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Which of the following opening in the base of the skull transmits the third branch of trigeminal nerve? | [
"Foramen ovale",
"Foramen lacerum",
"Foramen magnum",
"Foramen spinosum"
] | A | Foramen ovale is an opening at the base of the lateral pterygoid plate. It transmits the third branch of the trigeminal nerve, the accessory meningeal aery, and occasionally the superficial petrosal nerve. Foramen lacerum transmits the internal carotid aery.Foramen magnum transmits the medulla and its membranes, the spinal accessory nerves, the veebral aeries, and the anterior and posterior spinal aeries. | train | med_mcqa | null |
Which of the following is the preferred mode of contraception recommended during lactation: | [
"IUCD",
"DMPA",
"Progesterone only pills",
"OCP"
] | C | Medical eligibility criteria (MEC) categories for contraceptive eligibility: 1. A condition for which there is no restriction for the use of the contraceptive method. 2. A condition where the advantages of using the method generally outweigh the theoretical or proven risks. 3. A condition where the theoretical or proven risks usually outweigh the advantages of using the method. 4. A condition which represents an unacceptable health risk if the contraceptive method is used. Progestin-only Contraception methods do not impair milk production and are an excellent choice for lactating women. There are no increased risks of genital tract or breast neoplasia MEC 1 However, after the initial 6 weeks of delivery are over, use of IUCDs is equally good | train | med_mcqa | null |
A 30 year old nurse is evaluated for recurrent hypoglycaemia. She feels shaky, anxious, and sweaty; her plasma glucose is 50 mg/dl during the attack at work. She then drinks coffee & feels better. These episodes have not happened outside the work environment. She takes no medications and is otherwise healthy. Which is the most appropriate test in this patient? | [
"Measurement of IGF-1",
"Measurement of fasting insulin and glucose levels",
"Measurement of fasting insulin, glucose, and C-peptide levels",
"Measurement of insulin, glucose, and C-peptide levels during a symptomatic episode"
] | D | Whipple triad of symptoms: (1) Symptoms of hypoglycaemia (2) Low plasma glucose (3) Relief of symptoms with raising the plasma glucose level. The insulin levels must be obtained during an episode. If it is elevated, it suggests either endogenous hyperproduction of insulin or exogenous administration causing factitious hypoglycemia. C-peptide- determine normal cleavage of insulin from its precursor Normal C-peptide level with hypoglycaemia- surreptitious insulin use Low C-peptide level with hyperglycemia- pancreatic failure. Red flags in this case that point to surreptitious insulin use include the patient being a healthcare worker and the presence of symptoms only at work. Failure of counterregulatory hormones is rare cause of hypoglycaemia | train | med_mcqa | null |
Tonsillectomy and Im injections should be aoided during polio epidemic because - | [
"It is painful",
"It may lead to high grade fever",
"Risk of paralytic poliomyelitis increases",
"Risk of septicaemia"
] | C | Repeat question | train | med_mcqa | null |
In a patient with history of trauma and X-ray showing fracture of proximal pa of medial bone of forearm with dislocation. The muscles which may get paralysed- | [
"Flexor carpi ulnaris",
"Adductor pollicis",
"Extensor pollicis longus",
"Opponens pollicis"
] | C | Answer- C. Extensor pollicis longus Fracture of proximal pa of medial bone of forearm (ulna) with dislocation is Monteggia fracture-dislocation.Most common nerve which may be injured in Monteggia fracture-dislocation is posterior interosseus nerve (PIN). | train | med_mcqa | null |
The subarachnoid space ends at | [
"L1",
"L2",
"L5",
"S2"
] | D | Arachnoid & dural sheath end at the lower end of the S-2 veebra. Subarachnoid space terminates at the caudal (lower border) S-2 veebra. This is also the ending of the sub-dural space. Ref - BDC 6thedition vol 2 | train | med_mcqa | null |
Finish line prepared in full veneer crown is | [
"Buccal shoulder & lingually chamfer",
"Lingually shoulder & buccally chamfer",
