glossitis", "Tingling or numbness of extremities", "Nervous system involvement in 75 % cases", "All of the above" ]	D	All of the above	In pernicious anaemia Triad Generalised weakness Sore and painful tongue Tingling or numbness of extremities Nervous system involvement is present in 75% of cases Degeneration of myelin sheath & peripheral nerves	medmcqa
Type of Growth Chas used by Anganwadi workers (ICDS) for growth monitoring	[ "NCHS", "IAP", "MRGS", "CDC" ]	C	MRGS	ICDS GROWTH CHA: In NRHM and ICDS, Government of India has adopted WHO child Growth standards 2006 (also known as MGRS &;Multicenter Growth Reference study&; Standards) Normal zone Below -2SD: Malnutrition Below -3SD: Severe Malnutrition Ref: Park 25th edition PGno: 580-581	medmcqa
Which of the following is the most important mediator implicated in development of fever:	[ "PGF2", "PGE2", "PGD2", "FGA2" ]	B	PGE2	PGF2α is a vasoconstrictor whereas PGD2 and PGE2 are vasodilators. PGE2 is the most important chemical for development of fever.	medmcqa
A male child of 15 years with a mental age of 9 years has an IQ of:	[ "50", "60", "70", "80" ]	B	60	IQ = Mental age x 100/Chronological age =So, in this case, IQ = 9 x 100/15 = 60 Degree IQ level Mild 51-70 Moderate 36-50 Severe 21-35 Profound 0-20	medmcqa
Elastin fiber system present in the lamina propria consists all of these EXCEPT	[ "Oxytalan", "Elastin", "Elaunin", "Collagen" ]	D	Collagen	null	medmcqa
Purely serous gland among the following:	[ "Parotid gland", "Submandibular gland.", "Sublingual gland.", "None" ]	A	Parotid gland	null	medmcqa
Most common presentation of Renal Tuberculosis is:	[ "Renal colic", "Sterile Pyuria", "Intractable urgency", "Painful micturition" ]	B	Sterile Pyuria	Answer is B (Sterile Pyuria): The most common clinical presentation of Urological Tuberculosis is Sterile Pyuria. 'The most common clinical presentation of urological tuberculosis is sterile pyuria and painless hematuria - Textbook of Pulmonary and Critical Care Medicine `Renal Tuberculosis is probably underdiagnosed because it is frequently asymptomatic Many cases are diagnosed as a result of routine detection of sterile pyuria. The development of symptoms reflects a more advanced stage of disease' - Oxford Textbook of Medicine Classical Renal Tuberculosis Early Clinical Features: Symptoms of cystitis; Microscopic or macroscopic hematuria; Pyuria with negative bacterial culture (`sterile pyuria'); Constitutional symptoms. Late Clinical Features: Nephrolithiasis and ureteral colic; Intractable frequency and urgency; Refractory hypeension; Renal insufficiency due to obstructive nephropathy.	medmcqa
Which one is not poor prognostic factor for acute pancreatitis:	[ "Hyperglycemia", "Hypocalcemia", "Raised LDH level in blood", "Hyperamylasemia" ]	D	Hyperamylasemia	Answer is D (Hyperamylasemia) Serum amylase levels do not form any criteria for prognosis in acute pancreatitis. Hyperglycemia, Hypocalcemia and raised LDH levels are poor prognostic factors according to Ranson's criteria.	medmcqa
Cataract is seen in all except	[ "Rheumatoid ahritis", "Glucocoicoid admistration", "Galactosemia", "Hypoparathyroidism" ]	A	Rheumatoid ahritis	Rheumatoid ahritis causes thinning and melting of the peripheral cornea and sclerosing keratitis called scleromalcia perforans Refer: Khurana 6th edition page number 198	medmcqa
In Bater's Syndrome, which of the following is not seen-	[ "Metabolic Alkalosis", "Hypokalemia", "Hypomagnesemia", "Decrease in urinary calcium" ]	D	Decrease in urinary calcium	Bater's syndrome - There is loss of transpo function of Thick ascending loop of henle(TALH) Segment of nephron which results in hypokalemic metabolic alkalosis classic BS- typically suffer from polyuria and polydypsia due to reduction in renal concentrating ability . Increase in urinary calcium excretion 20% are hypomagnesemic. Marked activation of RAAS. Antenatal BS- They suffer from severe systemic disorder characterized by marked electrolyte wasting, polyhydramnios ,hypercalciuria with nephrocalcinosis . Ref:Harrison 20 th edition pg no 306.	medmcqa
Baby born at 30 weeks for 18-year-old prior gravida of weight 2 kg which died after 48 hours. Apgar scores were 5 and 8 at 1 and 5 minutes. On autopsy bilateral enlarged kidney with multiple radially arranged cysts. Which of the following finding is expected to be associated with?	[ "Imperforate anus", "Hepatic cyst and fibrosis", "Absence of ureter", "Holoprosencephaly" ]	B	Hepatic cyst and fibrosis	The clinical findings suggest autosomal recessive polycystic kidney disease. The diagnosis of autosomal recessive polycystic kidney disease is strongly suggested by bilateral palpable flank masses in an infant with pulmonary hypoplasia, oligohydramnios and hypertension and the absence of renal cysts in the parents. On imaging and biopsy the kidney shows innumerable cysts radiating from medulla to the cortex. Autosomal recessive kidney disease is associated with liver disease in about 45% cases. Both kidneys are markedly enlarged and grossly show innumerable cysts throughout the cortex and medulla. Microscopic studies demonstrate micro cysts radiating from medulla to the cortex located primarily within the collecting tubules and the ducts. Development of progressive interstitial fibrosis and tubular atrophy during advanced stages of disease eventually leads to renal failure. Liver involvement is characterized by bile duct proliferation and ectasia as well as by hepatic fibrosis	medmcqa
Which statement best describes the tears seen in Mallory-Weiss syndrome?	[ "Longtitudinal tears in lower 1/3 esophagus", "Circumferential tears in lower 1/3 esophagus", "Longtitudinal tears in middle 1/3 esophagus", "Circumferential tears in middle 1/3 esophagus" ]	A	Longtitudinal tears in lower 1/3 esophagus	Ans- A. Mallory-Weiss Tear- A Mallory-Weiss tear is a linear mucosal rent near or across the gastroesophageal junction that is often associated with retching or vomiting.	medmcqa
A 30 year biker sustained an compound fracture of the leg following RTA. The doctor has labeled it Gustilo Anderson type IIIB. Which of the following would represent the injury:	[ "Fracture with open wound less than 1 cm", "Fracture with open wound of 1-10 cm but soft tissue cover possible", "Open wound more than 10 cm and soft tissue coverage not possible.", "Open wound more than 10 cm with arterial injury" ]	C	Open wound more than 10 cm and soft tissue coverage not possible.	Ans. C. Open wound more than 10 cm and soft tissue coverage not possible.Gustilo Anderson ClassificationType IWound <=1cm, minimal contamination or muscle damageType IIWound 1-10cm, moderate soft tissue injuryType IIIAwound usually >10cm, high energy, extensive soft-tissue damage, contaminatedadequate tissue for flap coveragefarm injuries are automatically at least Gustillo IIIAType IIIBextensive periosteal stripping, wound requires soft tissue coverage (rotational or free flap)Type IIICvascular injury requiring vascular repair, regardless of degree of soft tissue injuryMost accurate way to grade open fractures is by intra-operative examination	medmcqa
A vitreous aspirate from a case of metastatic endophthalmitis on culture yields Gram-positive round to oval cells, 12-14 m in size. The aspirate on Gram staining shows the presence of pseudohyphae. Which of the following is the most likely aetiological agent	[ "Aspergillus", "Rhizopus", "Candida", "Fusarium" ]	C	Candida	Candida is a yeast-like fungus, grows paially as yeast and paially as chains of an elongated budding cell joined end to end forming pseudohyphae. on gram staining candida shows budding gram-positive yeast cells. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition	medmcqa
"Satellidsm" in presence of streak of staphylococci is shown by	[ "Bordetella pertussis", "Yersinia pestis", "Haemophilus influenzae", "Helicobacter pylori" ]	C	Haemophilus influenzae	Ans. c (Haemophilius influenzae) (Ref. Ananthanarayan Microbiology 7th ed., Fig. 36.2, p. 334)H. influenzae# Gram negative, nonmotile, non-sporing bacillus exhibiting considerable pleomorphism.# In sputum usually occurs as clusters of coccobacillary forms, while in the CSF from meningitis cases long, bacillary and filamentous forms predominate.# Strains isolated from acute infections are often capsulated.# They are relatively difficult to stain. Staining for 5-15 minutes with Loeffler's methylene blue or dilute carbol fuschin gives good results.# It is aerobic but grows anerobically also.# The optimum temp is 37degC. It does not grow below 20degC. Some strains require 10% CO2# It grows on blood agar but growth is scanty as the V factor is not freely available, being imprisoned inside the red blood cells.# Growth is therefore better if a source of factor V is also provided.# When Staph aureus is across a plate of blood agar on which a specimen containing H. influenzae has been inoculated, after' overnight incubation, the colonies of H. influenzae will be large and well developed alongside the streak of Staphylococcus, and smaller farther away. This phenomenon is called SATELLITISM.# It is however not very specific as it will also be positive with* other V factors requring hemophilli as well as occasional strains of Neisseriae and Diphtheroids.# Aerosol transmission.# Invasive disease caused by capsular type B.# Produces IgA protease.# Culture on chocolate agar requires factors V (NAD) and X (hematin) for growth.# Treat meningitis with ceftriaxone.# Rifampin prophylaxis in close contacts.# Vaccine contains type B capsular polysaccharide conjugated to diphtheria toxoid or other protein.# Given between 2 and 18 months age.	medmcqa
Most common symptom of alcohol withdrawal is:	[ "Bodyache", "Tremor", "Diarrhoea", "Rhinorrheo" ]	B	Tremor	B ie. Tremor	medmcqa
Hemolytic uremic syndrome is due to -	[ "Enterotoxigenic E. coli", "Enterohemorhagic E. coli", "Shigella", "Salmonella" ]	B	Enterohemorhagic E. coli	Ans. is 'b' i.e., Enterohemorhagic	medmcqa

Hea failure cells are found in

[ "Myocardium", "Lungs", "Liver", "Spleen" ]

B

Lungs

It is seen characteristically found in lungs during left hea failure.The morphology of lung in LVH described by: Lungs. Rising pressure in the pulmonary veins is ultimately transmitted back to the capillaries and aeries of the lungs, resulting in congestion and edema as well as pleural effusion due to an increase in hydrostatic pressure in the venules of the visceral pleura. The lungs are heavy and boggy, and microscopically show perivascular and interstitial transudates, alveolar septal edema, and accumulation of edema fluid in the alveolar spaces. In addition, variable numbers of red cells extravasate from the leaky capillaries into alveolar spaces, where they are phagocytosed by macrophages The subsequent breakdown of red cells and hemoglobin leads to the appearance of hemosiderin-laden alveolar macrophages-- so-called hea failure cells--that reflect previous epi sodes of pulmonary edema. (Robbins Basic Pathology,9th edition,pg no.367)

medmcqa

bisferens pulse is seen in all except ?

