question stringlengths 1 6.54k | choices listlengths 4 4 | answer stringclasses 4
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Which of the following vitamin deficiencies is most commonly seen in sho bowel syndrome: | [
"Vitamin B12",
"Biotin",
"Vitamin B1",
"Vitamin K"
] | A | Answer is A (Vitamin B 12) Cyanocobalamine (Vitamin B12) deficiency is the most common deficiency in patients with sho bowel syndrome associated with loss of ileum (Heal resection) since vitamin B12 is absorbed only in the ileum Sho Bowel Syndrome may be associated with deficiency offal-soluble vitamins (Vitamin A, D, E and K) and water soluble Vitamin B12 (when ileum is resected / non functional). The most common deficiency is determined essentially by the specific segment of the small intestine (jejunum or ileum) that is resected / non functional. Since the question does not specift the specific segment of the small intestine contributing to the sho bowel syndrome, the single best answer has to be selected by a method of exclusion. Vitamin B12 is the single best answer amongst the options provided (since none of the commonly deficient fat soluble vitamins (A, D or E) have been provided amongst the options and deficiency of Fat soluble Vitamin K is uncommon in Sho Bowel Syndrome) Deficiency of fat-soluble vitamin K is uncommon in sho bowel syndromesince 60% of the vitamin K is synthesized in the colon Deficiency of water-soluble vitamins Biotin and Thiamine is uncommon in sho bowel syndrome since thay are primarily absorbed in the duodenum and/or proximal jejunum. - Sho Bowel Syndrome is primarily associated with deficiency of fat-soluble vitamin (A, D and E) and water-soluble vitamin B12 (since this water soluble vitamin is absorbed only in the ileum) | train | med_mcqa | null |
Bonney&;s test demonstrates | [
"Stress urinary incontinence",
"Urge incontinence",
"Overflow",
"Prolalpse uterus"
] | A | MARSHALL AND BONNEY&;S TEST To demonstrate stress incontinence Procedure: Two fingers are placed in the vagina at the urethrovesical junction, on either side of urethra and the bladder neck region is elevated, on straining or coughing absence of leakage of urine indicates a positive test Positive stress test is indicative of beneficial outcome following surgical repair Ref: SHAW&;S TEXTBOOK OF GYNAECOLOGY; 15th edition; Pg no:189 | train | med_mcqa | null |
A 32 weeks premature infants, 900gm weight on the third days. The serum billirubin is 13 mg%. The treatment of choice is ___________ | [
"Exchange transfusion",
"Phototherapy",
"Wait and watch therapy",
"Pharmacologic therapy"
] | A | Low bih weight babies having high serum bilirubin may need exchanged transfusion treatment. An exchange transfusion is a blood transfusion in which the patient&;s blood or components of it are exchanged with other blood or blood products. The patient&;s blood is removed and replaced by donated blood or blood components. This exchange transfusion can be performed manually or using a machine . Reference: GHAI Essential pediatrics, 8th edition | train | med_mcqa | null |
Choose the best Lab value for a patient with central diabetes insipidus | [
"Urinary Osmolality - 50, Serum Osmolality - 300",
"Urinary Osmolality - 500, Serum Osmolality - 260",
"Urinary Osmolality - 50, Serum Osmolality - 260",
"Urinary Osmolality - 500, Serum Osmolality - 100"
] | A | Diabetes insipidus is the reverse of SIADH, here the ADH level is decreased which leads to excessive water loss from the kidney resulting in hypertonic plasma associated with dilute urine.
It can be
- Central → (due to impaired secretion of ADH from the neurohypophysis)
- Nephrogenic → (due to renal insensitivity or nonresponsiveness to ADH).
In both circumstances. the serum osnzolality is increased with inappropriately low urine osmolalitv.
The two may be distinguished, however, by the response to either exogenous or endogenous vasopressin.
In neurogenic (central) DI,
- ADH levels are 100, and the kidney rapidly acts to conserve water once exogenous ADH is administered.
In contrast, in nephrogenic DI,
- ADH is associated with normal or increased ADHe levels and administration of additional ADH has no significant effect on renal water reabsorption.
Also known | train | med_mcqa | null |
Scurvy is due to deficiency of | [
"Vitamin C",
"Vitamin A",
"Vitamin K",
"Vitamin E"
] | A | Deficiency of ascorbic acid results in scurvy, a disease characterized by sore and spongy gums, loose teeth, fragile blood vessels, swollen joints, and anemia. Many of the deficiency symptoms can be explained by a deficiency in the hydroxylation of collagen, resulting in defective connective tissue.Reference: Lippincott; 5th Edition; Page no: 377 | train | med_mcqa | null |
Main function of Vas deferens is- | [
"Secretion of PGs",
"Secretion of Fructose",
"Transport of sperm",
"Secretion of semen"
] | C | Ans. is 'c' i.e., Transport of sperm Vas Deferens* It is a thick-walled muscular tube, about 45 cm (18 inches) long, which begins at the tail of the epididymis as the direct continuation of the duct of the epididymis.* It runs upward along with vessels within the spermatic cord.* The terminal part of each vas deferens is sacculated and called ampulla of vas deferens.* It serves as a reservoir of sperm and tubular fluid.* The terminal narrow part of vas deferens joins the duct of seminal vesicle to form the ejaculatory duct at the base of the prostate gland.* Main function of vas deferens is to transpart spermatozos from the epididymis to ejaculatory duct.* Peristaltic contractions of smooth muscle help in propelling the semen.* The vas deferens is cord like when grasped between thumb and index finger because of its thick wall and small lumen. | train | med_mcqa | null |
Not included in type-I nutrient element | [
"Mg",
"Ca",
"Zn",
"K"
] | C | Type 1 nutrients Type 2 nutrients All VitaminsMost Trace Elements Iron IodineCopper SeleniumCalciumNitrogenSulphurEssential Amino Acids SodiumMagnesiumPhosphorusZinc Water (Refer: OP Ghai's Essential of paediatrics, 8thedition, pg no: 78) | train | med_mcqa | null |
Haemorrhagic conjunctivitis is caused by | [
"Enterovirus 70",
"Coxsackie virus",
"Enterovirus 72",
"Calcivirus"
] | A | Acute haemorrhagic conjunctivitis It is an acute inflammation of conjunctiva characterised by multiple conjunctival haemorrhages, conjunctival hyperaemia and mild follicular hyperplasia. The disease is caused by Picornavirus (enterovirus type 70) which are RNA viruses of small (pico) size. Ref;A.K.Khurana; 6th edition; Page no:76 | train | med_mcqa | null |
C terminal end of androgen receptor is concerned with: | [
"Ligand binding",
"Increasing biological half life",
"Increasing the affinity of receptor to DNA",
"Increasing the level of transcription"
] | A | A i.e. Ligand bindingAndrogen receptor belongs to nuclear receptor super family. At carboxy (C) terminal of nuclear receptor, a multifunctional ligand binding domain (LBD=E domain) is locatedQ. | train | med_mcqa | null |
Number of ovum at bih is | [
"2-3 million",
"2-5 million",
"7-10 million",
"10-15 million"
] | A | In humans no ova formed after bih. at time of bih there are 2 million ova.Ref: Ganong&;s review of medical physiology; 24th edition; page no: 401 | train | med_mcqa | null |
A 65-year-old man suffers a sudden fall in mean aerial pressure, 4 hours after his CABG surgery. Other findings include elevated JVP. What is the best next step in the management of this case? | [
"PRBC Transfusion",
"Vasopressors along with the inotropes",
"Immediate re-exploration of the mediastinum",
"Intra-aoic balloon pump"
] | C | This clinical presentation points towards a likely diagnosis of Cardiac tamponade. It is a common complication post CABG. It can be confirmed on an Echocardiography. It is a life-threatening condition hence it should be managed by immediate return to the OT for exploration and drainage of mediastinal hematoma. | train | med_mcqa | null |
ANCA positive vasculitis | [
"Henoch schonlein purpura",
"Behcet's syndrome",
"Wegener's granulomatosis",
"All"
] | C | Ans. is 'c' i.e., Wegener's granulomatosis | train | med_mcqa | null |
A lady with CA ovary in follow up with raised CA 125 level, Next step : | [
"CT",
"PET",
"MRI",
"Clinical exam and serial follow up of CA 125"
] | B | Ans. is b i.e. PET In a case of treated ovarian cancer - Treatment assessment is done by : Tumor marker CA 125 - It is a reliable indicator of disease response or progression. - If CA 125 levels decreases after treatment - It indicates response to treatment. - If CA 125 levels increase after treatement - It indicates relapse after treatment. - A review of the literature suggests that an elevated Ca 125 level predicts persistent disease at second look surgery in 97% of the cases but CA 125 is not sensitive enough to exclude subclinical disease in many patients. - Follow up in a patients of ovarian cancer is done by physical and pelvic examination along with estimation of CA 125 levels. Patient is advised to visit every 3-4 months for the first 2 years and then 6 monthly for 5 years. Clinical examination and CA 125 together can detect 90% of recurrences. Radiological procedures are not required in all cases. But since here CA 125 is elevated and we have to choose one option - the best is PET as : - CT scan cannot distinguish between a relapsed tumour and fibrosis where as PET scan will exactly demonstrate whether it is a relapsed tumour or a fibrosis. - In a patient treated with chemotherapy or radiotherapy fibrosis is common. It can present as a mass. | train | med_mcqa | null |
Shifting fluid sign is seen in: | [
"Exudative retinal detachment",
"Tractional retinal detachment",
"Rhegmatogenous retinal detachment",
"Retinal hole"
] | A | Shifting fluid is seen in exudative retinal detachmentwhich occurs due to exudation of fluid from the choroid which collects in the subretinal space. -Causes: Inflammatory conditions like choroiditis, posterior scleritis Choroidal tumors like melanoma Toxemia of pregnancy Malignant hypeension Coats disease -Clinical features: Floaters due to vitritis but no photopsia Visual field defect Detached retina appears smooth & convex in configuration. No break is seen. -Treatment: Systemic steroids Treatment of the cause | train | med_mcqa | null |
Which of the following is true regarding anthrax -a) M' Fadyean reaction shows capsule b) Humans are usually resistant to infectionc) Less than 100 spores can cause pulmonary infectiond) Gram stain shows organism with bulging sporese) Sputum microscopy helps in diagnosis | [
"abce",
"abcd",
"acde",
"abde"
] | A | Option b: Greenwood 16/e p226 says ‘Humans are relatively resistant to infection with B anthracis’
Option c: Harrison 17/e p1344 and 18/e p1769 says ‘While an LD50 of 10,000 spores is a generally accepted number for anthrax it has also been suggested that as few as one to three spores may be adequate to cause disease in some settings.’