"All shoulder",
"All chamfer"
] | A | null | train | med_mcqa | null |
Manganese deficiency features - | [
"Anemia",
"Alopecia",
"Ataxia",
"Gonadal atrophy"
] | C | null | train | med_mcqa | null |
Familial hypercholesterolemia is | [
"Deficient LDL receptors",
"Deficient HDL receptors",
"HMG CoA reductase deficiency",
"Deficient VLDL receptors"
] | A | Familial Hypercholesterolemia, or Type IIa hyperlipoproteinemia is defect in LDL-receptors or defect in Apo B100 apoprotein. In this disease, LDL levels & cholesterol is raised in blood. It is Autosomal dominant (AD). ADDITIONAL INFORMATION ON HYPERLIPOPROTEINEMIA: Type Defect Lipoprotein increased TGs Cholesterol Name I Lipoprotein Lipase or Apo C- II Chylomicron || VLDL | || Normal Familial Hyperchylomicronemia (AR) IIa LDL - receptor or Apo B100 LDL|| Normal || Familial Hypercholesterolemia IIb Unknown VLDL| LDL| | | Familial combined Hyperlipoproteinemia (AR) III Apo E Chylomicron Remanant || VLDL remnant | || || Dysbeta - lipoproteinemia or Broad - Beta disease (AR) | train | med_mcqa | null |
The MOST impoant risk factor for pancreatic cancer among the following is: | [
"Cigarette smoking",
"Chronic pancreatitis",
"Diabetes",
"Alcohol"
] | A | All are risk factors of pancreatic malignancy except alcohol. Cigarette smoking is the most common environmental risk factor for pancreatic malignancy. Other risk factors are chronic pancreatitis and diabetes. ALSO NOTE: Alcohol does not appear to be a risk factor. Ref: Harrison, Edition -18, Page-787 | train | med_mcqa | null |
In a patient with massive thromboembolism with hypotension after a fluid bolus of 1 L, the patient's blood pressure remains low at 88/50 mmHg. Echocardiogram demonstrates hypokinesis of the right ventricle. What is the next best step in the management of this patient? | [
"Treat with dopamine and recombinant tissue plasminogen activator, 100 mg IV",
"Continue IV fluids at 500 mL/hr for a total of 4 L of fluid resuscitation",
"Refer for inferior vena cava filter placement and continue current management",
"Refer for surgical embolectomy"
] | A | This patient is presenting with massive pulmonary embolus with ongoing hypotension, right ventricular dysfunction, and profound hypoxemia requiring 100% oxygen.In this setting, continuing with anticoagulation alone is inadequate, and the patient should receive circulatory suppo with fibrinolysis if there are no contraindications to therapy.The major contraindications to fibrinolysis include hypeension >180/110 mmHg, known intracranial disease or prior hemorrhagic stroke, recent surgery, or trauma.The recommended fibrinolytic regimen is recombinant tissue plasminogen activator (rTPA), 100 mg IV over 2 h.Heparin should be continued with the fibrinolytic to prevent a rebound hypercoagulable state with the dissolution of the clot.There is a 10% risk of major bleeding with fibrinolytic therapy with a 1-3% risk of intracranial haemorrhage. The only indication for fibrinolysis in pulmonary embolus (PE) is for massive PE presenting with life-threatening hypotension, right ventricular dysfunction, and refractory hypoxemia.In submassive PE presenting with preserved blood pressure and evidence of right ventricular dysfunction on echocardiogram, the decision to pursue fibrinolysis is made on a case-by-case situation. In addition to fibrinolysis, the patient should also receive circulatory suppo with vasopressors.Dopamine and dobutamine are the vasopressors of choice for the treatment of shock in PE. Caution should be taken with the ongoing high-volume fluid administration as a poorly functioning right ventricle may be poorly tolerant of additional fluids.Ongoing fluids may worsen right ventricular ischemia and fuher dilate the right ventricle, displacing the interventricular septum to the left to worsen cardiac output and hypotension. If the patient had contraindications to fibrinolysis and was unable to be stabilized with vasopressor suppo, referral for surgical embolectomy should be considered.Referral for inferior vena cava filter placement is not indicated at this time. The patient should be stabilized hemodynamically as a first priority.The indications for inferior vena cava filter placement are active bleeding, precluding anticoagulation, and recurrent deep venous thrombosis on adequate anticoagulation. | train | med_mcqa | null |