[ "AS+ AR", "AR", "HYPEROPHIC CARDIOMYOPATHY", "TOF" ]

D

TOF

Pulsus Bisferiens It is single pulse wave with two peaks in systole * d/t ejection of rapid jet of blood through aoic valve * Best felt in brachial and femoral aery * AS + AR * Severe AR * HOCM(Hyperophic obstructive cardiomyopathy) . REF : harrisons 21st ed

medmcqa

True about MRI/CT appearance of lateral meningocele:

[ "Solid dural masses", "Usually outside the spinal canal", "Widened neural foramen", "Generally there is no spinal cord compression & deformity" ]

C

Widened neural foramen

C i.e. Widened neural foramen - Lateral meningocele is non solid, CSF containing leptomeningeal outpouching through widened neural foramen usually into paraspinal, intrathoracic spaceQ. And it is generally associated with spinal deformities like, posterior (dorsal) scalloping, erosion of pedicles, thinning of neural arch & ribs, widening of spinal canal & neural foramen and kyphoscoliosis.

medmcqa

Rapid infusion of insulin causes-

[ "Hyperkalemia", "Hypokalemia", "Hypernatremia", "Hyponatremia" ]

B

Hypokalemia

* Insulin, b2-adrenergic activity, thyroid hormone, and alkalosis promote Na+/K+-ATPase-mediated cellular uptake of K+, leading to hypokalemia. * stimulation of endogenous insulin can provoke hypokalemia, hypomagnesemia, and/or hypophosphatemia in malnourished patients given a carbohydrate load. (reference harrisons principles of internal medicine, 19E page-305)

medmcqa

Which occupation increases risk for silicosis:

[ "Mica worker", "Sugarcane worker", "Cotton industry workers", "Coal mine workers" ]

A

Mica worker

Ans. a. Mica workerSILICOSISDefinition: Silicosis is an occupational lung disease caused by inhalation of silica dust.Epidemiology: Silicosis is seen in individuals who work in mining, quarrying, tunneling, glass and pottery making, and sandblasting.Signs and Symptoms: Silicosis will cause similar symptoms to asbestosis (or any other pneumoconiosis) except the acute form of silicosis, which is caused by massive exposure that causes lung failure in months.Pathology: Silica causes inflammatory reactions with pathologic lesions being the hyaline nodule.Chest X-ray: In silicosis there are nodules (1-10 mm) seen throughout the lungs that are most prominent in the upper lobes. A characteristic finding is eggshell calcifications (rare). In progressive massive fibrosis, densities are 10 mm or more and coalesce in large masses.Diagnosis: A lung biopsy is usually necessary for the diagnosis of Silicosis.Treatment: fhere is no effective therapy for silicosis. Death occurs usually because of progressive respiratory insufficiency. There is an association of silicosis with pulmonary TB. Patients with silicosis should have yearly purified protein derivative (PPD) tuberculin testing; a patient with positive reactive PPD (> 10 mm) should get isoniazid (INH) prophylaxis for 9 months.Extra MileCauses of interstitial lung disease (ILD)CauseDiseaseAsbestosAsbestosisGlass workers, mining, sandblasting, brickyardsSilicosisCoal workerCoal worker's pneumoconiosisCottonByssinosisElectronics, ceramics, fluorescent light bulbsBerylliosisMercuryPulmonary fibrosis

medmcqa

The commonest tumour of parotid is

[ "Mucoepidermoid", "Mixed parotid tumour", "Adenolymphoma", "Squamous cell carcinoma" ]

B

Mixed parotid tumour

Pleomorphic adenomas are benign tumors that consist of a mixture of ductal (epithelial) and myoepithelial cells, and therefore they show both epithelial and mesenchymal differentiation. Because of their remarkable histologic diversity, these neoplasms have also been called mixed tumors. They represent about 60% of tumors in the parotid. Wahin tumor is the second most common. Both are benign. Robbins 9e pg: 745

medmcqa

Meibomian gland carcinoma may be mistaken for:

[ "Recurrent stye", "Recurrent chalazion", "Recurrent concretions", "Chronic conjunctivitis" ]

B

Recurrent chalazion

Ans. (b) Recurrent chalazion.

medmcqa

At what age does the child who knows his age, gender, name, can draw a circle and make a tower of 9 cubes?

[ "2 years", "3 years", "4 years", "5 years" ]

B

3 years

Ans. is 'b' i.e., 3 years Important milestones of a 3 years child* Rides tricycle* Knows his age and sex.* Stands momentarily on one foot* Repeat a sentence of 6 syllables* Draws a circle* Has a vocabulary of 250 words* Can dress or undress himself completely* Counts 3 objects correctly* Builds tower of 10 cubes* Can withhold and postpone bowel movement

medmcqa

A patient with cancer received extreme degree of radiation toxicity. Fuher history revealed that the dose adjustment of a paicular drug was missed during the course of radiotherapy. Which of the following drugs required a dose adjustment in that patient during radiotherapy in order to prevent radiation toxicity -

[ "Vincristine", "Dactinomycin", "Cyclophosphamide", "6-Mercaptopurine" ]

B

Dactinomycin

Ans. is 'b' i.e., Dactinomycin o The patient was most probably taking a radiosensitiser i.e., drugs which increases the toxicity due to radiotherpy. o The dose of these drugs should be decreased during radiotherapy o Among the drugs given in the question Actinomycin D or Dactinomycin is a radiosensitizer o Hypoxic cells are resistant to radiotherapy o Augmentation of oxygen is the basis of radiosensitization

medmcqa

True about cytokines are all except:

[ "It is polypeptide", "Have autocrine and paracrine effects", "Involve in leukocytic movements", "It takes pa in intrinsic enzymatic reaction" ]

D

It takes pa in intrinsic enzymatic reaction

D i.e It takes pa in intrinsic enzymatic reaction They are polypeptideQ in nature.Induced their effect in three ways: Autocrine, paracrine & endocrine effects.Q Mediates natural immunity Affects leucocytic movementQRegulate lymphocytic growth activation & differentiation.Activate inflammatory cells & stimulate hematopoesis.

medmcqa

Hydrocortisone acts as an anti–inflammatory agent because of induction of the synthesis of which of the following protein ?

[ "Heat shock protein 90", "Inhibin", "Transcortin", "Lipocortin" ]

D

Lipocortin

null

medmcqa

The operation of choice in ulcerative colitis

[ "Proctocolectomy with ileoanal anastomosis", "Subtotal colectomy and ileostomy", "Proctocolectomy and permanent end ileostomy", "Subtotal colectomy and ileorectal anastomosis" ]

A

Proctocolectomy with ileoanal anastomosis

The operation of choice in ulcerative colitis is proctocolectomy (with preservation of the anal sphincter complex) with ileoanal J pouch anastomosis (IPAA).Total proctocolectomy has the advantage of removing all diseased mucosa, thereby preventing fuher inflammation and the potential for progression to dysplasia or carcinoma. ie; Total colon and rectum are removed, ileal pouch is constructed (to function like rectum) and anastomosed to the anal canalRef: Sabiston 20e pg: 1372, Harrison 19e pg: 1962

medmcqa

Incised wounds on genitalia: AIIMS 09, 10

[ "Homicidal", "Suicidal", "Accidental", "Self-inflicted" ]

A

Homicidal

Ans. Homicidal

medmcqa

The pleural space into which lung tissue just above the cardiac notch would tend to expand during deep inspiration is the?

[ "Anterior mediastinum", "Costodiaphragmatic recess", "Costomediastinal recess", "Cupola" ]

C

Costomediastinal recess

The costomediastinal recess is an area right next to the cardiac notch, which is an indentation in the superior lobe of the left lung. This is where the medial area of the superior lobe of the left lung would tend to expand if it became very inflated. The lung would not enter the anterior mediastinum, which is an area between the two pleural sacs, bounded anteriorly by the sternum and posteriorly by the pericardium. The anterior mediastinum contains areolar tissue, sternopericardial ligaments, lymph vessels and nodes, but no lung tissue. The costodiaphragmatic recess is the recess at the inferior border of a lung. This is the space into which the inferior lobe of the lung would expand following deep inhalation. The cupola is the serous membrane lining the pleural cavity which extends above the level of the 1st rib into the root of the neck. The most superior poion of the superior lobe might expand into this space. The pulmonary ligament is the fold of pleura located below the root of the lung where the visceral pleura and the mediastinal parietal pleura are continuous with each other.

medmcqa

The co-factor for glycogen phosphorylase in glycogenolysis is:

[ "Thiamine pyrophosphate", "Pyridoxal phosphate", "Citrate", "FAD" ]

B

Pyridoxal phosphate

Glycogen phosphorylase catalyses the rate limiting step in glycogenolysis by catalyzing the phosphorolytic cleavage of glycogen to yield glucose 1-phosphate. Glycogen phosphorylase requires pyridoxal phosphate as its coenzyme.

medmcqa

In a patient with CSF otorrhea a cotton plug is kept in ear near Eustachian tube. A dye is injected in the sub- arachnoid space. The plug gets stained. Which of the following is most likely site of CSF leak?