Option d: Gram stain shows organism with non bulging spores.
Bulging spores are seen for Clostridium
Option e: Microscopy of the sample like lesion, blood, sputum reveals gram-positive bacilli in chain.
Ref: Apurba Sastry’s Essentials of Medical Microbiology/ p250-53, Ananthanarayan 9/e p247-48, 8/e p243 | train | med_mcqa | null |
Secondary deposits from carcinoma breast is commonest in- | [
"Lung",
"Liver",
"Brain",
"Bone"
] | D | null | train | med_mcqa | null |
In a population, total births in a year are 3050. There are 50 still births, 100 neonates die in first 7 days and 150 die in next 8-28th day life. Calculate Neonatal Mortality Rate. | [
"250",
"100",
"83",
"90"
] | C | null | train | med_mcqa | null |
Frontonasal duct opens into: | [
"Inferior meatus",
"Middle meatus",
"Superior meatus",
"Inferior meatus"
] | B | The frontonasal duct is a communication between the frontal air sinuses and their corresponding nasal cavity. The duct is lined by mucous membrane. The duct empties into the nasal cavity middle nasal meatus through the infundibulum of the semilunar hiatus. Ref: Dhingra 6th edition, page 136. | train | med_mcqa | null |
Which one of the following is TRUE regarding media for culturing organisms? | [
"Agar has nutrient propeies",
"Chocolate medium is selective medium",
"Addition of selective substances in a solid medium is called enrichment media",
"Nutrient broth is basal medium"
] | D | Nutrient broth is an example for simple medium or basal medium. It consists of peptone, meat extract, sodium chloride and water. Agar is used for preparing for solid media. Its chief constituent is a long chain polysaccharide. It has viually no nutritive value and is not affected by the growth of bacteria. Chocolate agar, blood agar, and egg media are examples for enriched media. They are used to grow bacteria which are more exacting in their nutritional needs. Addition of substances which have a stimulating effect on the bacteria to be grown or an inhibitory effect on those to be suppressed in a liquid medium is called enrichment media. The result is an absolute increase in the numbers of the wanted bacterium. Ref: Ananthanarayan and Paniker's Textbook of Microbiology By Ananthanarayan And Paniker, 7th edition, Page 34, 37. | train | med_mcqa | null |
Which of the following is true of an occlusal rest for a removable partial denture?
1. One-third facial lingual width of the tooth
2. 1.5 mm deep for base metal
3. 2.0 mm labiolingual width of the tooth
4. Floor inclines apically toward the center of the tooth | [
"All of the above",
"1, 3, and 4",
"1, 2, and 4",
"3 and 4"
] | C | Rests are critical for the health of the soft tissues underlying the denture resin basis and the minor and major connectors. It should prevent tilting action and should direct forces through the long axis of the abutment tooth. In order to function as specified, an occlusal rest should have a rounded (semicircular) outline form, be one-third the facial lingual width of the tooth, one-half the width between cusps, and at least 1.5 mm deep for base metal. The rest floor inclines apically toward the center of the tooth and the angle formed with the vertical minor connector should be less than 90 degrees. | train | med_mcqa | null |
A 18-month old baby presents with recurrent episodes of excessive crying followed by cyanosis, unconsciousness and occassional seizures since 9 months of age. The most likely diagnosis is - | [
"Epilepsy",
"Anoxic spells",
"Breath holding spells",
"Vasovagal attack"
] | C | Ans. is 'c' i.e., Breath holding spells | train | med_mcqa | null |
Mr. and Mrs. Annadural have a 2 month old baby suffering with down's syndrome. Karyotype of Mrs. Annadural shows translocation variety of Down syndrome. Which of the following investigation will you advise to the parents before the next pregnancy? | [
"Triple test",
"α-fetoprotein",
"Karyotyping",
"β-human chorionic gonadotropin"
] | C | When a pregnant woman has a history of previous child with Down syndrome, it becomes important to know the type of chromosomal constitution, not only in that particular child but also in the parents because the risk of recurrence in future pregnancy depends on all these factors (as shown in Table in Ans. 1).
Karyotyping of Mrs. Annadural has already been done and a translocation variety of Down’s detected. Risk of recurrence however does not depend on mother’s karyotype alone, but it also depends on the father’s karyotype. Father’s karyotyping is therefore the test of choice prior to next pregnancy to determine the risk of recurrence. | train | med_mcqa | null |
Breteau index is used for | [
"Aedes",
"Anopheles",
"Hook - worm infection",
"Hard tick"
] | A | null | train | med_mcqa | null |
Reverse transcriptase is a RNA dependent DNA polymerase. Which of these use it? | [
"Hepatitis A virus",
"Hepatitis B virus",
"Hepatitis E virus",
"Hepatitis C virus"
] | B | Ans. (b) Hepatitis B virus Set ot te,, DNA polymerase of HBV has both DNA-dependent DNA polymerase and RNA-dependent reverse transcriptase activities. Not Instead of DNA replication directly from a DNA template, hepadnaviruses rely on reverse transcription (effected by the DNA polymerase) of minus-strand DNA from a "pregenomic" RNA intermediate. Then plus-strand DNA is transcribed from the minus strand DNA template by the DNA-dependent DNA polymerase and conveed in the hepatocyte nucleus to a covalently closed circular DNA, which serves as a template for messenger RNA and pregenomic RNA. | train | med_mcqa | null |
Not a family of selectin | [
"P selectin",
"L selectin",
"A selectin",
"E selectin"
] | C | null | train | med_mcqa | null |
Not a germ cell tumor of ovary: | [
"Endodermal sinus tumor",
"Polyembryoma",
"Dysgerminoma",
"Brenner tumor"
] | D | Germ cell tumors (GCT) account for 15-20% of ovarian tumors and the vast majority (95%) are benign cystic teratomas. The remaining 5% are found principally in children and young adults and have a higher incidence of malignant behavior various germ cell tumors are as under:
Mature (benign) teratomas
Immature (malignant) teratomas
Monodermal or highly specialized teratomas
Dysgenninomas
Endodermal (yolk) sac tumors
Choriocarcinoma
Embryonal carcinoma
Polyembryoma
Mixed germ cell tumors (MGCT)
Brenner tumors are uncommon tumors which account for less than 2% of ovarian neoplasms. These solid neoplasms are characterized by a dense fibrous stroma "punctuated" by nests of transitional cells resembling those lining the urinary bladder. Brenner tumors are occasionally found in mucinous cyst adenomas suggesting that these tumors arise from coelomic epithelial inclusion cysts through metaplasia of the cyst lining of transitional epithelium. | train | med_mcqa | null |
If a transaction is made between the pons and medulla with intact vagi, respiration will become: | [
"Apneustic",
"Irregular",
"Slow and deep",
"All of the above"
] | B | Regulatory centres of respiration: "Unlike in the hea, there is no single 'pacemaker' neurone responsible for initiating breathing. Instead, a group-pacemaker system exists in which groups of associated neurones generate regular bursts of neuronal activity. For breathing, the group pacemaker involves a complex interaction of at least six groups of neurones with identifiable firing patterns spread throughout the medulla, although concentrated in the region of the pre-Botzinger complex " - Nunn's respiratory physiology 8ed pg 52 DRG: contains mainly inspiratory neurons (I) and generations ramp signals VRG: contains both I and E neurons that emain almost totally inactive during normal quiet respiration A pneumotaxic center, located dorsally in the nucleus parabrachialis of the upper pons, transmits signals to the inspiratory area. The primary effect of this center is to control the "switchoff" point of the inspiratory ramp, probably by inhibiting apneustic centre Section A: Cut at upper pa of pons: Normal rhythmic breathing continues. Loss of voluntary breathe holding. If vagi are cut, increase in depth and slow breathing. Section B: Cut at midpons: Apneustic center (Ap) intact but pneumotaxic separated. Ap stimulates Inspiratory (I) neurons, which increase depth of breathing. Vagi cut: Arrest of respiration in maximum inspiratory phase (apneusis) interrupted by brief expiration. Section C: Cut at inferior poion of pons: All the pontine tissue is separated Vagi intact or cut: Irregular and gasping Section D: Cut below medulla: Complete transaction of brainstem: Stops all respiration (apnoea and death) | train | med_mcqa | null |