Treatment of choice for annular pancreas is | [
"Duodenoduodenostomy",
"Gastrojejunostomy",
"Vagotomy",
"Billroth type II gastrectomy"
] | A | Ans. is 'a' i.e., Duodenoduodenostomy "The usual treatment is bypass (duodenoduodenostomy)" -- Bailey and Love"Retrocolicduodenojejunostomy is the procedure of choice." -- Harrison"Treatment usually involves bypass, through duodenojejunostomy, rather than resection." -- Sabiston"The surgical treatment of choice for duodenal obstruction due to duodenal stenosis or atresia or annularpancreas is a duodenoduodenostomy." -- Schwartz 9/e | train | med_mcqa | null |
Enophthalmos is seen in - | [
"Blow out fracture of orbit wall",
"Hyperthyroidism",
"Radiation Injuries",
"Diabetes meilitus"
] | A | Arts. Is 'a' i.e., Blow out fracture of orbit wall o Enophthalmos is seen in blow out fracture of orbit wall.o Post traumatic enophthalmos is caused by blow out fracture through the floor of orbit.ENOPHTHALMOSo It is the inward displacement of the eyeball. About 50 percent cases of mild enophthalmos are misdiagnosed as having ipsilateral ptosis or contralateral proptosis,o Common causes areCongenital. Microphthalmos and maxillary hypoplasia.Traumatic, Blow out fractures of floor of the orbit.Post-inflammatory'. Cicatrization of extraocular muscles as in the pseudotumour syndromes.Paralytic enophthalmos. It is seen in Homer's syndrome (due to paralysis of cervical sympathetics).Atrophy of orbital contents. Senile atrophy of orbital fat, atrophy due to irradiation of malignant tumour, following cicatrizing metastatic carcinoma and due to scleroderma. | train | med_mcqa | null |
Treponema pallidum crosses placenta: | [
"After 36 weeks",
"After 28 weeks",
"After 2nd trimester",
"At any stage of pregnancy"
] | D | Transmission of Treponema pallidum from an infected woman to her fetus across the placenta may occur at any stage of pregnancy, but the lesions of congenital syphilis usually develop after-the 4th month of gestation, when "fetal immunologic" competence begins to develop. | train | med_mcqa | null |
Small airways have laminar air flow because | [
"Reynold's number>2000",
"Very small diameter",
"Extremely low velocity",
"Low cross sectional area."
] | C | The probability of turbulence is determined by Reynold's number. When it is more than 3000, the flow is almost always turbulent. When it is less than 2000, the flow is usually non-turbulent (laminar). Reynold's number is directly propoional to Density of fluid Diameter of vessel Velocity of flow Ref: guyton and hall textbook of medical physiology 12 edition page number:321,321,322 | train | med_mcqa | null |
All are true regarding coup injury except | [
"Injury at the site of impact",
"Occur when head is fixed",
"Severe than cotre- couple injury",
"External injury like contusion, laceration on scalp or skull fracture seen"
] | C | Features of coup injury Injury at the site of impact External injury like contusion, laceration on scalp or skull fracture Due to the direct impact on brain May occur when head is fixed Less severe than contre coup Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 168 | train | med_mcqa | null |
A patient presents with respiratory distress and shows pH = 7.2, PCO2 = 50 mmHg, PO2 = 85 mmHg and HCO3 = 20 mEq/L. The cause is | [
"Metabolic acidosis",
"Metabolic alkalosis",
"Respiratory acidosis with compensatory Metabolic alkalosis",
"Respiratory acidosis with decompensatory Metabolic acidosis"
] | D | (D) Respiratory acidosis with decompensatory Metabolic acidosis PREDICTION OF COMPENSATORY RESPONSES ON SIMPLE ACID-BASE DISTURBANCESDisorderPrediction of Compensation* Metabolic acidosisPaco2 = (1.5 x HCO3-) + 8OrPaco2 will | 1.25 mmHg per mmol/L |in orPaco2 = + 15* Metabolic alkalosisPaco2 will | 0.75 mmHg per mmol/L | in Paco2 will | 6 mmHg per mmol/L | in Paco2 = + 15* Respiratory alkalosis * Acute will | 2 mmol/L per 10 mmHg |, in Paco2* Chronic will|4 mmol/L per 10 mmHg | in Paco2* Respiratory acidosis * Acute will | 1 mmol/L per 10 mmHg | in Paco2* Chronic will | 4 mmol/L per 10 mmHg | in Paco2 | train | med_mcqa | null |