[ "Temporal bone", "Ethmoid", "Sphenoid", "Cribriform plate" ]

A

Temporal bone

Ans. A. Temporal bone.CSF otorrhea# The most common cause of CSF otorrhea is trauma with fracture involving the tegmen tympani. Tegmen tympani which is formed in part by the petrous portion of the temporal bone, and the squamous portion of the temporal bone, forms the roof of the middle ear cavity. Other etiologies include perilymphatic fistula, surgeries involving the temporal bone, congenital anomalies, and destructive temporal bone tumors.# Fluid leaking from the nose or external auditory canal must first be positively identified as CSF. Drops of fluid from a CSF leak placed on absorbent filter paper may result in the double-ring sign, a central circle of blood and an outer clear ring of CSF. Serum glucose, chloride, and total protein tests of the fluid are not specific or conclusive for CSF.# Confirm or exclude the presence of CSF in leaking fluid by means of an immunoelectrophoretic study of the fluid for beta-2 transferrin or, beta-trace protein.# Methods for detecting CSF fistulas with intrathecal injections of dye pose a risk of chemical meningitis. Methylene blue, indigo carmine, and phenolsulfonphthalein (PSP) dyes are no longer in use. Some use a dilute solution of fluorescein to localize CSF fistulas both preoperatively and during surgery. Typically, is injected into the lumbar subarachnoid space over more than 1 minute. Cotton pledgets are placed in the nose. The dye reaches the skull base in 6 hours and is present over the cerebral convexities in 24 hours. The pledgets are examined for green fluorescence in a dark room with ultraviolet light 6 hours after the intrathecal PSP injection.# CT myelography is used in the detection of spinal CSF leak. CT cranial cisternography is performed with injection of 5-7 mL of nonionic myelographic contrast medium into the lumbar subarachnoid space. The patient is maintained in the prone position until a CT scan is performed. CT cistemographic findings in CSF leak include the concentration of contrast medium in portions of a paranasal sinus or within ethmoid or mastoid air cells. Occasionally, a stream of contrast medium is seen at the fistula site.Most common site for linear skull fracturesis the parietal bone, which is the thinnest of the cranial bones.Temporal bone fracturesclassified as transverse (extending across the petrous portion) or longitudinal (extending lateral to medial). Complication asso with transverse temporal bone fracture include CN VIII and CN VII injury, whereas longitudinal temporal fracture can cause hemotympanum, torn tympanic membrane, CSF leak, and conductive haering loss due to bony disruption.Basilar fracture of the temporal boneresults in "battle sign," which is postauricular ecchymoses and can be associated with CSF otorrhea.A frontal basilar farcture results in"raccoon's eyes", which is periorbital ecchymoses. CSF rhinorrhea can result due to frontal basilar fracture. The majority of CSF leaks resolve within 7 days without surgical intervention.

medmcqa

In pregnancy :

[ "Plasma fibrinogen levels are increased", "Fibrinogen levels are decreased", "Thyroglobulins are decreased", "IgD are markedly increased" ]

A

Plasma fibrinogen levels are increased

medmcqa

A 9-month-old girl is presented with PR bleed, vomiting, mass & colicky pain in Rt lumbar region with masked liver dullness. She is in shock like condition. Management should includes – a) Barium enema b) Saline reduction c) Give O2 d) Nasogastric tube d) IV fluid

[ "abc", "acd", "bcd", "abde" ]

D

abde

PR bleed, vomiting, mass in right lumbar region, colicky pain and masked liver dullness in a 9-month infant suggest the diagnosis of intussusception. Patient is also having shock, so she requires treatment of shock and intussusception. Diagnosis of intussusception The clinical history and physical findings are usually sufficiently typical for diagnosis. Plain abdominal radiographs may show a density in the area of the intussusception. A barium enema shows a filling defect or cupping in the head of barium where its advance is obstructed by the intussusceptum. A central linear column of barium may be visible in the compressed lumen of the intussusceptum, and a thin rim of barium may be seen traped around the invaginating intestine in the folds of mucosa within the intussuscipiens (coiled-spring sign), especially after evacuation. Retrogression of the intussusceptum under the pressure of the enema and gaseous distention of the small intestine from obstruction are also useful radiographic signs. Ileoileal intussusuception is usually not demonstrable by barium enema but is suspected because of gaseous distention of the intestine above the lesion. The use of "air" enemas in the diagnosis and treatment of intussusception has supplanted hydrostatic reduction. Reflux of air into the terminal ileum and the disappearance of the mass at the ileocecal valve document successful reduction. Air reduction is associated with fewer complications and lower radiation exposure than traditional hydrostatic techniques. Ultrasonography is a sensitive diagnostic tool in the diagnosis of intussusception. Treatment of Intussusception The child should be first stabilized. A tube should be passed into the stomach through nose (nasogastric tube). An intravenous line should be placed and fluids should be given to prevent dehydration. Reduction of an acute intussusception is an emergency procedure and performed immediately after diagnosis in preparation for possible surgery. The reduction can be achieved by installation of barium, saline or air. "In patients with prolonged intussusception with signs of shock, peritoneal irritation, intestinal perforation or pneumatosis intestinal, reduction (with barium, saline or air) should not be attempted". In the above cases and in cases where reduction by barium/saline/air fails, surgery is required, i.e., manual operative reduction. If the manual operative reduction is not possible or the bowel is not viable, resection of the intussusception is necessary, with an end to end anastomosis. Treatment of shock (e.g. O2 IV fluid etc) should be given first if it is present. About option a & b As the patient is in shock, reduction by air or barium is contraindicated. However, a barium enema can be used as a diagnostic modality.

medmcqa

Lower l/3rd of anal canal is derived from-

[ "Proctodaeum", "Cloaca", "Urogenital Sinus", "Midgut" ]

B

Cloaca

Ans. is 'b' i.e., Proctodaeum * 'The lower third of the anal canal is an ectodermal derivative and is derived from the proctodaeum.'* Part of anal canal above pectinate line develops from dorsal part of endodermal cloaca (primitive rectum) and part of anal canal below pectinate line develops from ectodermal proctodeum.

medmcqa

Injury caused to the pedestrian in a vehicular accident due to his/her striking onto the object on road is known as -

[ "Primary injury", "Secondary injury", "Acceleration injury", "Decceleration injury" ]

B

Secondary injury

Secondary injury is caused by person violently falling on ground (road) or on stationary object.

medmcqa

The area of the colon which is least visualized by barium studies -

[ "Sigmoid", "Hepatic flexure", "Splenic flexure", "Caecum" ]

A

Sigmoid

null

medmcqa

Transitional epithelium is seen in-

[ "Esophagus", "Vagina", "Urinary bladder", "Trachea" ]

C

Urinary bladder

Lining of urinary bladder is Transitional epithelium.

medmcqa

Strawberry berry gallbladder' is seen in

[ "Porcelain gall bladder", "Cholesterosis", "Necrosis of gall bladder", "Gall bladder carcinoma" ]

B

Cholesterosis

the strawberry gallbladder is seen in cholesterosis,i.e.abnormal deposition of cholestrol in gallbladder.In the freshstate,the interior of the gallbladder looks something like a strawberry,the yellow specks (submucous aggregations of cholesterol crystals and cholesterol esters )correspond to the seeds. It may be associated with cholesterol stones. Ref Bailey and love 27e p1188

medmcqa

Gabapentin has which mechanism of action for its antiepileptic effect ?

[ "Inhibits monoamine oxidase", "Blocks the re-uptake of neurotransmitters", "Increase the release of neurotransmitters", "Block Na+channels" ]

C

Increase the release of neurotransmitters

null

medmcqa

Criteria for a pancreas donor include:

[ "No history of diabetes", "No liver donation", "No replaced hepatic aery vessels arising from the superior mesenteric aery (SMA)", "No previous splenectomy" ]

A

No history of diabetes

- Combined liver-pancreas procurement should be routine, even if the right hepatic aery arises from the superior mesenteric aery. - In this situation, since the transplanted liver is the life-saving organ, the proximal superior mesenteric aery should remain with the liver and the distal superior mesenteric aery supplying the head of the pancreas can be reconstructed on a Y-graft of iliac aery with the splenic aery. - Successful pancreas transplantation can be performed using donors who have previously undergone splenectomy; however, there should be no significant pancreatitis and no history of diabetes in the donor.

medmcqa

In hyperventilation

[ "P50 and Hb affinity for O2 increases", "P50 and Hb affinity for O2 decreases", "P50 increases and affinity O2 decreases", "P50 decreases and affinity O2 increases" ]

C

P50 increases and affinity O2 decreases

Abnormally fast and deep breathing, the result of either an emotional state or a physiological condition. Emotional causes include acute anxiety and emotional tension, such as in nervous, anxious patients who may have other functional disturbances related to emotional problems. Physiological causes include a rapid decrease in intracranial pressure, other neurologic problems, and metabolic, pulmonary, and cardiovascular conditions.Ref: Ganong&;s Review of Medical Physiology; 24th edition; page no:647

medmcqa

Lacunar infarction is seen in:

[ "Large vessel stroke", "Small vessel stroke", "Artery to artery embolic stroke", "Temporal arteritis" ]

B

Small vessel stroke

(Small vessel stroke) (2378-H 16th) (864-66-CMDT-2009) (2519-H17th)(A) LACUNAR INFARCTION - refer to infarction following atherothrombotic or lipohyalinotic occlusion of a small artery (30 to 300 pm) in the brain. The term small vessel stroke denotes occlusion of such small penetrating artery and is now the preferred.* Lacunar infarctions are associated with poorly controlled hypertension or diabetes.(B) CEREBRAL INFARCTION - Thrombotic or embolic occlusion of a major vessels leads to cerebral infarction.* Causes include the disorders predisposing to transient ischemic attacks and atherosclerosis.

medmcqa

In papilledema, all the following are true except -

[ "Blurring of the disc", "Congestion of retinal veins", "Soft white exudates around the disc", "Sudden loss of vision" ]

D

Sudden loss of vision

Visual acuity and pupillary reactions usually remain fairly normal until late stages when optic atrophy sets. Even then, there is gradually progressive painless loss of vision.