All are true about aspirin sensitive asthma excpet - | [
"Nasal polyposis",
"Treatment with inhaled corticosteroids",
"Rhinosinusitis",
"Increased prostaglandins"
] | D | Ans. is 'd' i.e., Increased prostaglandins o Aspirin-sensitive asthma is associated with severe rhinosinusitis and recurrent nasal polyposis.o The complex pathogenesis of aspirin-sensitive asthma involves chronic eosinophilic inflammatory changes, with evidence of increased mast cell activation.o Aspirin-sensitive asthma is an underdiagnosed condition affecting up to 20% of the adult asthmatic population.o It is associated with more severe asthma, requires increased use of inhaled and oral corticosteroids, more presentations to hospital and a risk of life - threatening reactions with aspirin,o The cyclo-oxygenase pathways play a major role in the respiratory reactions that develop after aspirin ingestion.Aspirin sensitive respiratory syndrome primarily affects adults and is characterized by:Perennial vasomotor rhinitis|Hyperplastic rhino-sinusitis with Nasal Polyps|Aspirin exposure|Block cycloxygenase without affecting lipoxygenase|Increased leukotriene|Progressive AsthmaOn exposure to even very small quantities of aspirin, affected individuals typically develop ocular and nasal congestion with acute, often severe, episodes of airway obstruction. | train | med_mcqa | null |
All of the following statements about Parvovirus B -19 are TRUE, EXCEPT: | [
"DNA virus",
"Crosses placenta in only < 10% of cases",
"Can cause severe anemia",
"Can cause Aplastic crisis"
] | B | Parvovirus B-19 causes a infection called Erythema infectiosum or Fifth disease. Around 50-70% cases are around 5-15 years of age. Transmission from mother to fetus is around 15-30%. It causes, anemia, aplastic crisis, rashes, ahralgia, rarely hydrops fetalis. Ref: Kliegman, Behrman, Jenson, Stanton (2008), "Nelson textbook of Pediatrics", Chapter 248, "Parvovirus B19", Volume 1, Page 1357; Medical Microbiology By Jawetz , 24th Edition, Pages 414, 417 | train | med_mcqa | null |
A dead born foetus does not have | [
"Rigor mois at bih",
"Adipocere formation",
"Maceration",
"Mummification"
] | B | B i.e. Adipocere formation | train | med_mcqa | null |
Which of the following increases turbulence in blood flow | [
"Reynolds number less than 2000",
"Decrease in velocity of blood",
"Decrease in density of blood",
"Increase in diameter of blood vessel"
] | D | The flow of blood (Laminar or turbulent) depends on
- Fluid density (S)
- Tube diameter (D)
- The velocity of the fluid (V)
- The viscosity of fluid (n)
This can be expressed by Reynold’s number (R) = SDV/n
Normal flow is laminar. But if the velocity crosses a critical limit (Critical velocity) flow becomes turbulent. If R>2000, flow is turbulent. | train | med_mcqa | null |
A postmenopausal woman presents with pruritic white lesions on the vulva. Punch biopsy of a representative area is obtained. Which of the following histologic findings is consistent with the diagnosis of lichen sclerosus? | [
"Blunting or loss of rete pegs",
"Presence of thickened keratin layer",
"Acute inflammatory infiltration",
"Increase in the number of cellular layers in the epidermis"
] | A | Lichen sclerosus was formerly termed lichen sclerosus et atrophicus, but recent studies have concluded that atrophy does not exist. Patients with lichen sclerosus of the vulva tend to be older; they typically present with pruritus, and the lesions are usually white with crinkled skin and well-defined borders. The histologic appearance of lichen sclerosus includes loss of the rete pegs within the dermis, chronic inflammatory infiltrate below the dermis, the development of a homogenous subepithelial layer in the dermis, a decrease in the number of cellular layers, and a decrease in the number of melanocytes. Mechanical trauma produces bullous areas of lymphedema and lacunae, which are then filled with erythrocytes. Ulcerations and ecchymoses may be seen in these traumatized areas as well. Mitotic figures are rare in lichen sclerosus, and hyperkeratosis is not a feature. While a significant cause of symptoms, lichen sclerosus is not a premalignant lesion. Its importance lies in the fact that it must be distinguished from vulvar squamous cancer. | train | med_mcqa | null |
Recurrent corneal erosions are seen in: March 2011, March 2012 | [
"Corneal dystrophy",
"Keratoglobus",
"Keratoconus",
"Peutz-anomalies"
] | A | Ans. A: Corneal dystrophyEpithelial and subepithelial corneal dystrophies may present with bouts of recurrent corneal erosions Bowman layer corneal dystrophy usually presents with recurrent corneal erosionsRecurrent corneal erosionIt is characterized by the failure of the cornea's outermost layer of epithelial cells to attach to the underlying basement membrane (Bowman's layer).The condition is excruciatingly painful because the loss of these cells results in the exposure of sensitive corneal nerves.There is often a history of previous corneal injury (corneal abrasion or ulcer), but also may be due to corneal dystrophy or corneal disease.In other words, one may suffer from corneal erosions as a result of another disorder, such as map dot fingerprint diseasePresentationSymptom include recurring attacks of severe acute ocular pain, foreign-body sensation, photophobia (i.e. sensitivity to bright lights), and tearing often at the time of awakening or during sleep when the eyelids are rubbed or opened.Signs of the condition include corneal abrasion or localized roughening of the corneal epithelium, sometimes with map-like lines, epithelial dots or microcyts, or fingerprint patternsInvestigationThe erosion may be seen by using the magnification of an ophthalmoscope, although usually fluorescein stain must be applied first and a blue-light used.Use of slit lamp microscopes allow for more thorough evaluation under the higher magnification.ManagementWith the eye generally profusely watering, the type of tears being produced have little adhesive propey.Water or saline eye drops tend therefore to be ineffective.Rather a 'better quality' of tear is required with higher 'wetting ability' (i.e. greater amount of glycoproteins) and so aificial tears (e.g. viscotears) are applied frequently.Where episodes frequently occur, or there is an underlying disorder, one medical, or three types of surgical curative procedures may be attempted:Use of therapeutic contact lens, controlled puncturing of the surface layer of the eye (Anterior Stromal Puncture) and laser phototherapeutic keratectomy (PTK).These all essentially try to allow the surface epithelium to reestablish with normal binding to the underlying basement membraneMedicalPatients with recalcitrant recurrent corneal erosions often show increased levels of matrix metalloproteinase (MMP) enzymes.These enzymes dissolve the basement membrane and fibrils of the hemidesmosomes, which can lead to the separation of the epithelial layer.Treatment with oral tetracycline antibiotics (such as doxycycline or oxytetracycline) together with a topical coicosteroid (such as prednisolone), reduce MMP activity and may rapidly resolve and prevent fuher episodes in cases unresponsive to conventional therapies. | train | med_mcqa | null |
A 60-year-old man is in a car crash in which he is the driver. He did not have a seat belt or an airbag. He is found to have multiple rib fractures over his right chest. His pulse is weaker during inspiration. What are the most likely diagnoses? | [
"Flail chest",
"Empyema",
"Diaphragm rupture",
"Cervical rib"
] | A | Flail chest should be suspected in multiple rib fractures where the individual rib is divided in two places. Paradoxical movement results in lung compression as the flail segment moves inward during inspiration. | train | med_mcqa | null |
Fluroacetate inhibits - | [
"Citrate synthetase",
"Aconitase",
"Succinate dehydrogenase",
"Alphaketoglutarate dehydrogenase"
] | B | B i.e. Aconitase | train | med_mcqa | null |
In a case of Paucibacillary leprosy, treatment is considered adequate if the patient has received the six monthly doses of combined therapy within:- | [
"6 months",
"9 months",
"12 months",
"15 months"