Ligament of shoulder joint are all except | [
"Coracoclavicular",
"Glenohumoral",
"Coracohumeral",
"Transverse humeral"
] | A | A glenohumeral ligament connects the glenoid cavity to the humerus. Coracohumeral connects the coracoid process to the neck of the humerus. A transverse humeral ligament connects the upper pa of the bicipital groove of the humerus. BD Chaurasia 7th edition Page no: 146,147 | train | med_mcqa | null |
Which of the following phospholipid is predominantly found in the inner mitochondrial membrane? | [
"Cardiolipin",
"Cephalin",
"Lecithin",
"Sphingomyelin"
] | A | Cardiolipin: Diphosphatidyl glycerol i.e. 2 phosphatidic acid moieties attached to glycerol. Found in inner mitochondrial membrane. Physiological role: Increases the efficiency of the oxidative phosphorylation by acting as proton trap. Involved in signalling of apoptosis (programmed cell death). Anticoagulant Pathological role: Bah syndrome - defective biosynthesis of Cardiolipin. Antiphospholipid syndrome thrombotic condition leading to aboion. Anti-cardiolipin antibodies are found. | train | med_mcqa | null |
All are treatment of deep transverse arrest except : | [
"Ventouse",
"Cesarean section",
"Manual rotation with outlet forceps",
"Craniotomy"
] | C | Manual rotation with outlet forceps | train | med_mcqa | null |
Which of the following is NOT TRUE about Eponymous fracture? | [
"Monteggia fracture is fracture of the proximal third of the ulna with radial head dislocation",
"Galeazzi fracture is fracture of the distal third of the radius with dislocation of the distal radio-ulnar joint",
"Colles fracture is fracture at coico-cancellous junction of the distal end of the radius with dors... | D | An eponym is the name of a person, whether real or fictitious, after which a paicular place, tribe, era, discovery, or other item is named or thought to be named. One who is referred to as eponymous is someone who gives his or her name to something. "Pott's fracture is bimalleolar fracture of ankle, trimalleolar fracture of ankle is called cotton's fracture" All other eponymous fractures are correctly defined. Ref: Maheshwari 3/e, Page 2-3. | train | med_mcqa | null |
The best advice to be given to a patient of newly diagnosed type 2 Diabetes mellitus- | [
"Saturated fat intake <10% of total fat",
"Consistent calorie intake",
"Carbohydraterestrictitm",
"Exercise"
] | D | All patients with diabetes should be advised to achieve a significant level of physical activity and to maintain this in the long term. This can include activities such as walking, gardening, swimming or cycling. Supervised and structured exercise programmes may be of paicular benefit to people with type 2 diabetes. Various guidelines exist for physical activity in the general population. Those from the US Depament of Health and Human services (2008) suggest that adults (18-64 years) should build up to achieve a weekly minimum of 2.5 hours of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise, or a combination thereof. The aerobic (moderate-intensity) activity should be performed for at least 10 minutes each time and spread throughout the week, with at least 30 minutes on at least 5 days of the week. Older adults should also follow these guidelines as far as their abilities allow. Recently, it has also been suggested that a combination of both aerobic and resistance exercise may lead to greater improvements in glycaemic control. In type 1 diabetes, exercise can increase the risk of hypoglycaemia, so patients should seek specialist advice on taking extra carbohydrate, reducing insulin doses and choosing an injection site. DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-821 | train | med_mcqa | null |
Perforin ? | [
"NK cell",
"Cytotoxic T cell",
"Plasma cell",
"Monocyte"
] | B | Ans. is 'b' i.e., Cytotoxic T cell Cytotoxic T Lymphocyte-Mediated Apoptosis Cytotoxic T lymphocytes (CTLs) recognize foreign antigens presented on the surface of infected host cells. Upon activation, CTLs secrete perforin, a transmembrane pore-forming molecule, which promotes entry of the CTL granule serine proteases called granzymes. Granzymes cleave proteins at aspaate residues and thus activate a variety of cellular caspases. In this way the CTL kills target cells by directly inducing the effector phase of apoptosis. | train | med_mcqa | null |