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Which of the following is the safest method of sterilization in immediate post paum period :

[ "Minilaparotomy", "Laparoscopy", "Hysteroscopic method", "None" ]

A

Minilaparotomy

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Meniscal tears usually result from which of the following circumstances?

[ "Hyperextension", "Flexion and rotation", "Simple hyperflexion", "Compression" ]

B

Flexion and rotation

Most meniscal tears are produced by flexion and rapid rotation. A classic example ("football knee") involves a player who is hit while running. The knee, supporting all the player's weight, usually is slightly flexed, and the foot is anchored to the ground by cleats. Impact from an opposing player usually causes rotation almost entirely restricted to the knee. The injury involves rapid rotation of the flexed femoral condyles about the tibial plateau, which most frequently tears the medial meniscus. (Less frequently, the lateral meniscus is torn.) A tear in the inner free border of the cartilage is also common whenever excessive rotation without flexion or extension occurs. Early surgical removal of the displaced menisci is usually recommended to prevent further damage to the cartilage or ligaments.

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Antidote used in methyl alcohol poisoning is?

[ "EDTA", "Alpha methyl dopa", "Acetyl cysteine", "Fomepizole" ]

D

Fomepizole

ANSWER; (D) FomepizoleREF: APPENDIX-42 below for list of "Antidotes" APPENDIX - 42AntidotesAntidotePoison/drug/toxinN-AcetylcysteineAcetaminophenCarbon tetrachlorideOther hepatotoxinsAmyl nitrite, sodium nitrite and sodium thiosulfate (Cyanide antidote kit)NitrilesBromatesChloratesCyanide (e.g., HCN, KCX and NaCN)Mustard agentsNitroprussideSmoke inhalation (combustion of synthetic materials)Antivenin, Crotalidae Polyvalent (Equine Origin)Pit viper envenomation (e.g. rattlesnakes, cottonmouths, timber rattlers and copperheads)Antivenin, Crotalidae Polyvalent Immune Fab - Ovine (CroFab)Pit viper envenomation (e.g.. rattlesnakes, cottonmouths, timber rattlers and copperheads)Atropine sulfateAlpba2 agonists (e.g., clonidine)Alzheimer drugs (e.g., donepezil, galantamine, rivastigmine, tacrine)Antimyesthenk agents (e.g., pyridostigmine)Bradyarrhythmia-producing agents (e.g., beta blockers, calcium channel blockers and digitalis glycosides)Cholinergic agonists (e.g., bethanechol) .Muscarine-containing mushrooms Nerve agents (sarin, soman, tabun and VX)Organophosphate and carbamate insecticidesDigoxin immune FabCardiac glycoside-containing plants (foxglove and oleander)Digitoxin, DigoxinEthanolEthylene glycolMethanolFlumazenilBenzodiazepinesZaleplonZolpidemFolic acid and Folinic acid (Leucovorin)Formaldehyde/Formie AcidMethanolMethotrexate, trimetrexatePyrimethamineTrimethoprimFomepizoleEthylene glycolMethanolGlucagonBeta blockersCalcium channel blockersHypoglycemiaHypoglycemic agentsHydroxocobalaminNitrilesBromatesChloratesCyanide (e.g., HCN, KCN and NaCN)Mustard agents NitroprussideSmoke inhalation (combustion of synthetic materials)Hyperbaric oxygen (HBO)Carbon monoxideCarbon tetrachlorideCyanideHydrogen sulfideMethemoglobinemiaMethylene blueMethemoglobin-inducing agents including;Aniline dyesDapsoneLocal anesthetics (e.g., benzocaine)MetoclopramideNaphthaleneNitrates and nitritesNitrobenzenePhenazopyridineNalmefene and NaloxoneACE inhibitorsAlpha2 agonists (e.g., clonidine)Imidazoline decongestants (e.g., oxymetazoline and tetrahydrozoline) LoperamideOpioids (e.g., codeine, fentanyl, heroin, meperidine, morphine)Physostigmine salicylateAntihistaminesAtropine and other anticholinergic agentsDhatura poisoningIntrathecal baclofenPhytonadione (Vitamin Kl)Long-acting anticoagulant rodenticides (e.g., brodifacoum and bromadiolone) WarfarinPralidoxime chloride (2-PAM)Antimyesthenic agents (e.g., pyridostigmine)Nerve agents (sarin, soman, tabun and VX)Organophosphate insecticidesTacrineProtamine sulfateEnoxaparinHeparinPyridoxine hydrochloride (Vitamin B6)Acrylamide Ethylene glycol Hydrazine Isoniazid (INH)Sodium bicarbonateChlorine gasHyperkalemiaSerum Alkalinization:Agents producing a quinidine-like effect as noted by widened QRS complex on EKG (e.g., amantadine, carbamazepine, chloroquine,cocaine, diphenhydramine, flecainide,tricyclic antidepressants, quinidine)Urine Alkalinization:Weakly acidic agents (chlorpropamide, methotrexate, phenobarbital and salicylates)Deferoxamine and DeferasiroxAcute iron poisoningDimercaprol (BAL in oil)Hydrofluoric acid (HF)Hyperkalemia (not digoxin-induced)HypermagnesemiaCalcium disodium EDTA (Versenate)Acute arsenic poisoning,Acute mercury poisoning,Lead poisoning (in addition to EDTA)Dicobalt EDTACyanide poisoningSucdmer/ Dimercaptosuccinic acid (DMSA)Lead poisoning,Arsenic poisoning,Mercury poisoningDimercapto-propane sulfonate (DMPS)Severe acute arsenic poisoning,Severe acute mercury poisoningD-Penicillamine (Cuprimine)Mainly in: copper toxicityOccasionally adjunctive therapy in: Gold toxicity, Arsenic poisoning, Lead poisoning, Rheumatoid arthritisBotulinum antitoxin * Bivalent (types AB)<< Trivalent (types ABE)Food-borne botulismWound botulismBotulism as a biological weaponNote: Not currently recommended for infant botulismL-CarnitineValproic acidCyproheptadine HCLMedications causing serotonin symdromeDantrolene sodiumMedications causing neuroleptic malignant symdrome (NMS)Medications causing malignant hyperthermiaInsulin and dextroseBeta blockersCalcium channel blockers (diltiazem, nifedipine, verapamil)Octreotide acetateSulfonylurea hypoglycemic agents (e.g., glipizide, glyburide)Sodium thiosulfateBromatesChloratesMustard agentsNitroprussideThiamineEthanolEthylene glycolPrussian blue, ferric hexacyan ofer rateRadioactive cesium (Cs-137), radioactive thallium (Tl-201), and nonradioactive thallium

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In a child with respiratory distress, failure to thrive. His sweat chloride leveles were estimated 35 meq/L and 41 meq/L. What is next best test to do cystic fibrosis for diagnosis aEUR'

[ "Nasal transmembrane potential difference", "DNA analysis AF 508 mutation", "CT chest", "72 hour fecal fat estimation" ]

C

CT chest

Trans epithelial nasal potential difference Diagnosis of cystic fibrosis Sweat chloride testing The sweat test is the standard approach to diagnosis. The diagnosis is made by elevated sodium and chloride level in the sweat > 60 meoll. Two tests on different days are required .for accurate diagnosis. A normal sweat chloride dose not exclude the diagnosis. Genotyping and other tests such as measurement of nasal membrane potential difference, pancreatic .function should be done if there is high clinical suspicion of cystic fibrosis. Nasal potential difference Measurement of nasal transepithelial potential difference in vivo can be useful adjunct in the diagnosis of cystic fibrosis. Individuals with cystic fibrosis demonstrate a significantly more negative baseline nasal potential difference, with the topical application of amiloride there is loss of this potential difference. Nasal potential difference is a sensitive test of electrolyte transpo (CFTR) function that can be used to suppo or refute a diagnosis of cystic fibrosis. Genetic analysis Cystic .fibrosis is an autosomal recessive disorder. It is caused due to defect in CFTR (Cystic fibrosis transmembrane conductance regulator) protein. Cystic fibrosis is associated with large number of mutations. More than 1500 CFTR polymoiphisms are associated with cystic fibrosis syndrome. The most prevalent mutation of CFTR is the deletion of single phenylalanine residue at amino acid 4.508 This mutation is responsible for high incidence of cystic fibrosis in nohern European populations. Approximately 50% of individuals with CF who are of nohern European ancestry are homozygous for 4.508 and > 70% carry at least one 4.508 gene. The remainder of patients has an extensive array of mutation, none of which has prevalence of more than several percent. Testing for cystic .fibrosis mutation was not possible because of the large no. of mutations associated with the disease. Now days commercial laboratories test for 30-80 of the most common CFTR mutations. This testing identifies > 90% individuals who carry 2 CF mutations. No where it is mentioned in the texts that testing only for 4508 is enough for diagnosis. Detection of atleast 2 CF mutations are necessary for making the diagnosis of cystic fibrosis. The patient has features of cystic fibrosis but sweat chloride levels are normal. - To diagnose cystic .fibrosis in this patient, another laboratory evidence demonstrating CFTR dysfunction is required. This can be done by two methods:? - Demonstrating abnormal potential difference - Demonstrating abnormal CF mutations. But the diagnostic criteria for cystic fibrosis requires. - Demonstration of two CF mutations (demonstration of single abnormal F508 mutation is not enough) So we are left with abnormal nasal potential difference. - It is an established laboratory evidence for CFTR dysfunction and is accepted as a diagnostic criteria to establish the diagnosis of cystic fibrosis. Diagnostic criteria for cystic fibrosis Presence of typical clinical features (respiratory, G.LT, genitourinary) OR A history of CF in a sibling OR A positive newborn screening test PLUS Laboratory evidence for CFTR Dysfunction Two elevated sweat chloride concentrations obtained on separate days OR Identification of two CF mutations OR An abnormal nasal potential difference

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Child attains a height of 100 cm at the age of: March 2011

[ "1 year", "2 years", "3 years", "4 years" ]

D

4 years

Ans. D: 4 years A normal Indian child is 100 cm tall at the age of 4.5 years

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Breast conservation surgery is contraindicated in

[ "Tumor > 4 cm", "Multicentric tumor", "Axillary LN involvement", "All of the above" ]

D

All of the above

.Contraindications * Tumour > 4 cm * Positive axillary nodes > N1 * Tumour margin is not free of tumour after breast conservative surgery needs MRM * Poorly differentiated tumour * Multicentric tumour * Tumour/breast size ratio is more (centeral tumour) * Tumour beneath the nipple * Extensive intraductal carcinoma Ref; (page no;553 ) 5th edition of SRB&;S manual of Surgery

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ECG changes in hyperkalemia are all except -

[ "Prolonged PR interval", "Depressed ST-segment", "Inverted T wave", "Wide QRS" ]

C

Inverted T wave

Ans. is 'c' i.e., Inverted T wave HypokalemiaHyperkalemiao Prominent U wave (earliest change)o Sine wave configurationo Flattening and inversion of T-waveo Tall, tented T-wave (peaked & narrow)o Prolonged PR-interval, QRS widening (in severe H~) o Prolonged PR-interval, QRS widening and(But PR & QRS constant when K+ +- 3.5 mEq/L)o |HR (Complete heart block or ventricularo Prolonged QT intervalasystole may occur)o Depressed / sagging of ST-segmento Depressed ST-segment

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Fructose intolerance is due to deficiency of?