] | B | Adequate treatment: Patients has received 6 months of PBL therapy in 9 months or 12 months of MBL therapy within 18 months Multi drug therapy (MDT) of Leprosy: Paucibacillary Leprosy (PBL) Multibacillary Leprosy (MBL) No. of skin lesions <= 5 >= 5 Nerve involvement 0-1 nerve >= 1 nerve Treatment Day 1: Supervised monthly Rifampicin 600 mg Clofazimine 300 mg Dapsone 100 mg Day 1: Supervised monthly Rifampicin 600 mg Clofazimine 300 mg Dapsone 100 mg Day 2-28: Daily Dapsone 100 mg Clofazimine 50 mg Day 2-28; Daily Clofazimine 50 mg Dapsone 100 mg Duration of treatment 6 months 12 months Duration of follow up 2 years 5 years | train | med_mcqa | null |
The following gram stain shows which bacteria? | [
"Streptococcus pneumonia",
"Staphylococcus aureus",
"Listeria monocytogenes",
"Vibrio cholera"
] | D | Ans. (d) Vibrio cholera.* The following picture shows presence of Vibrio cholera in gram Stain. Notice that the Long arrow points to a curved gram-negative rod. Arrowhead points to a flagellum at one end of a curved gram-negative rod.Image source- style="font-family: Times New Roman, Times, serif"> | train | med_mcqa | null |
Thanatometer is used for? | [
"Measure JOP after death",
"Measuring moisture content in the body after death",
"Measuring core body temperature after death",
"Measuring extent of rigor mortis after death"
] | C | Thanatometer is used to measure core body temperature after death. Clinical thermometer which is commonly used in living persons can't be used. Most common site for measuring core body temperature is Rectum, except in cases of sodomy. | train | med_mcqa | null |
Which of the following is approved for the treatment of cystic fibrosis with G551D mutation? | [
"Biostrophin",
"Peginesatide",
"Lumacaftor",
"Ivacaftor"
] | D | Biostrophin is a vehicle for gene therapy in Duchenne and Becker's muscular dystrophyPeginesatide is an erythropoietin analog for anemia of chronic kidney diseaseLumacaftor is a CFTR potentiator for cystic fibrosis with F508 mutationIvacaftor is a CFTR potentiator for cystic fibrosis with G551D mutation | train | med_mcqa | null |
Meconium is excreted by a new born till _______ day: | [
"2",
"3",
"6",
"4"
] | B | The baby may pass meconium in utero or soon after birth, but all healthy newborn babies must evacuate within 24 hours of birth. During the first 2..3 days the baby passes black, tarry (like tar) 'meconium' stools which are followed by greenish (transitional) stools for the next 1 or 2 days.
The normal breastfed baby usually passes 4-8 semisolid sticky golden yellow stools everyday. Some babies may pass stools after each feed due to the 'exaggerated' gastrocolic reflex. The stools are often very small (at times like drippings of the birds) with normal consistency. The babies continue to gain weight.
Tar means a thick, sticky, brown to black liquid with a pungent odor, obtained by the destructive distillation of wood, coal, peat, shale, etc. | train | med_mcqa | null |
The plasma clearance value of glucose in a diabetes mellitus patient will be | [
"Zero",
"Equal to that of inulin clearance",
"Greater than that of PAH clearance",
"Greater than zero"
] | D | Ans. (d) Greater than zero(Ref: Ganong, 25th ed/p.678)Diabetes mellitus is characterized by renal glycosuria. Glucose appears in urine. So, plasma clearance of glucose is greater than zero | train | med_mcqa | null |
Which of the following aery gives rise to posterior gastric aery | [
"Splenic aery",
"Left gastric aery",
"Right gastric aery",
"Left gastroepiploic aery"
] | A | Coelic trunk:Hepatic aery /Left gastric aery and splenic aery .Splenic aery give rise to Post gastric aery ,sho gastric aery and left gastro epiploic aery Posterior gastric aery supplies the posterior wall. | train | med_mcqa | null |
Most common site of mandibular fracture is | [
"Angle of mandible",
"Condylar process",
"Coronoid process",
"Ramus"
] | B | Mandibular fractures are typically the result of trauma. This can include a fall onto the chin or a hit from the side. Rarely they may be due to osteonecrosis or tumors in the bone. The most common area of fracture is at the condyle (36%), body (21%), angle (20%) and symphysis (14%). | train | med_mcqa | null |
Which among the following is the most common fungal infection seen in immunocompetent patients: | [
"Aspergillus",
"Cryptococcus",
"Candida",
"Penicillium marneffei"
] | C | Ans. (c) Candida PR Arora 2/e, p 671. Clinical Mycology FlirN J Anaessie 2/e, p 2, 11. 6,37 Candidiasis is the commonest mycosis involving skin, its appendeges, mucosa and internal organs. Oral thrush and vulvovaginal candidiasis are commonest manifestation of candida in immunocompetent. Other impoant points: Aspergillus is the most common fungal sinus infection in immunocompetent patients ...Clinical Mycology by Elias J Anaessie 2/e, p 631 Candida is the most common cause of nosocomial fungal infection ...Clinical Mycology by Elias J Anaessie 2/e, P No. 2 Cryptococcus neoformans is the most common cause of community associated oppuinistic fungal infection Clinical Mycology by Elias J Anaessie 2/e, P No. 11 Cryptococcus neoformans is the most life threatening fungal pathogen. | train | med_mcqa | null |
What will be the best treatment for the below patient? | [
"Laser photocoagulation",
"Three monthly injections of Ranibizumab",
"Photodynamic therapy",
"Observation and follow-up"
] | B | Ans. (b) Three monthly injections of RanibizumabOption a - LP is done for extrafoveal lesions, rarely done now a days.Option b - Anti-VEGF drugs are the mainstay of treatment for Wet ARMD as has been seen in many trials such as MARINA, ANCHOR, Pronto trial etcOption c - PDT can be done, but used only ifPurely occult CNVPredominantly classical CNV, subfoveal, not larger than 5400 microns and a visual acuity of 6/60 or better.Option d - Wet ARMD needs to be treated. Observation may be done in cases of Dry ARMD. | train | med_mcqa | null |
Immediate management of a child with foreign body inhalation is - | [
"IPPV",
"Bronchoscopy",
"Tracheostomy",
"Exploratory Thoracotomy"
] | B | Ans. is 'b' i.e., Bronchoscopy Treatment of aspirated foreign body A) Treatment of foreign body in upper respiratory tract. o If obstruction is complete --> Immediate intervention. o If obstruction is paial --> Patients should allow to use their own cough reflex to extrude the foreign body --> If it fails than intervention should be done. o Method of removal of foreign body : - 1)If child is younger than 1 year --> Child should be placed face down over the rescuir's arm with head positioned below trunk. Five measured back blows are delivered rapidly between the scapula. If obstruction persists, the infant should be rolled over and five rapid chest compressions should be performed. This sequence is repeated until the obstruction is relieved. 2) If child is elder than 1 year ---> Abdominal thursts (Heimlich maneuver) should be performed. B) Treatment of foreign body in lower respiratory tract. o The treatment of choice is prompt endoscopic (bronchoscopic) removal of foreign body. | train | med_mcqa | null |
True about function of brain are all except: | [
"Sensitive to hypoxia",
"Dependent on glucose",
"Uses fatty acids in starvation",
"Does not store energy"
] | C | C i.e. Use fatty acid in starvationBrain FuelBrain tissue normally uses glucoseQ as an exclusive fuel, except during starvationDuring starvation brain can adapt to use ketone bodiesQ as an energy source.The brain contains essentially no fuel reservesQ and must be continuously supplied with fuel from the blood. | train | med_mcqa | null |
Drug of choice for chylamydial trachomatis is: March 2007 | [
"Penicilin",
"Erythromycin",
"Vancomycin",
"Azithromycin"
] | D | Ans. D: Azithromycin Because of higher efficacy, better gastric tolerance and convenient once a day dosing, azithromycin is now preferred over erythromycin as first choice drug for infections such as: Legionnaires' pneumonia Chlamydia trachomatis Donovanosis caused by calymmatobacterium granulomatis Chancroid and PPNg urethritis. | train | med_mcqa | null |
Macrocytic anemia not seen in? | [
"Folate deficiency",
"Anemia of chronic disease",
"Previous ileum resection",
"Regional enteritis"
] | B | Microcytosis is seen in folate deficiency And all GIT diseases , due to inhibition of folate mechanism - nuclear maturation lags behind that of cytoplasm Reference test book of Pathology 7th edition author Harsha Mohan page number 280- 283 | train | med_mcqa | null |