Anti-double stranded DNA is highly specific for - | [
"Systemic sclerosis",
"S.L.E.",
"Polymyositis",
"Rheumatic sclerosis"
] | B | null | train | med_mcqa | null |
'Ely's cysts' are a feature of: | [
"Osteoarthritis of TMJ",
"Chronic suppurative osteomyelitis",
"Fibrous dysplasia",
"Gorlin-Goltz syndrome"
] | A | In severe degenerative joint disease (DJD), the glenoid fossa may appear grossly enlarged because of erosion of the posterior slope of the articular eminence. This erosion may allow the condylar head to move forward and superiorly into an abnormal anterior position that may result in an anterior open bite. The condyle may also be markedly diminished in size and altered in shape because of severe erosions. In some cases, small, round, radiolucent areas with irregular margins surrounded by a varying area of increased density are visible deep to the articulating surfaces. These lesions are called Ely cysts or subchondral bone cysts, but they are not true cysts; they are areas of degeneration that contain fibrous tissue, granulation tissue, and osteoid.
Oral radiology ; White and Pharaoh 7th edition page no: 509 | train | med_mcqa | null |
Maximum shortening of lower limb is seen in: | [
"Fracture shaft femur",
"Fracture neck femur",
"Fracture intertrochanteric femur",
"Transcervical fracture neck femur"
] | A | (a) Fracture shaft femurLower limb injures associated with maximum shortening are posterior dislocation of hip > fracture shaft femur > Fracture subtrochanteric femur > Intertrochanteric fracture > Fracture Neck Femur | train | med_mcqa | null |
All of the following are features of phaeochromocytoma except : | [
"Hypeensive paroxysm",
"Headache",
"Ohostatic hypotension",
"Wheezing"
] | D | Answer is D (Wheezing): Wheezing has not been mentioned as a symptom of Pheochromocytoma. The most common symptoms in order of frequency during paroxysm are: - Headache - Palpitation - Vomiting - Sweating - Dyspnea - Weakness - Pallor The most common manifestation is hypeension. e It most commonly occurs in paroxysms i.e. Paroxysmal Hypeension The most common symptom is headache Ohothostatic Hypotension 2 :is seen as a consequence of diminished plasma volume & blunted sympathetic reflexes. | train | med_mcqa | null |
An 8 year old female presents to the dental clinic due to the increasing gaps between her upper front teeth. Her parents reveal to the doctor that she constantly has her fingers in the mouth despite being reminded. On clinical examination it was noted that the labial flaring and protrusive spacing of maxillary anterior teeth and increased overjet was present. The condition the girl is currently having can be best described as | [
"Tongue thrusting",
"Thumb sucking",
"Mouth breathing",
"Digit sucking"
] | D | If the intensity of the habit persists or increases and adverse dental and skeletal changes are noted beyond age 4 years, corrective measures may be needed to avoid undesirable occlusal problems. By the age of 6to 7 years, estimates indicate that approximately 10% to 15% of children have a persistent digit-sucking habit that runs the gamut from incidental sucking at bedtime to pronounced habits that seems to be almost constant. Almost all authorities recognize that persistent digit-sucking habits extending into the incisor transition period can cause a malocclusion or aggravate an already existing one. Pressure generated from the habit can produce changes in the anterior segments of the dental arches, with labial flaring and protrusive spacing of maxillary anterior teeth and increased overjet. Remodeling of the maxillary alveolar process and vertical displacement of the maxillary anterior teeth can result in an open-bite relationship. | train | med_mcqa | null |
A 35yr old female who was an Occasional drinker complained of Severe Pruritis that becomes more bothersome in evening. On examination, patient was noted to have icteric sclera. Lab tests revealed anti-mitochondrial antibodies. What is the possible diagnosis? | [
"Primary sclerosing cholangitis",