[ "Aldolase B", "Fructokinase", "Triokinase", "Aldolase A" ]

A

Aldolase B

Ans. is 'a' i.e., Aldolase B DiseaseDificient enzymesEssential fructosuriaFructokinaseHereditary fructose intoleranceAldolase-BGalactosemiaGalactose-1-phosphate uridyl transferase (most common), Galactokinase UDP-galactose-4-epimeraseLactose intoleranceLactase (b-galactosidase)Essential pentosuriaL-xylulose dehydrogenase (xylulose reductase)

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All of the following statements are true regarding anterior axillary lymph nodes EXCEPT-

[ "Present on anterior wall of axilla on pectoral muscle", "Present along the lateral thoracic vein", "Drains into central axillary lymph nodes", "Drains the medial aspect of mammary gland" ]

D

Drains the medial aspect of mammary gland

Anterior axillary / pectoral lymph nodes are present along the lateral thoracic vein on the anterior wall of axilla on pectoral muscle. These drains the lateral aspect of mammary gland. And finally drains into central axillary lymph nodes.

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Inheritence of Familial hypophosphatemic Rickets is

[ "Autosomal recessive", "X-linked dominant", "X-linked recessive", "Autosomal dominant" ]

B

X-linked dominant

null

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Paranasal sinuses presents at bih are

[ "Frontal and maxillary", "Ethmoid and maxillary", "Frontal and ethmoid", "Sphenoid and ethmoid" ]

B

Ethmoid and maxillary

Paranasal sinuses develop as outpouchings from the mucous membrane of a lateral wall of the nose. The growth of sinuses continues during childhood and into early adult life. Radiologically maxillary sinuses can be identified at 4-5 months, ethmoids at 1 year, sphenoid at 4 years and frontals at 6 years. Reference: Diseases of ear, nose and throat; PL Dhingra; 6th edition; Pg no.189

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In children, the most common lesion in anterior teeth are due to

[ "Nursing bottle caries", "Dental trauma", "Malformation of tooth", "Discolouration" ]

A

Nursing bottle caries

- In children, the most common lesion in anterior teeth are due to nursing bottle caries. - These lesions begin on the labial surface of all anterior and they progress rapidly as diffused demineralization of the entire surface of all existing teeth.

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Ketone bodies are used by all except ?

[ "Brain", "RBCs", "Skeletal muscles", "Hepatocytes" ]

D

Hepatocytes

Ans. is 'd' i.e., Hepatocytes Ketone bodies are synthesized by liver and are utilized by extrahepatic tissues like hea, muscles, renal coex and brain (in starvation). Liver cannot utilize ketone bodies because it lacks enzyme succinyl-CoA-acetoacetate CoA transferase, which is required for the activation of ketone bodies. The first reaction in use of ketone bodies is activation of acetoacetate. CoA-transferase Succinyl CoA + acetoacetate ___________________ Acetoacetyl CoA + succinate

medmcqa

Bevelling of inner table of skull is found in

[ "Fire arm entry wound", "Fire arm exit wound", "Drowning", "Infanticide" ]

A

Fire arm entry wound

A i.e. Firearm entry wound When a bullet traverses the skull, the apeure in the bone differs in relation to the outer & inner tables; the defect is larger in the I direction in which the bullet travelsQ

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A patient comes with history of unresponsive fever and cough. X-ray revealed pneumonia. Sputum examination showed gram positive, paially acid fast bacteria with branching filaments that grows on sheep blood agar. The most likely etiologic agents is:

[ "Actinomycetes", "Nocardia", "Aspergillosis", "Pneumococci" ]

B

Nocardia

Ans. (b) i.e. Nocardia

medmcqa

Most sensitive test for sanguinarine is :

[ "Paper chromatography", "HCL", "Fecl3", "Nitric acid" ]

B

HCL

Can be detected by both Nitric acid test and paper chromatography test (Most sensitive test).

medmcqa

Budd - Chiari Syndrome occurs in:

[ "Antithrombin deficiency", "Protein C deficiency", "Oral contraceptive use", "All of the above" ]

D

All of the above

(All of the above) (336, 627, 1862, 1874-H 16th) (612-13-CMDT-09) (362, 661, 733,1945, 1990-Hl7th)BUDD-CHIAR1 SYNDROME (Hepatic vein obstruction)* Many cases associated with polycythemia vera or other proliferative diseases* Predisposition to thrombosis (e.g. - hyperprothrombinemia) factor II G20210 A mutation) activated protein C resistance (Factor V Leiden mutation) Protein C or S or antithrombin deficiency, the methylenetetrahydro folate reductase mutation, antiphospholipid antibodies can be identified.* Right sided heart failure or constrictive pericarditis, neoplasm.* Paroxysmal nocturnal hemoglobinuria, Behcet's syndrome blunt abdominal trauma, use of oral contraceptives and pregnancy.* Cytotoxic agents and pyrrolizidine alkaloids ("bush teas")The screening test of choice is colour or pulsed Doppler ultrasonography

medmcqa

Osteoblastic secondaries are most commonly seen from which primary malignancy?

[ "Lung", "Prostate", "Adrenal", "Breast" ]

B

Prostate

Ans is 'b' i.e. Prostate

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Most common type of hypospadias is: September 2011

[ "Glandular", "Penile", "Coronal", "Perineal" ]

A

Glandular

Ans. A: Glandular Glandular hypospadias is common and does not usually require treatment Hypospadias: The external meatus opens on the underside of the penis or the perineum, and the inferior aspect of the prepuce is poorly developed (hooded prepuce) Meatal stenosis occurs Bifid scrotum 6 - 10 months of age is the best time for surgery

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Which of the following is the most common location of hypertensive haemorrhage -

[ "Pons", "Thalamus", "Putamen/external capsule", "Subcortical white matter" ]

C

Putamen/external capsule

null

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A 32-year old male with no past medical history is brought to the emergency department after being injured in a bomb blast. On examination he is suspected to have a splenic injury and is supposed to undergo an emergency laparotomy. Which of the following is the ideal anaesthetic agent of choice?

[ "Remifentanil", "Morphine", "Etomidate", "Halothane" ]

C

Etomidate

Ans. c. Etomidate (Ref: Morgan 4/e p167, 194, 199)A 32-year -old male with no past medical history is brought to the emergency department after being injured in a bomb blast. On examination he is suspected to have a splenic injury and is supposed to undergo an emergency laparotomy. The ideal anaesthetic agent of choice would be etomidate, as it has minimal effects on the cardiovascular system."Abdominal trauma patient especially with splenic injury are at high risk of hypotension, etomidate is agent of choice as it has minimal effects on the cardiovascular system.""Etomidate has minimal effects on the cardiovascular system. A mild reduction in peripheral vascular resistance is responsible for a slight decline in arterial blood pressure. Myocardial contractility and cardiac output are usually unchanged. Etomidate does not release histamine.""Opioids: In general, opioids do not seriously impair cardiovascular function. Meperidine tends to increase heart rate (it is structurally similar to atropine). Ramifentanyl, and alfentanyl are associated with vagus-mediated bradycardia With the exception of meperidine, the opioids do not depress cardiac contractility. Nonetheless, arterial blood pressure often falls as a result of bradycardia, venodilation, and decreased sympathetic reflexes, sometimes requiring vasopressor (eg., ephedrine) support. Meperidine and morphine evoke histamine release in some individuals that can lead to profound drops in systemic vascular resistance and arterial blood pressure.""Halothane: A dose-dependent reduction of arterial blood pressure is due to direct myocardial depression. 2.0 MAC of halothane results in a 50% decrease in blood pressure and cardiac output."EtomidateEtomidate is a carboxylated imidazole compound that is a selective positive allosteric modulator at GABA-A receptorQUnlike thiopental does not appear to affect other pentameric ion channels.It is structurally unrelated to other agents.Mechanism of Action:Selective positive allosteric modulator at GABA-A receptorQPharmacokinetics:It is rapidly acting general anesthetic agent with a short duration of action (2-3 min), resulting predominantly from redistribution, although it is also eliminated rapidly from bodyQ.Characteristic Features:It is characterized by hemodynamic stability, minimal respiratory depression and cerebroprotective effectQ.It is a sedative hypnotic but lacks analgesic propertiesQAs with thiopental, cerebral blood flow and metabolism, intracranial and intraocular pressure all fall with etomidateQAs with methohexital, excitatory phenomenon (on induction) may be seen which can be prevented by benzodiazepine premedication or concomitant use of opioid.Central sympathetic out flow is stimulated, which maintains hemodynamics. Because of minimal cardiovascular effect, CPP is well maintained.It enhances somatosensory evoked potentials on EEG.Side-Effects:It causes adrenocortical suppressionQ by inhibiting enzymes 11-beta hydroxylase (mainly) and 17-alpha hydroxylase involved in cortisol and aldosterone (mineralocorticoid) productionQ. Vitamin C supplementation restores cortisol level.Excitatory phenomenon causing myoclonus, hiccups and other involuntary movements (40%); emergence phenomenon causing restlessness and delirium during recoveryQHigh incidence of nausea and vomiting (highest among all IV anesthetics i.e. ~40%)Pain on injection; Vitamin C deficiency; ThrombophlebitisQ