All are true about circulating changes in exercising muscle EXCEPT? | [
"Complete flow stops on maximal tension reaching 70%",
"Blood supply increases by 30 times between contractions",
"Dilation of arterioles and pre-capillaries",
"Peripheral resistance increases"
] | D | Ans. D Peripheral resistance increasesRef: Ganongy 25th ed. pg. 549* Blood flow of resting skeletal muscle is low (2-4 ml/100 gm/min)* When the muscle contracts, it compresses the vessels and when it develops 70% of its maximal tension, blood is completely interrupted.* Between contractions the flow is increased by 30 times* This is due to dilatation of arterioles and precapillary sphincters cause of 10-100 times increase in open capillaries* During exercise there is a net fall in peripheral resistance, due to vasodilation in exercising muscles. Hence the SBP increases moderately and diastolic pressure remains unchanged or falls. | train | med_mcqa | null |
In computed tomography (CT), the attenuation value are measured in Hounsefield units (HU). An attenuation value of '0' (zero) HV corresponds to: | [
"Water",
"Very dense bone structure",
"AIR",
"Fat"
] | A | A i.e. Water | train | med_mcqa | null |
When osmotic fragility is normal, RBC's begin to hemolyse when suspended in saline ? | [
"0.33%",
"0.48%",
"0.90%",
"1.20%"
] | B | Ans. is 'b' i.e., 0.48% | train | med_mcqa | null |
Treatment for poosystemic encephalopathy is all except | [
"High protein diet",
"Lactulose",
"Oral neomycin",
"Enema"
] | A | It most often results from high gut protein or acute metabolic stress (eg, GI bleeding, infection, electrolyte abnormality) in a patient with poosystemic shunting. Symptoms are mainly neuropsychiatric (eg, confusion, asterixis, coma). Diagnosis is based on clinical findings. Ref Davidson edition23rd pg 864 | train | med_mcqa | null |
True about Falx cerebri ? | [
"Separates cerebellum from occipital lobe",
"Contains straight sinus",
"Separates two cerebellar hemispheres",
"Contains occipital sinus"
] | B | Dura mater is the toughtest and thickest membrane covering the brain. It is divisible into outer endosteal layer or endocranium (covering inner surface of skull bones) and inner meningeal layer. Inner meningeal layer is folded on itself at places dividing the cranial cavity into intercommunicating compaments which lodge different pas of brain :-i) Falx cerebri : It is a large sickle shaped fold projecting into median longitudinal fissure between two cerebral hemisphere. It contains superior saggital sinus (along lower concave free margin), and straight sinus (along line of attachment of falx cerebri to tentorium cerebelli).ii) Tentorium cerebelli iii) Falx cerebelli iv) Diaphragma sellae | train | med_mcqa | null |
Sulphur granules are composed of | [
"Organisms",
"Leucocytes",
"Erythrocytes",
"Keratinocytes"
] | A | Granules are bacterial colonies and will be found to consist of a dense network of thin gram-positive filaments surrounded by a peripheral zone of swollen radiating club shaped structures - sun Ray appearance ( antigen antibody complex ). Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition | train | med_mcqa | null |
In a centrifugal distribution, protein that is precipitated first is: | [
"Fibrous",
"Globular",
"Completely disorganized",
"None of the above"
] | A | A i.e. Fibrous | train | med_mcqa | null |
Esophageal motility disorder is best diagnosed is? | [
"Barium studies",
"Esophagoscopy",
"24 hour pH monitoring",
"Manometry"
] | D | <p>Davidson&;s principles and practice of medicine 22nd edition. *Manometry confirms the high pressure non relaxing oesophageal sphincter with poor contractility of the oesophageal body.</p> | train | med_mcqa | null |
Biopsy of the lower oesophagus in a patient with chronic reflux demonstrates epithelial metaplasia. Which of the following cell types was most likely observed in the involved areas? | [
"Ciliated columnar epithelium",
"Ciliated columnar epithelium",
"Keratinizing squamous epithelium",
"Nonciliated columnar epithelium"
] | D | The medical condition is Barrett's esophagus, in which the normally nonkeratinizing squamous epithelium of the esophagus undergoes metaplasia to gastric or intestinal-like epithelium composed of nonciliated columnar epithelial cells. | train | med_mcqa | null |
According to myogenic hypothesis of renal autoregulation, the afferent arterioles contract in response to stretch induced by | [
"NO release",
"Noradrenaline release",
"Opening of Ca2+ channels",
"Adenosine release"
] | C | Stretch on smooth muscle (afferent arterioles) opens Ca+ channel, which causes contraction of afferent arterioles.the medullary interstitium.
REGULATION OF GFR
Regulation is done by:
Blood pressure: Autoregulation
Resistance of afferent and efferent anterioles
- Autoregulation: Constant maintenance of renal blood flow or, GFR over the span of renal perfusion pressure (pressure in renal artery minus pressure in renal vein ) from 80 to about 170mm Hg
- Mechanism of autoregulation:
i) Myogenic mechanism- contraction or relaxation of anteriolar smooth muscle in response to changes in vascular pressures; mediated by Ca++
ii) Tubule glomerular feedback (TGF) mechanism-mediated by macula densa cells (described later) | train | med_mcqa | null |
All are True about endometrial carcinoma in clinical stage III except : | [
"Vaginal metastasis",
"Para aoic lymph node involvement",
"Pelvic lymph node involvement",
"Peritoneal involvement"
] | D | Endometrial cancer stage III: Stage IIIA: Involvement of uterine serosa and/ or adnexa Stage IIIB: Involvement of vagina and/or parametrium Stage IIIC: IIIC1: Positive Pelvic nodes IIIC2: Positive Paraaoic nodes with or without positive pelvic nodes Ref: FIGO SURGICAL STAGING 2014 | train | med_mcqa | null |
Nalgonda tech is used for | [
"Deflouridation",
"fluoridation",
"Purification of water",
"None"
] | A | null | train | med_mcqa | null |
TOC in mycosis fungoides | [
"5 - FU",
"Radiotherapy",
"Full skin electron Threapy",
"I/V Adriamycin"
] | C | C i.e. Full skin electron therapy | train | med_mcqa | null |
DMF(s) is defined as: | [
"Irreversible index",
"Measures cumulative index",
"Morbidity index",
"All of the above"
] | D | null | train | med_mcqa | null |
Which of the following statements about Histamine is true: | [
"Is found in Mast cells",
"Increases gastric acid secretion",
"Related to arousal and blood pressure",
"All of the above"
] | D | D i.e. All Histamine is formed by decarboxylation of amino acid histidineQ, and is found in mast cell, basophils, enterochromaffin like cells of gastric mucosa and brainQ. It has been related to arousal, sexual behaviourQ, regulation of secretion of some anterior pituitary hormones, blood pressure, drinking & pain threshold. | train | med_mcqa | null |
Which is raised in polycystic ovarian syndrome? | [
"17-a1pha-OH-progesterone",
"FSH",
"LH",
"TSH"
] | C | PCOS includes chronic non-ovulation and hyperandrogenemia associated with normal or raised estrogen (E2), raised LH, and low FSH/LH ratio. Age - 15-25 years Features- The raised E2 level causes negative feedback to pituitary resulting in diminished FSH, but raised LH. The involvement of adrenal glands is seen in raised androstenedione, dehydroepiandrosterone, testosterone and 17-alpha-Hydroxy-progesterone. | train | med_mcqa | null |
Empyema thoracis is most commonly caused by which organism | [
"Streptococcus pneumoniae",
"Pseudomonas",
"Mycoplasma",
"Stapylococcus aureus"
] | A | Empyema thoracis is collection of pus in the pleural cavity.It is commonly seen in post-pneumonic patients and in tuberculosis.Streptococcus pneumoniae is the most common causative agent.Empyema is the most common focal complication of pneumococcal pneumonia,occurring in <5% of cases.When fluid in the pleural space is accompanied by fever and leukocytosis after 4-5 days of appropriate antibiotic treatment for pneumococcal pneumonia,empyema should be considered. Reference:Harrison's medicine-18th edition,page no:1156. | train | med_mcqa | null |
A Patient infected with MRSA needs Dialysis. The physician had already been staed the patient on linezolid. On the day of undergoing dialysis, when to administer linezolid in this patient : | [
"After dialysis",
"Before dialysis",
"Can be administered irrespective of dialysis",
"During dialysis"