"Xanthogranulomatous cholecystitis",
"Primary biliary cirrhosis",
"Alcoholic cirrhosis"
] | C | PBC- primary biliary cirrhosis Autoimmune disorder M/C in females Pathology Progressive destruction of intrahepatic bile ducts only Diagnostic appearance - florid duct lesion with lymphocytic infiltration and granulomatous inflammation Clinical features Pruritis precedes jaundiceQ Pruritis and fatigue - characteristic symptoms Diagnosis Anti-mitochondrial Ab - Can confirm diagnosis Investigation of choice - Biopsy Treatment Liver transplantation (severe pruritus & fatigue are indications for LT) | train | med_mcqa | null |
Cholelithiasis and choledocholithiasis is caused by? | [
"Clofibrate",
"Chloramphenicol",
"Cotrimaxozole",
"NS AIDS"
] | A | ANSWER: (A) ClofibrateREF: Robbin's 8th ed CH: 8Drugs causing cholelithiasis and choledocholithiasis:Clofibrates: Clofibrate, used to lower blood cholesterol, increases hepatic HMG-CoA reductase and decreases conversion of cholesterol to bile acids by reducing cholesterol 7-a-hydroxylase activity. The net result of these influences is excess biliary secretion of cholesterolEstrogen and OOP'SSomatostatin analogues appear to predispose to gallstones by decreasing gallbladder emptying.Ampicillin | train | med_mcqa | null |
Amphetamine causes which of the following ? | [
"IUGR",
"Cardiac anamoly",
"Cleft lip",
"All the above"
] | D | Ans. is 'd' i.e., All the above Following are the fetal or neonatal effects of amphetamines : IUGR Abruptio placentae Glassy eyed look Prematurity Hypoglycemia Lethargy Cardiac anamolies Sweating Feeding problems Cleft palate Poor visual tracing | train | med_mcqa | null |
Which of the following is not an oncogenic virus? | [
"Hepatitis C virus",
"HPV",
"EBV",
"Hepatitis A virus"
] | D | Although many viruses can cause various tumors in animals, only seven of them are associated with human cancers and are currently considered oncogenic viruses. These viruses include hepatitis B virus (HBV), hepatitis C virus (HCV), human papillomavirus (HPV), Epstein Barr virus (EBV), human herpes virus 8 (HHV8), Merkel cell polyomavirus (MCPyV), and HTLV-1. Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 541 | train | med_mcqa | null |
False about PSC | [
"PSC in UC, the association is 30%",
"Low incidence of cholangitis",
"Increased incidence of colonic carcinoma in PSC+UC",
"Despite the presence of diffuse disease, hepatic duct bifurcation is most severely structured segment"
] | A | Primary sclerosing cholangitis PSC is a cholestatic liver disease characterized by fibrotic strictures involving intrahepatic and extrahepatic biliary tree in the absence of a known precipitating cause More common in HLA B8/DR3 Incidence of UC in PSC ranges from 75-80% PSC is present in 5.5% of patients with chronic UC Ref: Sabiston 20th edition Pgno :1508-1509 | train | med_mcqa | null |
The initial fluid rate in burns patient for first 24 hours is - | [
"TBSA x wt x 8",
"TBSA x wt x 4",
"TBSA x wt x 3",
"TBSA x wt x 2"
] | B | Ans. is 'b' i.e., TBS A x wt x 4 * Proper fluid management is critical to survival in a burn patient.* The hypovolemic shock in burn patient is special in the sense that the total body water remains unchanged in a burn patient. The thermal injury leads to a massive fluid shift from intravascular compartment to the extravascular compartment (interstitial + intracellular) leading to edema formation (in both burned parts and non burned parts of body)* This fluid shift is maximum in the first 24 hrs.* Fluid resuscitation begins with an isotonic crystalloid solution - Ringer's lactate solution (RL) is the preferred solution (Normal saline should be avoided as the volumes required for resuscitation may lead to hyperchloremic metabolic acidosis). The concept behind the continuous fluid resuscitation is that the burn (and/or inhalation injury) drives an inflammatory response that leads to capillary leak; as the plasma leaks into the extra vascular space, crystalloid administration would maintain the intravascular volume.