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A 30-year-old multiparous female complains of a painless ulcer in vulva. She has several sexual partners. Her previous pregnancy has ended in a still birth at 24 weeks. What is the first test, which should be performed in this case:

[ "ELISA for HIV", "VDRL Test", "Culture of scraping from the ulcer", "Election microscopy of scraping from the ulcer" ]

B

VDRL Test

Ans is b, i.e. VDRL TestRef: Dutta Gynae 6th/ed, p262The female is presenting with a single painless ulcer, she has multiple sex partners and her pregnancy resulted in still birth at 24 weeks. All this points towards syphilis as the diagnosis.The first test to be performed in this case is VDRL test (screening test).Confirmatory test = specific treponemal test like Treponema haemaggluteration test or fluorescent treponemal antibody test.InfectionDiagnosisChlamydiaNAAT or PCRGonorrheaNAATChancroidCulture of scrapings from ulcerGenital herpesElectron microscopy of scrapings from ulcerLGVELISA test

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The treatment for CNS leukaemia is

[ "Intrathecal methotrexate", "Vincristine and prednisolone", "Intrathecal vincristine", "IV prednisolone" ]

A

Intrathecal methotrexate

Intrathecal methotrexate is a chemotherapy drug which is given to prevent leukaemia cells entering the cerebrospinal fluid (CSF) around the spine and brain. This drug is also used to treat leukaemia found in the CSF for CNS leukemias Ref Davidson 23rd edition pg 788

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A young girl presented with swelling of right thigh with history of trauma 2 months back. Now she presents with swelling at mid shaft of femur and low grade fever. ESR is midly raised. X ray shows a laminated Periosteal reaction, next line of investigation would be

[ "MRI", "Biopsy", "Bone scan", "Blood count and CRP" ]

A

MRI

Next best investigation is MRI Extent of soft tissue involvement Skip lesions in the same compament Relationship if neurovascular bundle to the tumor Intramedulary extent of tumor Refer Campbell 13th/e

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Fatty acid synthase complex result in formation of

[ "14 carbon chain", "16 carbon chain", "18 carbon chain", "20 carbon chain" ]

B

16 carbon chain

Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 136-138

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Arthritis mutilans is a feature of?

[ "Lichen planus", "Psoriasis", "Staphylococcal scalded skin syndrome", "Eczema" ]

B

Psoriasis

Ans. b (Psoriasis). (Ref. Harrison' sprinciples of medicine -18th/Chapter 52.)PSORIASIS# Classical features:- White scaly plaques with specific distribution over the body.- Pitting (thimble) of nails.- Onychodystrophy, Subungual hypertrophy.- Arthritis mutilans, rare and late feature {pencil in cup sign, pestle in mortar sign). (MH 2008)# Treatment:- Unstable psoriasis = liberal application of topical bland emollient & supportive therapy.- PUVA therapy is used in severe cases.- Oral methotrexate, retinoids, cylosporin can be used, however systemic steroids are usually avoided for the fear of precipitating pustular psoriasis upon withdrawal.

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Sine wave pattern in E.C.G. is seen in-

[ "Hypokalemia", "Hyperkalemia", "Hyponatremia", "Hypermatremia" ]

B

Hyperkalemia

null

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Maximum recommended external beam radiation therapy dose for a case of Carcinoma cervix is?

[ "80 Gy", "70 Gy", "50 Gy", "35 Gy" ]

C

50 Gy

Ans. C. 50 Gy."External-beam doses of more than 40 to 45 Gy to the central pelvis tend to compromise the dose deliverable to paracentral tissues and increase the risk of late complications. However, recently IMRT (Intensity Modulated Radiotherapy) allows delivery of doses exceeding 60 Gy with relative sparing of adjacent critical structures"Discussion:RADIATION THERAPY IN CERVICAL CANCERAs with radical surgery, the goal of radical radiotherapy is to sterilize disease in the cervix, paracervical tissues, and regional lymph nodes in the pelvis. Patients are usually treated with a combination of external-beam irradiation to the pelvis and brachytherapy. Brachytherapy is a critical element in the curative radiation Rx of all carcinomas of the cervix. Even relatively small tumors that involve multiple quadrants of the cervix are usually treated with total doses of 80 to 85 Gy to point A.Teletherapy dose rates:# An initial dose of 40 to 45 Gy to the whole pelvis, is believed to deliver a homogeneous distribution to the entire region at risk for microscopic disease and the additional tumor shrinkage achieved before brachytherapy outweigh other considerations.# External-beam doses of more than 40 to 45 Gy to the central pelvis tend to compromise the dose deliverable to paracentral tissues and increase the risk of late complications.# Recently, there has been considerable interest in the use of IMRT to treat the pelvis in patients with endometrial and cervical cancer. Unlike standard two-field and four-field techniques, IMRT makes it possible to deliver a lower daily dose to the intrapelvic contents than to surrounding pelvic lymph nodes. IMRT allows delivery of doses exceeding 60 Gy with relative sparing of adjacent critical structures.Brachytherapy dose rates:# An effort should always be made to deliver at least 85 Gy (with LDR brachytherapy-csl37) to Point A for patients with bulky central disease.# If the intracavitary placement has been optimized, this can usually be accomplished without exceeding a dose of 75 Gy to the bladder reference point or 70 Gy to the rectal reference point.# The dose to the surface of the lateral wall of the apical vagina should not usually exceed 120 to 140 Gy.# A total dose (external-beam and intracavitary) of 50 to 55 Gy appears to be sufficient to sterilize microscopic disease in the pelvic nodes in most patients. It is customary to treat lymph nodes known to contain gross disease and heavily involved parametria to a total dose of 60 to 65 Gy (including the contribution from brachytherapy Rxs).

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During skeletal muscle contraction:

[ "A band shorten", "Both H and I band shorten", "Both A and I band shorten", "Both A and H band shorten" ]

B

Both H and I band shorten

During muscle contraction, two Z lines come closer; the length of the ‘A band’ remains constant whereas the length of H and I band decreases. The M line becomes more prominent.

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ln &;V&;-Exotropia amount of detion

[ "Decreases in upward gaze and increases in downward gaze", "Decreases in upward as well as downward gaze", "Increases in upward as well as downward gaze", "Increases in upward gaze and decreases in downward gaze" ]

D

Increases in upward gaze and decreases in downward gaze

A' AND 'V' PATTERN HETEROTROPIA The terms 'A' or 'V' pattern squint are labelled when the amount of detion in squinting eye varies by more than 10deg and 15deg, respectively, between upward and downward gaze. 'A' and 'V' esotropia. In 'A' esotropia the amount of detion increases in upward gaze and decreases in downward gaze. The reverse occurs in 'V' esotropia. 'A' and 'V' exotropia. In 'A' exotropia the amount of detion decreases in upward gaze and increases in downward gaze. The reverse occurs in 'V' exotropia. Ref:- A K KHURANA; pg num:-334

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Late metabolic acidosis in newborns are caused due to feeding of which formula:

[ "Whey predominant", "Casein predominant", "Both of the above", "None of the above" ]

B

Casein predominant

Casein dominant formulas or cow's milk has higher concentration of aromatic acids like tyrosine and phenylalanine that may lead to late metabolic acidosis. Ref: Nutrition and Child Development, K.E. Elizabeth, 4th edition pg: 26

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Commonest cutaneous eruption in SLE is:

[ "Palmar erythema", "Discoid lesions", "Erythema of light exposed area", "Diffuse morbiliform erythema" ]

C

Erythema of light exposed area

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"Sub-mucosal glands" are present in?

[ "Duodenum", "Colon", "Anal canal", "Stomach" ]

A

Duodenum

Duodenum and oesophagus have submucosal glands. The submucosa of the duodenum is densely packed with mucous Brunner&;s glands.The oesophagus has occasional submucosal mucous glands.Reference: Chaurasia; 6th edition

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Coenzyme A in TCA contains which of the following?

[ "Thiamine", "Riboflavin", "Panthothenic acid", "Nicotinic acid" ]

C

Panthothenic acid

Co-enzyme Activity of Pantothenic Acid - i. The beta mercaptoethanol amine (NH2-CH2- CH2-SH) contains one thiol or sulfhydryl (-SH) group. It is the active site where acyl groups are carried. Therefore the co-enzyme A is sometimes abbreted as CoA-SH to denote this active site. ii. The thio ester bond in acyl-CoA is a high energy bond. These acyl groups are transferred to other acceptors, for example: Acetyl CoA + Choline - Acetyl choline + CoA (enzyme is acetyl choline synthase) iii. Acyl groups are also accepted by the CoA molecule during the metabolism of other substrates, for example: Pyruvate+CoA+NAD+ - AcetylCoA+CO2+NADH (Enzyme is pyruvate dehydrogenase). iv. The impoant CoA derivatives are: Acetyl CoA Succinyl CoA HMG CoA Acyl CoA. v. Co-enzyme A is an impoant component of fatty acid synthase complex. The ACP (acyl carrier protein) also contains pantothenic acid. Ref: DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY, EIGHTH EDITION,PG.NO.,472.

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Test normally undeaken to demonstrate the presence of collateral circulation of hand is NOT RELATED-SURGERY

[ "Kety Schmidt test", "Allen's test", "Sellick's test", "Swan Ganz test" ]

B

Allen's test

Allen's test is done to determine the presence of collateral circulation of hand before cannulating radial aery.

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Pudendal canal is a pa of -

[ "Colle's fascia", "Obturator fascia", "Scarpa's fascia", "None" ]

B

Obturator fascia

Ans. is'b'i.e., Obturator fasciaPudendal canal (Alcock's canal) is a fascial canal in the lateral wall of ischeorectal (ischeo-anal) fossa.It is a space between obturator fascia and lunate fascia. Other believe that it is formed by splitting of the obturator fascia.Contents of pudendal canal are -Pudendal nerve,Internal pudendal aery, andInternal pudendal vein.