] | A | Linezolid: -Linezolid and its breakdown products are eliminated by dialysis -Therefore the drug should be administered after hemodialysis. | train | med_mcqa | null |
What is Na+ concentration of normal saline | [
"154 meq",
"131 meq",
"101 meq",
"91 meq"
] | A | Crystalloid pH mOsm/L Na+ CI- Ca2+ Lactate- K+ Mg2+ Gluconate- Acetate- NS (0.9% Saline) 5.6 (4.5 - 7.0) 308o 154o 154 LR 6.6 (6.0 - 7.5) 274 130 109 3 28 4 Normosol 7.4 (6.5-7.6) 295 140 98 5 3 23 27 | train | med_mcqa | null |
Billing's method of contraception refers to: | [
"Monitoring BBT",
"Cervical mucus method",
"Rhythm method",
"Coitus interruptus method"
] | B | null | train | med_mcqa | null |
Hydrocortisone Acetate is injected in a painful arthritic TMJ to? | [
"Increase the blood supply",
"Lubricate the synovial joint",
"Anaesthetize the nerve supply",
"Decrease the inflammatory response"
] | D | null | train | med_mcqa | null |
Most impoant dose-limiting toxicity of cancer chemotherapy is: | [
"Gastrointestinal toxicity",
"Neurotoxicity",
"Bone marrow suppression",
"Nephrotoxicity"
] | C | G E N ERAL TOXICITY OF CYTOTOXIC DRUGS Majority of the cytotoxic drugs have more profound effect on rapidly multiplying cells, because the most impoant target of action are the nucleic acids and their precursors; rapid nucleic acid synthesis occurs during cell division. Many cancers (especially large solid tumours) have a lower growth fraction (lower percentage of cells are in division) than normal bone marrow, epithelial linings, reticuloendothelial (RE) system and gonads. These tissues are paicularly affected in a dose-dependent manner by majority of drugs; though, there are differences in susceptibility to individual members. 1 . Bone marrow Depression of bone marrow results in granulocytopenia, agranulocytosis, thrombocytopenia, aplastic anaemia. This is the most serious toxicity; often limits the dose that can be employed. Infections and bleeding are the usual complications. 2. Lymphoreticular tissue Lymphocytopenia and inhibition of lymphocyte function results in suppression of cell mediated as well as humoral immunity. Because of action (1) and (2) + damage to epithelial surfaces, the host defence mechanisms (specific as well as nonspecific) are broken down | train | med_mcqa | null |
During cardiopulmonary resuscitation, cardiac massage is given – | [
"Upper third of sternum",
"Mid third of sternum",
"Lower third of sternum",
"Precordiurn"
] | C | During CPR in adults, chest compression (cardiac massage) is given over lower 1/3rd of sternum. | train | med_mcqa | null |
Etomidate causes all except ? | [
"Coronary insufficiency",
"Decreased steroid",
"Decreases Intracranial tension",
"Nausea and vomiting"
] | A | Ans. is 'a' i.e., Coronary insufficiency Etomidate produces little cardiovascular and respiratory depression --> Agent of choice for cardiovascular surgeries (bypass, aneurysms, valve surgery). Etomidate is the most cardiostable inducing agent. Etomidate has the highest incidence of nausea and vomiting amonst inducing agents 30%-40%. It can produce hiccups and myoclonus. Superficial thrombophlebitis and pain on injection may occur --> Pain can be reduced by using larger vein and injecting lidocaine just before etomidate. | train | med_mcqa | null |
Indications for Sympathectomy are all except: | [
"Intermittent claudication",
"Ischemic pains",
"Rest pains",
"Buerger's disease"
] | A | Lumbar Sympathectomy is not of value in the management of intermittent claudication, as blood flow in the skin but not in the muscle is controlled by sympathetic nervous system. Blood flow in the skin but not in the muscle is controlled by a sympathetic nervous system. If the overlying aerial supply is inadequate, ischemic changes in the skin may be relieved by sympathetic blockage but the impaired blood flow to muscles is unlikely to improveQ. Indications of Sympathectomy (BARA CHEF) Buerger's disease Atherosclerosis producing ischemia of limbsQ Raynaud's disease AcrocyanosisQ ErythrocyanosisQ Frost biteQ HyperhydrosisQ Peripheral vascular insufficiency CausalgiaQ | train | med_mcqa | null |
True about measles is all except | [
"Kopliks spots appear as rash disappears",
"It is prevented by both active and passive immunization",
"Otitis media and meningitis are the most common complications",
"TB is aggravated in post measles"
] | A | Measles (Rubeola): Incubation period: 10-14 days. Causative agent: RNA Paramyxovirus (so for only one serotype known) Source of infection: Cases (Carriers are not known to occur) Period of communicability: 4 days before and 5 days after the appearance of the rash. (Rash is retroauricular in origin) Measles has no second attacks (life long immunity is seen) Secondary attack rate of measle is 80% Measles shows a cyclical trend: Increases every 2-3 years. Blood cell type predominantly infected in Measles: Monocyte. Pathognomic clinical feature: Koplik spots (on buccal mucosa opposite Lower 2nd molar) Pathognomic microscopic feature: Wahin Finkedly cells (Multinucleated giant cells) MC complication of measles in young children: Otitis media. SSPE: Subacute sclerosing pan Encephalitis. Is a rare complication of measles: 1 per 10000-100000 cases of Measles (7-10 years after initial infection) Epidemic of measles occur: If propoion of susceptible children is > 40% If measles is introduced in a virgin community it infects >90% of children. Eradication of measles: Requires a vaccination coverage >96% Baby measles (Exanthem subitum-roseola infantum): Sixth disease (3 day fever) Ref: Park 25th edition Pgno: 159 | train | med_mcqa | null |
The best graphic representation of frequency distribution of data gathered of a continuous variable is- | [
"Simple bar graph",
"Multiple bar",
"Line diagram",
"Histogram"
] | A | . | train | med_mcqa | null |
All of the following are true for retinopathy of prematurity except: | [
"Occurs in premature infants due to late crying",
"Due to hypoxia there occurs neovascularization followed by fibroproliferation",
"End result is bilateral blindness",
"Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation"
] | A | Ans. Occurs in premature infants due to late crying | train | med_mcqa | null |
Increased permeability in acute inflammation is due to | [
"Histamine",
"IL-2",
"TGF-p",
"FGF"
] | A | Formation of endothelial gaps in venules, i.e. immediate transient response is the most common mechanism causing increased vascular permeability in acute inflammation,
Mediators involved in this mechanism are
i. Immediate (more important): Histamine, bradykinin, leukotrienes, neuropeptide substance P.
ii. Somewhat delayed: IL-1, TNF, IFNγ | train | med_mcqa | null |
A 14-year-old boy presents with acute onset of right flank pain, which developed after he helped his father paint the ceiling of his bedroom. Physical examination demonstrates an area of ecchymosis in the right flank that is tender to palpation. The patient has a lifelong history of easy bruising. His brother shows the same tendency. The serum level of clotting factor VIII is less than 2% of normal. Which of the following is the most likely underlying mechanism for bleeding tendency in this patient? | [
"Circulating antibodies directed against factor VIII",
"Decreased hepatic synthesis of multiple coagulation factors",
"Deficiency of vitamin K",
"Genetic defect involving the factor VIII gene"
] | D | Hemophilia A -X-linked recessive disorder of blood clotting that results in spontaneous bleeding, paicularly into joints, muscles, and internal organs and easy bruising. -Classic hemophilia results from mutations in the gene encoding factor VIII . -Intrinsic Pathway affected -Factor VIIIa complex is the most impoant activator of factor X required for conversion of prothrombin to thrombin. | train | med_mcqa | null |
Which of the following is not a common site for metastatic calci | [
"Gastric mucosa",
"Kidney",
"Lung",
"Parathyroid"
] | D | Metastatic calcification may occur widely throughout the body but principally affects.
Interstitial tissues of gastric mucosa
Kidneys
Lungs
Systemic arteries and
Pulmonary veins
The common feature of all these sites, which makes them prone to calcification is that they can lose acid and therefore they have an internal alkaline component favourable for metastatic calcification.
Also, know
Metastatic calcification occurs in normal tissues whenever there is hypercalcemia.