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The most common complication of hypermature sclerotic cataract is

[ "Dislocation of the lens", "Phacomorphic glaucoma", "Uveitis", "Neovascularization of retina" ]

A

Dislocation of the lens

Subluxation of the lens is the most common complication of nuclear sclerotic hypermature cataract refer Khurana 6th edition page number 184

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True regarding 10-0 sutures is/are?

[ "Thicker than 1-0 sutures", "Synthetic sutures", "Diameter is 0.9 mm", "Stronger than 1-0" ]

B

Synthetic sutures

Answer- B. Synthetic suturesThe larger the size ascribed to the suture, the smaller the diameter be.10-0 sutures- 0.2 (0.020-0.029)

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Eye examination of a 48-year-old man showed a golden brown ring around the cornea. You suspect a Kayser Fleisher ring, which is characteristically seen in which of the following conditions?

[ "Hemosiderosis", "Wilson's disease", "Tyrosinemia", "Hereditary cataract" ]

B

Wilson's disease

Kayser Fleisher Ring is seen in Wilson's disease. KF ring is a golden brown ring which occur due to deposition of copper under the peripheral pas of the Descement's membrane of the cornea. Wilson's disease is a rare autosomal recessive disease of young adults characterized by abnormal copper metabolism which inturn causes changes in the basal nuclei, liver cirrhosis, and corneal pigmentation. Abnormal copper metabolism can result in deposition of copper in the posterior capsule of the lens resulting in sunflower cataract. Ref: Comprehensive Ophthalmology by A K Khurana, 4th edn, page 410

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Lisch nodules are seen in: March 2009

[ "Retinoblastoma", "Neurofibromatosis", "Retiniitis pigmentosa", "Neuroblastoma" ]

B

Neurofibromatosis

Ans. B: Neurofibromatosis

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Postnatally when is the growth velocity maximum

[ "In the first year of life", "In the second year of life", "In the seventh year of life", "In adolescence" ]

A

In the first year of life

Postnatally there are 2 periods of accelerated growth, they are: 1st yr of growth Growth spu during pubey Ref: Nelson's, 20th edition, Page-84

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A Down syndrome child is mentally retarded. All cytogenetic abnormalities may occur except?

[ "Deleted chromosome 21", "Trisomy 21", "Robertsonian translocation", "Mosaic" ]

A

Deleted chromosome 21

a. Deleted chromosome 21(Ref: Nelson's 20/e p 610-615, Ghai 8/e p 637-639)An extra copy of chr 21 is required to cause trisomy 21 (Down syndrome), so deletion of chr 21 will not cause it.

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Which of the following is a fungus -

[ "Klebsiella", "Clostridia", "Pneumocystis jerovecii", "Listeria" ]

C

Pneumocystis jerovecii

Pneumocystis jerovecii is considered to be fungus based on following points: It takes fungal stains like Gomori’s methanamine silver stain It possesses chitin at all stages of development (component of fungal cell wall) Based on molecular study of 5S –rRNA.

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If a child's teeth do not form, this would primarily affect the growth of the:

[ "Maxilla", "Mandible", "Whole face", "Alveolar bone" ]

D

Alveolar bone

Key Concept: If teeth do not form, this would primarily aﬀect the growth of the alveolar bone.

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In cholangiography CBD stone appears as

[ "Meniscus sign", "Cutoff sign", "Slight flow of dye from the sides", "Ability to absorb water" ]

A

Meniscus sign

Mr cholangiography : provides excellent anatomic detail, with sensitivity and specificity of 95 %and 98 %respectively for CBD stones Typical meniscus sign is seen when the CBD stone is wedged at the level of the papilla Ref: Sutton 6th edition Pgno : 971

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Which of the following is the first bone to ossify in human body

[ "Mandible", "Maxilla", "Clavicle", "Humerus" ]

C

Clavicle

The mandible is the second bone, next to the clavicle, to ossify in the body.

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All of the following are features of Mobiz type I block except -

[ "Constant PR interval", "Normal QRS morphology", "Regular atrial rhythm", "Atrial rate - ventricular rate" ]

A

Constant PR interval

null

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Differential diagnosis of rosacea includes all of the following except?

[ "Acne vulgaris", "Lupus erythematosus", "BCC", "Melasma" ]

D

Melasma

Ans. is 'd' i.e., Melasma ACNE ROSACEA* Acne rosacea, commonly called rosacea, is a chronic non-curable skin disease with periodic ups and down. It occurs in middle age (30-50 years). It is more common in females, but is more severe in males. Rosacea is a centrofacial disease, i.e., it involves the central face - Cheeks, Chin, Forehead, Nose, making typical cruciate pattern of involvement. Periorbital 8c perioral areas are spared.* Clinical features are intermittant flushing followed by more permanent erythma and telangiectasia. On this back-ground, erythmatous papules, papulo pustules and rarely nodules develop. Lesions may be exacerbated by light (photosensitive) and spicy foods.Complications are: -1. Rhinophyma: - Rhinophyma is large, bulbous, ruddy appearance of nose caused by granulomatous infiltration of skin. It is slowly progressive condition due to hypertrophy of sebaceous gland on the tip of nose. It is also known as Potato nose.2. Ophthalmologic: - Blephritis, Conjuctivits, Keratitis.3. Lymphedema : - Infra-orbital and on forehead.Differential diagnosis1. Erythematous and telengiectatic phase - carcinoid syndrome, LE2. Popular and pustular phase - acne vulgaris, lupus milliaris, seborrheic dermatitis, demodicidosis3. Rhinophyma - BCC

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All are features of familial hemolytic uremic syndromes except:

[ "Characterized by microangiopathic hemolytic anemia", "Hemolysis results from an inherited intrinsic red cell abnormalities", "Atypical HUS is a severe disease with up to 15% moality in the acute phase", "50% of cases progressing to end-stage renal disease" ]

B

Hemolysis results from an inherited intrinsic red cell abnormalities

Familial HUS mostly affecting children, characterized by microangiopathic hemolytic anemia (HA) with presence of fragmented erythrocytes in the peripheral blood smear, thrombocytopenia and acute renal failure. The hemolysis results from an inherited defect external to red cells. Atypical HUS is a severe disease with up to 15% moality in the acute phase and up to 50% of cases progressing to end-stage renal disease. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 880

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The behaviour therapeutic falls in management of enuresis, The pharmacological drug of choice for this case is –

[ "Phenytoin", "Diazepalm", "Imipramine", "AlPrax" ]

C

Imipramine

Desmopressin is best answer. But it is not given in options. Amongst the given options only imipramine is used in enuresis.

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Earliest symptom of glomus tumor is:

[ "Pulsatile tinnitus", "Deafness", "Headache", "Veigo" ]

A

Pulsatile tinnitus

Ans. A Pulsatile tinnitus "The two most common presenting symptoms of paraganglioma of temporal bone (Glomus tumor) are conductive hearing losso and pulsatile tinnnus" Hearing loss is conductive and slowly progressive Tinnitus is pulsatile and of swishing character", synchronous with pulse", and can be temporarily stopped by carotid pressure", Thus, both pulsatile tinnitus and deafness are seen in glomus tumor.

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Dorsal root ganglion contains -

[ "Dendrides of motor neuron", "Dendrides of sensory neuron", "Body of motor neuron", "Body of sensory neuron" ]

D

Body of sensory neuron

Ans. is 'd' i.e., Body of sensory neuron o The various sensations from the sensory receptors are carried to the spinal cord through the spinal nerves. As thespinal nerve approaches the spinal cord, it divides into the dorsal (sensory) roots and ventral (motor roots). Ganglion for dorsal root (Le. dorsal root ganglion - DRG) contains the cell body (soma) of sensory neuron, coming from the receptors. The axon of the sensory neuron enter the spinal cord (in dorsal root of spinal nerve) and terminates in the dorsal horn of spinal cord. The axons of DRG neuron (sensory neuron) may follow any of the following three routesi) First, A few branches synapses with motor neuron in the ventral horn of spinal cord either directly or through intemeurons, and motor neuron leaves through ventral root in same spinal nerve to complete the reflex arcs for spinal reflexes.ii) Second, they ascend up in the spinal cord towards the brainstem in specific tracts, resulting in conscious perception.iii) Third, they relay in reticular formation and nonspecific thalamic nuclei, resulting in general arousal.

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All of the following bones are pneumatic, except:

[ "Maxillary", "Parietal", "Frontal", "Ethmoidal" ]

B

Parietal

Pneumatic bones are those bones which contain an air filled cavity within them. In humans, they are seen in relation to the the nasal cavity – they enclose the paranasal sinuses. Pneumatic bones are – maxilla, frontal bone, sphenoid and ethmoid.

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Battle's sign is associated with:

[ "Orbital cellulitis", "Head injury", "Conjunctivitis", "Liver failure" ]

B

Head injury

Extravasation of blood results in ecchymosis behind the ear, known as Battle's sign. A fracture of the anterior skull base can result in anosmia (loss of smell from damage to the olfactory nerve), CSF drainage from the nose (rhinorrhea), or periorbital ecchymoses, known as raccoon eyes. Ref: Schwaz's principle of surgery 9th edition, chapter 42.

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Line I in International Death Certificate is

[ "Disease leading directly to death", "Interval between onset and death", "Antecedent causes", "Other conditions not related to disease" ]

A

Disease leading directly to death

Ans. is 'a' i.e., Disease leading directly to death International Death Cetificate* The certificate has two parts (Part I and Part II) and a section to record the time interval between the onset of each codition and the date of death.* Part I - To record diseases or conditions related to the sequence of events leading directly to the death.* Part II - To record conditions that have no direct connection with the events leading to death but which, by their nature, contributed to the death.INTERNATIONAL FORM OF THE MEDICAL CERTIFICATE FOR CAUSE OF DEATHINTERNATIONAL FORM OF MEDICAL CERTIFICATE OF DEATHCause of deathApproximate interval between onset and deathIDisease or condition directly leading to death a) .................................due to (or as a consequence of)...............Antecedent causesMorbid conditions, if any, giving rise to the above cause, stating the underlying condition last.b)..................................due to (or as a consequence of)...............c) ..................................due to (or as a consequence of)...............d) .................................................IIOther significant conditions contributing to the death, but not related to the disease or conditions causing it .................................................."this does not mean the mode of dying, e.g. heart failure, respiratory failure, it means the disease, injury, or complication that caused death.