Usually, deposition of the calcium does not cause any clinical dysfunction but sometimes massive deposition in the lung may produce abnormality and in kidneys may produce nephrocalcinosis. | train | med_mcqa | null |
Which among the following factors level is not altered in vit K deficiency? | [
"Prothrombin",
"Factor VIII",
"Factor VII",
"Factor X"
] | B | Ans b: (Factor VIII) Ref: Harrison p.367, 728-730Coagulation factors II, VII, IX, X and protein C, S and Z are dependent on Vit K for post translational modification. Vit K also for bone protein osteocalcin and vascular smooth muscle protein- matrix glaproteinFew more points:* Gamma carboxy glutamic acid residues in the Vit k dependent factors will help in their critical action including calcium and phospholipid binding* Mutations in Vit k epoxide reductase complex 1 (VKORC1) andgene encoding gamma glutamyl carboxylase(GGCX) result in defect free enzyme and there in Vit K dependent factors with decreased activity.* Causes mild to severe bleeding episodes from birth* Prolongation of PT is the most common and earliest finding in Vit K deficiency. Factor V11 has the shortest tl/2, so PT prolonged much before changes in aPTT | train | med_mcqa | null |
A village health guide is selected by | [
"Panchayat",
"Zilla parishad",
"Block Development Officer",
"Medical Officer in-charge"
] | A | Health guides come from and are chosen by the community they work.They should be permanent residents of local community, have formal education up to 6th standard, acceptable to all sections, spend 2-3 hrs for community health work.Park 23e pg: 902 | train | med_mcqa | null |
In erythropoiesis: | [
"Size of the cells increases in subsequent stages",
"Haemoglobin appears at early normoblast stage",
"Mitosis occurs in the late normoblast at the fastest rate",
"Folic acid is useful as a maturation factor"
] | D | D | train | med_mcqa | null |
A patient put on ventilator shows a reading of ABG analysis as | PaCO2, Normal PaO2 and pH 7.5, what is the likely diagnosis? | [
"Respiratory acidosis",
"Metabolic alkalosis",
"Metabolic acidosis",
"Respiratory alkalosis"
] | D | The ABG analysis reading in this patient clearly ours for respiratory alkalosis. In respiratory alkalosis: ? |PaCO2 ? | HCO3/PaCO2 ratio ? |pH ? the plasma K is often reduced and Cl increased Respiratory alkalosis is commonly seen in anesthetized or mechanically ventilated patient. Ref: Harrison's Internal Medicine, 18th Edition, Pages 363-372 | train | med_mcqa | null |
All are adulterants of Heroin, except - | [
"Chalk powder",
"Quinine",
"Charcoal",
"Fructose"
] | C | Important adulterants in heroin are starch (fructose & sucrose), caffeine, quinine, Paracetamol, scopolamine (Hyoscine), Noscapine, Lidocaine, Procaine, Phenobarbitone, Theophylline, Strychnine, Chalk, Flour, Talcum powder, Powdered milk, Phenacetin. | train | med_mcqa | null |
Carriers not seen in ? | [
"Rabies",
"Typhoid fever",
"Polio",
"Malaria"
] | A | Ans. is 'a' i.e., Rabies | train | med_mcqa | null |
Long-term use of tamoxifen may cause | [
"Endometrial CA",
"Cervical CA",
"Vaginal CA",
"Ovarian CA"
] | A | Tamoxifen acts as an anti-estrogen in breast tissue, but it acts like an estrogen in the uterus. In women who have gone through menopause, it can cause endometrial hyperplasia, which increases the risk of endometrial cancer.Though the risk of developing endometrial cancer from tamoxifen is low (less than 1% per year). | train | med_mcqa | null |
A 75 year old female with a long history of cigarette smoking is found to have a small tumor at the periphery of her right upper lobe. Initially, the tumor was believed to be a Stage I carcinoma (T1 NO MO), but after surgery it is found to be Stage II (T1 N1 MO). What is found at surgery that changed the staging? | [
"Involvement of the chest wall",
"Positive bronchial lymph nodes",
"Small cell histology",
"Tumor at the carina"
] | B | Although it is nearly impossible to memorize the staging rules for all the different kinds of tumors, there are several basic principles common to all. The TNM stage of a tumor is determined by the tumor size and extent (T for tumor), lymph node involvement (N for nodes), and metastasis (M for metastasis). N0 always means no lymph nodes are involved. An NI lesion has positive nodes, and only 2nd choice, positive bronchial lymph nodes, changes the patient's nodal status. Involvement of the chest wall is a feature of tumor size and extent-thus, it is a component of the T in TNM-staging. T2 lesions involve the chest wall. Histological features of the tumor, such as small cell morphology , are not considered in tumor stage, but rather in tumor grade. Small cell tumors are considered high-grade carcinomas. Tumor extending to the carina reflects the tumor size and extent-thus, it is a component of the T in TNM-staging: T3 lesions involve the carina . Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 4. Neoplasia. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture. | train | med_mcqa | null |
A patient has subclinical folate deficiency. All of the following drugs can precipitate megaloblastic anemia in this patient except: | [
"Alcohol",
"Phenytoin",
"Chloroquine",
"Sulfasalzine"
] | C | Ans. (C) Chloroquine(Ref: Harrison 17/e p649)Megaloblastic anemia can be caused by deficiency of folic acid or vitamin B12 . The drugs that can result in deficiency of folic acid include alcohol, phenytoin and sulfonamides | train | med_mcqa | null |
An elderly male presents with T3N0 laryngeal carcinoma. Treatment is:(AllMS Nov 2014, May 2014) | [
"Neo-adjuvant chemotherapy followed by radiotherapy",
"Concurrent chemoradiotherapy",
"Radical radiotherapy followed by chemotherapy",
"Radical radiotherapy without chemotherapy"
] | B | Ans. b. Concurrent chemoradiotherapy (Ref: style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif"> HealthProfessionai/pagel)An elderly mate presents with T3N0 laryngeal carcinoma. Treatment is concurrent chemoradiotherapy."Advanced laryngeal cancers are often treated by combining radiation with concurrent chemotherapy for larynx preservation and total laryngectomy for bulky T4 disease or salvage.""Concurrent radiation therapy plus Cisplatin resulted in a statistically higher percentage of patients with an intact larynx at 10 years. ""Concomitant Cisplatin with radiation therapy resulted in a 41% reduction in risk of locoregional failure compared with radiation therapy alone. "A 28-year-old patient of neurocysticercosis develops generalized peeling of skin all over except palms and soles starting one month after taking anti-epileptics. Most probable diagnosis is toxic epidermal necrolysis. Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a rare, life-threatening skin condition that is usually caused by a reaction to drugs.Epidermal Necrolysis (EN)Also known as Stevens-Johnson svndrome-toxic epidermal necrolysis (SJS-TEN) complex.EN is almost always due to drugsQ.Etiology of Epidermal NecrolysisDrugsMiscellaneousIdiopathic* Anticonvulsants: carbamazepine, phenytoin barbiturates, lamotrigineQ* Chemotherapeutic agents: sulfonamides, penicillinQ* NSAlDs: Butazones, oxicams* Others: Allopurinol, nevirapineQ* SUE, GVHD* Lymphoreticular malignancies* Infections (Mycoplasma pneumoniae, herpes virus infection)* 5% of patientsMorphology:Consists of deeply erythematous (often purpuric) irregular lesions that rapidly coalesce.Either develop bullae or peel-off in sheets either spontaneously or when pressure is applied (positive Nikolsky's signQ)On peeling, leave large areas of denuded skin that heal with hyperpigmentation.Based on total body surface area (BSA) of skin detached, EN classified intoSJS<10% BSASJS/TEN overlap (Stevens-Johnson syndrome- Toxic Epidermal Necrolysis)10-30% BSATEN> 30% BSAQSites:Symmetrical involvement of face, truck and proximal part of extremities; Spares distal part of extremities.Mucous membranes: Mouth & eyes frequently, other mucosae less frequently affected; manifest as hemorrhagic crusts & white pseudomembrane of the lipsComplications:EN is an emergency, associated with high mortality due to;Infections: Including sepsisFluid & electrolyte imbalancePulmonary involvement: Interstitial syndromeRenal failure: A direct nephrotoxic effect of the drug or due to hypotensionOphthalmic complications: Acute complications and late sequelae like dry eyes, symbiepharonInvestigations:Biopsy: Subepidermal split with necrotic epidermisQProvocation: Causative drug can be identified by provocation test, but this is controversialTreatment:General measures: Withdrawal of suspected drug with supportive careSpecific therapy: Use of steroids is controversial. IVIg & cyclosporine are promising modalities.Fixed Drug EruptionAdverse cutaneous drug reaction appearing soon after ingestionQ (from 30 min to 8 hours) of offending agent in previously sensitized individuals.Drugs Implicated in Fixed Drug Eruption* PhenolpthaleinQ (present in some laxatives)* BarbituratesQ* MetronidazoleQ* FluoroquinolonesQ* SulphonamidesQ (Cotrimoxazole, dapsone)* TertracyclineQ* Salicylates & phenacetinQCharacteristic Features:Mucocutaneous junction (lip, glans) is most frequently involved, genital skin (glans) is the most commonly involved siteQ.Most commonly lesions are solitaryQ but they may be multiple.Lesions evolve from macules to papules to vesicles & bullae then erodeQ.Lesions heal by hyperpigmentationQUsually asymptomaticQ but may be pruritic, painful, or burning (when eroded)Lesions persist if the drug is continued and resolve days to w eeks after drug is continuedFDE occurs repeatedly at the same (i.e. fixed) site within hours, every time drug is taken and heals by residual grayish or slate colored hyperpigmentationv.Diagnosis:Diagnosis is confirmed by provocation.Rechallenging the patient to the suspected offending drug is the only known test to possibly discern the causative agent.Treatment:The main goal of treatment is to identify the causative agent and avoid it.Symptomatic treatment: Systemic antihistamines and topical corticosteroids may be all that are required. | train | med_mcqa | null |