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Which of the following is a feature of pernicious anaemia

[ "Glossitis", "Tingling or numbness of extremities", "Nervous system involvement in 75 % cases", "All of the above" ]

D

All of the above

In pernicious anaemia Triad Generalised weakness Sore and painful tongue Tingling or numbness of extremities Nervous system involvement is present in 75% of cases Degeneration of myelin sheath & peripheral nerves

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Type of Growth Chas used by Anganwadi workers (ICDS) for growth monitoring

[ "NCHS", "IAP", "MRGS", "CDC" ]

C

MRGS

ICDS GROWTH CHA: In NRHM and ICDS, Government of India has adopted WHO child Growth standards 2006 (also known as MGRS &;Multicenter Growth Reference study&; Standards) Normal zone Below -2SD: Malnutrition Below -3SD: Severe Malnutrition Ref: Park 25th edition PGno: 580-581

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Which of the following is the most important mediator implicated in development of fever:

[ "PGF2", "PGE2", "PGD2", "FGA2" ]

B

PGE2

PGF2α is a vasoconstrictor whereas PGD2 and PGE2 are vasodilators. PGE2 is the most important chemical for development of fever.

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A male child of 15 years with a mental age of 9 years has an IQ of:

[ "50", "60", "70", "80" ]

B

60

IQ = Mental age x 100/Chronological age =So, in this case, IQ = 9 x 100/15 = 60 Degree IQ level Mild 51-70 Moderate 36-50 Severe 21-35 Profound 0-20

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Elastin fiber system present in the lamina propria consists all of these EXCEPT

[ "Oxytalan", "Elastin", "Elaunin", "Collagen" ]

D

Collagen

null

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Purely serous gland among the following:

[ "Parotid gland", "Submandibular gland.", "Sublingual gland.", "None" ]

A

Parotid gland

null

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Most common presentation of Renal Tuberculosis is:

[ "Renal colic", "Sterile Pyuria", "Intractable urgency", "Painful micturition" ]

B

Sterile Pyuria

Answer is B (Sterile Pyuria): The most common clinical presentation of Urological Tuberculosis is Sterile Pyuria. 'The most common clinical presentation of urological tuberculosis is sterile pyuria and painless hematuria - Textbook of Pulmonary and Critical Care Medicine `Renal Tuberculosis is probably underdiagnosed because it is frequently asymptomatic Many cases are diagnosed as a result of routine detection of sterile pyuria. The development of symptoms reflects a more advanced stage of disease' - Oxford Textbook of Medicine Classical Renal Tuberculosis Early Clinical Features: Symptoms of cystitis; Microscopic or macroscopic hematuria; Pyuria with negative bacterial culture (`sterile pyuria'); Constitutional symptoms. Late Clinical Features: Nephrolithiasis and ureteral colic; Intractable frequency and urgency; Refractory hypeension; Renal insufficiency due to obstructive nephropathy.

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Which one is not poor prognostic factor for acute pancreatitis:

[ "Hyperglycemia", "Hypocalcemia", "Raised LDH level in blood", "Hyperamylasemia" ]

D

Hyperamylasemia

Answer is D (Hyperamylasemia) Serum amylase levels do not form any criteria for prognosis in acute pancreatitis. Hyperglycemia, Hypocalcemia and raised LDH levels are poor prognostic factors according to Ranson's criteria.

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Cataract is seen in all except

[ "Rheumatoid ahritis", "Glucocoicoid admistration", "Galactosemia", "Hypoparathyroidism" ]

A

Rheumatoid ahritis

Rheumatoid ahritis causes thinning and melting of the peripheral cornea and sclerosing keratitis called scleromalcia perforans Refer: Khurana 6th edition page number 198

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In Bater's Syndrome, which of the following is not seen-

[ "Metabolic Alkalosis", "Hypokalemia", "Hypomagnesemia", "Decrease in urinary calcium" ]

D

Decrease in urinary calcium

Bater's syndrome - There is loss of transpo function of Thick ascending loop of henle(TALH) Segment of nephron which results in hypokalemic metabolic alkalosis classic BS- typically suffer from polyuria and polydypsia due to reduction in renal concentrating ability . Increase in urinary calcium excretion 20% are hypomagnesemic. Marked activation of RAAS. Antenatal BS- They suffer from severe systemic disorder characterized by marked electrolyte wasting, polyhydramnios ,hypercalciuria with nephrocalcinosis . Ref:Harrison 20 th edition pg no 306.

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Baby born at 30 weeks for 18-year-old prior gravida of weight 2 kg which died after 48 hours. Apgar scores were 5 and 8 at 1 and 5 minutes. On autopsy bilateral enlarged kidney with multiple radially arranged cysts. Which of the following finding is expected to be associated with?

[ "Imperforate anus", "Hepatic cyst and fibrosis", "Absence of ureter", "Holoprosencephaly" ]

B

Hepatic cyst and fibrosis

The clinical findings suggest autosomal recessive polycystic kidney disease. The diagnosis of autosomal recessive polycystic kidney disease is strongly suggested by bilateral palpable flank masses in an infant with pulmonary hypoplasia, oligohydramnios and hypertension and the absence of renal cysts in the parents. On imaging and biopsy the kidney shows innumerable cysts radiating from medulla to the cortex. Autosomal recessive kidney disease is associated with liver disease in about 45% cases. Both kidneys are markedly enlarged and grossly show innumerable cysts throughout the cortex and medulla. Microscopic studies demonstrate micro cysts radiating from medulla to the cortex located primarily within the collecting tubules and the ducts. Development of progressive interstitial fibrosis and tubular atrophy during advanced stages of disease eventually leads to renal failure. Liver involvement is characterized by bile duct proliferation and ectasia as well as by hepatic fibrosis

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Which statement best describes the tears seen in Mallory-Weiss syndrome?

[ "Longtitudinal tears in lower 1/3 esophagus", "Circumferential tears in lower 1/3 esophagus", "Longtitudinal tears in middle 1/3 esophagus", "Circumferential tears in middle 1/3 esophagus" ]

A

Longtitudinal tears in lower 1/3 esophagus

Ans- A. Mallory-Weiss Tear- A Mallory-Weiss tear is a linear mucosal rent near or across the gastroesophageal junction that is often associated with retching or vomiting.

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A 30 year biker sustained an compound fracture of the leg following RTA. The doctor has labeled it Gustilo Anderson type IIIB. Which of the following would represent the injury:

[ "Fracture with open wound less than 1 cm", "Fracture with open wound of 1-10 cm but soft tissue cover possible", "Open wound more than 10 cm and soft tissue coverage not possible.", "Open wound more than 10 cm with arterial injury" ]

C

Open wound more than 10 cm and soft tissue coverage not possible.

Ans. C. Open wound more than 10 cm and soft tissue coverage not possible.Gustilo Anderson ClassificationType IWound <=1cm, minimal contamination or muscle damageType IIWound 1-10cm, moderate soft tissue injuryType IIIAwound usually >10cm, high energy, extensive soft-tissue damage, contaminatedadequate tissue for flap coveragefarm injuries are automatically at least Gustillo IIIAType IIIBextensive periosteal stripping, wound requires soft tissue coverage (rotational or free flap)Type IIICvascular injury requiring vascular repair, regardless of degree of soft tissue injuryMost accurate way to grade open fractures is by intra-operative examination

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A vitreous aspirate from a case of metastatic endophthalmitis on culture yields Gram-positive round to oval cells, 12-14 m in size. The aspirate on Gram staining shows the presence of pseudohyphae. Which of the following is the most likely aetiological agent

[ "Aspergillus", "Rhizopus", "Candida", "Fusarium" ]

C

Candida

Candida is a yeast-like fungus, grows paially as yeast and paially as chains of an elongated budding cell joined end to end forming pseudohyphae. on gram staining candida shows budding gram-positive yeast cells. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition

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"Satellidsm" in presence of streak of staphylococci is shown by

[ "Bordetella pertussis", "Yersinia pestis", "Haemophilus influenzae", "Helicobacter pylori" ]

C

Haemophilus influenzae

Ans. c (Haemophilius influenzae) (Ref. Ananthanarayan Microbiology 7th ed., Fig. 36.2, p. 334)H. influenzae# Gram negative, nonmotile, non-sporing bacillus exhibiting considerable pleomorphism.# In sputum usually occurs as clusters of coccobacillary forms, while in the CSF from meningitis cases long, bacillary and filamentous forms predominate.# Strains isolated from acute infections are often capsulated.# They are relatively difficult to stain. Staining for 5-15 minutes with Loeffler's methylene blue or dilute carbol fuschin gives good results.# It is aerobic but grows anerobically also.# The optimum temp is 37degC. It does not grow below 20degC. Some strains require 10% CO2# It grows on blood agar but growth is scanty as the V factor is not freely available, being imprisoned inside the red blood cells.# Growth is therefore better if a source of factor V is also provided.# When Staph aureus is across a plate of blood agar on which a specimen containing H. influenzae has been inoculated, after' overnight incubation, the colonies of H. influenzae will be large and well developed alongside the streak of Staphylococcus, and smaller farther away. This phenomenon is called SATELLITISM.# It is however not very specific as it will also be positive with* other V factors requring hemophilli as well as occasional strains of Neisseriae and Diphtheroids.# Aerosol transmission.# Invasive disease caused by capsular type B.# Produces IgA protease.# Culture on chocolate agar requires factors V (NAD) and X (hematin) for growth.# Treat meningitis with ceftriaxone.# Rifampin prophylaxis in close contacts.# Vaccine contains type B capsular polysaccharide conjugated to diphtheria toxoid or other protein.# Given between 2 and 18 months age.

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Most common symptom of alcohol withdrawal is:

[ "Bodyache", "Tremor", "Diarrhoea", "Rhinorrheo" ]

B

Tremor

B ie. Tremor

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Hemolytic uremic syndrome is due to -

[ "Enterotoxigenic E. coli", "Enterohemorhagic E. coli", "Shigella", "Salmonella" ]

B

Enterohemorhagic E. coli

Ans. is 'b' i.e., Enterohemorhagic

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