Regarding Sudeck's osteodystrophy all are true except: | [
"Burning pain",
"Stiffness and swelling",
"Erythematous and cyanotic discolouration",
"Self limiting and good prognosis"
] | D | (d) Self limiting and good prognosis- Recovery is prolonged and painful both for patient and surgeon. 3 years usually elapse before the bones are remineralized and it is rare that full range of movements returns. | train | med_mcqa | null |
In which pa of the brain is the cerebral aqueduct is found? | [
"Diencephalon",
"Mesencephalon",
"Metencephalon",
"Myelencephalon"
] | B | Cerebral aqueduct of sylvius is found in the Midbrain (mesencephalon); it connects the third ventricle to the fouh ventricle. Midbrain is derived from mesencephalon. | train | med_mcqa | null |
34 years old male with femur shaft fracturedevelops petechiae over chest 4 days after the injury. What is the most probable diagnosis? | [
"Fat embolism",
"Air embolism",
"Thrombocytopenia",
"Hypocomplimentemia"
] | A | Ans. is 'a' i.e., Fat embolism o Fat embolism means circulation of fat globule away from its site of origin,o When fat embolism causes symptoms it is called fat embolism syndrome,o Causes of fat embolism1. Fracture of long bone (most common) - Blunt trauma2. Soft tissue trauma3. Bums4. Parenteral lipid infusion5. Sickle cell crisis6. Recent Corticosteroid adn7. Acute pancreatitis8. D.M.9. Liposuction10. Decompression sicknesso Fracture s of bone is the most common cause of fat embolism.o Amongst the long bones, femur fracture is associated with fat embolism most commonly.o Multiple fractures increase the risk of fat embolism.Clinical manifestations of fat embolismo Clinical features are evident within 1-3 days. About 25 percent of patients develop symptoms within 12 hours and 75 percent within 36 hours. Occasionally the onset may be delayed for several days and some patients may go unnoticed initially. Early warning signs are a slight rise in temperature (pyrexia) and tachycardia.o The classical triad of fat embolism syndrome isRespiratory symptoms : Dyspnea, tachypnea, cyanosis, ARDS, low PO2.Neurological symptoms : Confusion, disorientation, restlessness, irritation, delirium, convulsion, coma.Petechial rash : In axilla, neck, periumblical area, conjunctiva of lower lid, retina, front & beck of chest, shoulder. | train | med_mcqa | null |
Partial Pressure of Oxygen in aortic blood (Pa02) is/are decreased in all except: | [
"Pulmonary edema",
"Pulmonary Fibrosis",
"Polycythemia",
"Cor pulmonale"
] | C | C. PolycythemiaPa02 = measures oxygen in the blood (80-100mm Hg)Sa02 = measures tissue perfusion (pulse ox 95-100%)Pa02 (Partial Pressure of Oxygen in Arterial Blood)webapp1.dlib.indiana.edIt reflects the amount of oxygen gas dissolved in the blood. It primarily measures the effectiveness of the lungs in pulling oxygen into the blood stream from the atmosphere.Elevated pO2 levels are associated with:Increased oxygen levels in the inhaled airPolycythemiaDecreased PO2 levels are associated with:Decreased oxygen levels in the inhaled airAnemiaHeart decompensationChronic obstructive pulmonary diseaseRestrictive pulmonary diseaseHypoventilation"Cor pulmonale is a condition that causes the right side of the heart to fail. Long-term high blood pressure in the arteries of the lung and right ventricle of the heart can lead to cor pulmonale" - medlineplus.govType II Respiratory Failure Harrison 19th/1732This type of respiratory failure is a consequence of alveolar hypoventilation and results from the inability to eliminate carbon dioxide effectively.Mechanisms are categorized by impaired central nervous system (CNS) drive to breathe, impaired strength with failure of neuromuscular function in the respiratory system, and increased load (s) on the respiratory system.Reasons for diminished CNS drive to breathe include drug overdose, brainstem injury, sleep-disordered breathing, and severe hypothyroidism.Reduced strength can be due to impaired neuromuscular transmission (e.g., myasthenia gravis, Guillain-Barre syndrome, amyotrophic lateral sclerosis) or respiratory muscle weakness (e.g., myopathy, electrolyte derangements, fatigue)Type I Acute Hypoxemic Respiratory FailureHarrison 19th/1731This type of respiratory failure occurs with alveolar flooding and subsequent intrapulmonary shunt physiology. Alveolar flooding may be a consequence of pulmonary edema, pneumonia, or alveolar hemorrhage.Pulmonary edema can be further categorized as occurring due to elevated pulmonary microvascular pressures, as seen in heart failure and intravascular volume overload or ARDS ("low pressure pulmonary edema," This syndrome is defined by acute onset (<=1 week) of bilateral opacities on chest imaging that art not fully explained by cardiac failure or fluid overload and of shunt physiology requiring positive end-expiratory pressure (PEEP).Type I respiratory failure occurs in clinical settings such as sepsis, gastric aspiration, pneumonia, near-drowning multiple blood transfusions, and pancreatitis.The mortality rate among patients with ARDS was traditional very high (50-70%), although changes in patient care have led to mortality rates closer to 30% (see below(Davidson 22nd/664): How to interpret blood gas abnormalities in respiratory failure Type 1Type II Hypoxia (Pa02 <8.0kPa (60 mmHg)Normal or low PaC02 (<6.6 kPa (50 mmHg)Hypoxia (Pa02 <8.0 kPa (60 mmHg) Raised PaC02 (> 6.6 kPa (50 mmHg) AcuteChronicAcuteChronicH+--|- or |Bicarbonate---|CausesAcute asthma Pulmonary edema Pneumonia Lobar collapse Pneumothorax Pulmonary embolus ARDSCOPDLung fibrosis Lymphangitis Carcinomatosa Right-to-left shuntsAcute severe asthma Acute exacerbation of COPD Upper airway obstruction Acute neuropathies/paralysis Narcotic drugsPrimary alveolar hypoventilation Flail chest injuryCOPDSleep apnea KyphoscoliosisMyopathies/muscular dystrophy Ankylosing spondylitis | train | med_mcqa | null |
Low molecular weight heparin inhibits ? | [
"Factor Xa",
"Factor Xa and IIa",
"Factor IIa",
"Factors II, VII, IX and X"
] | A | Ans. is 'a' i.e., Factor Xa o Low molecular (fractionated) heparins inhibits -4 Factor Xa o Unfractionated inhibits --) Factor Ha & Xa | train | med_mcqa | null |
Distinct amino acid sequence at the antigen combining site is called: | [
"Idiotype",
"Allotype",
"Epitope",
"Paratope"
] | A | Ans. (a)Idiotype is based on antigenic difference in the hypervariable region.Allotype is based on alleleic difference in immunoglobulins e.g., Gm type.Isotype is antigenic differences in constant regions of heavy chain decide isotypes. | train | med_mcqa | null |
Dusky hue of vestibule and ant vaginal wall is | [
"Chadwick sign",
"Osiandersign",
"Goodel sign",
"Hegar sign"
] | A | Ans. (a) Chadwick sign | train | med_mcqa | null |
Dowry death is under | [
"Sec 304A",
"Sec 304B",
"Sec 113A",
"Sec 498A"
] | B | Sec 304B Dowry death where the death of a woman is caused by any burn or bodily injury or occurs otherwise than under normal circumstances within 7 years of her marriage and it is shown that soon before her death she was subjected to cruelty or harassment by her husband or any relative of her husband for, or in connection with, any demand for dowry, such death shall be called dowry death. Ref: TEXTBOOK OF FORENSIC MEDICINE AND TOXICOLOGY KRISHNAN VIJ FIFTH EDITION PAGE 169 | train | med_mcqa | null |
X-ray Artifact is | [
"A radiolucent area",
"Any abnormal opacity in the radiograph",
"Produced when patient moves while taking the shoot",
"All of the above"
] | C | X-ray artifacts. Artifacts can present in a variety of ways including abnormal shadow noted on a radiograph or degraded image quality and have been produced by artificial means from hardware failure, operator error and software (post-processing) artifacts. | train | med_mcqa | null |
Boerhaave's syndrome is due to ? | [
"Drug induced esophagus perforation",
"Corrosive injury",
"Spontaneous perforation",
"Gastro-esophageal reflux disease"
] | C | Ans. is 'c' i.e., Spontaneous perforation | train | med_mcqa | null |
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