# The quantity of crystalloid needed for adequate resuscitation is determined by Parkland formula i.e. 4 mL/kg per % of TBSA burn. (Note that a number of formulas exist for calculating fluid needs during burn resuscitation, suggesting that no one formula benefits all patients. Parkland is one of the most commonly used formulas)# Half of the calculated fluid is given in first 8 hrs and half in next 16 hrs.* Colloids are given in the next 24 hrs. The reason behind it being the observation that in the initial period, the vascular permeability is so large that even larger protein molecules leak from the capillaries. (But some workers, prefer to use colloids after 8 to 12 hrs, while there are some who use it from the very beginning)* A number of parameters are widely used to assess burn resuscitation, but the most common remain the simple outcomes of blood pressure and urine output. As in any critically ill patient, the target MAP is 60 mmHg to ensure optimal end-organ perfusion. Goals for urine output should be 30 mL/h in adults and 1 to 1.5 mL/kg per hour in pediatric patients.* There is no use of diuretics in burn resuscitation.* Children under 20 kg have the additional requirement that they do not have sufficient glycogen stores to maintain an adequate glucose level in response to the inflammatory response. Specific pediatric formulas have been described, but the simplest approach is to add maintenance IV fluid with glucose supplementation in addition to the calculated resuscitation fluid with lactated Ringer's. | train | med_mcqa | null |
Ring of Sommerring is seen in | [
"Galactosemia",
"Dislocation of lens",
"Acute congestive glaucoma",
"After cataract"
] | D | D i.e. After cataract | train | med_mcqa | null |
Which of the following procedures is routine technique for karyotyping using light microscopy: | [
"C-banding",
"G-banding",
"Q-banding",
"V-staining"
] | B | G-banding which includes staining with Giemsa is the most common technique used for karyotyping Q-banding- fluorescent pattern obtained using quinacrine for staining C-banding- selective chromosome stain in which Giemsa stain is used to stain heterochromatic regions close to the centromeres V-staining- method for detecting apoptotic cells. | train | med_mcqa | null |
The response which is graded by an observer on agree or disagree continuum is based on? | [
"Visual analogue scale",
"Guttman scale",
"Likert scale",
"Adjective scale"
] | B | null | train | med_mcqa | null |
One year old male child with sparse blond hair, developmental delay and tremors, diagnosis | [
"Albinism",
"Phenylketonuria",
"Cerebral palsy",
"Infantile tremor syndrome"
] | B | Phenylketonuria is due to deficiency of enzyme phenylalanine hydroxylase or of its cofactor tetrahydrobiopterin ;leads to accumulation of phenylalanine in body fluids and brain. It is mainly characterized by profound mental retardation ,lighter complexion and neurologic symptoms like tremors,hyperreflexia and spasticity. Reference: Nelson TB of pediatrics 19th edition, pg 418 | train | med_mcqa | null |
Infection of thenar space is drained by incision at? | [
"1st Webspace",
"2nd Webspace",
"Just above flexor retinaculum",
"3rd Webspace"
] | A | Thenar space communicates with fascial sheath of 1st Lumbrical. Mid palmar space communicates with fascial sheath of 2nd, 3rd & 4th Lumbrical. 2nd space cannot be incised in palmar space infection due to risk of damaging intermediate septum. Infections of thenar space is drained by incising 1st webspace. | train | med_mcqa | null |
The endoscope that examines the respiratory tract is called as | [
"Bronchoscopy",
"Laparoscopy",
"Colonoscopy",
"Arthroscopy"
] | A | Broncoscope is inserted in the body via the nasal passage and it used to image the respiratory tract.
It has a very thin tube so that the patient feels minimal discomfort as the scope goes down the track.
A laryngoscope can be used to examine the larynx. It is inserted through the mouth and the direction of the scope is changed at the epiglottis.
This allows the scope to look at the larynx and not enter the GI tract. | train | med_mcqa | null |
The hypothesis 'Greater in the lipid solubility of the compound in olive oil, the greater is its anesthetic potency'is referred to as - | [
"Meyer-Overton rule",
"Pressure reversal rule",
"Critical volume hypothesis",
"Lipid bilayer expansion hypothesis"
] | A | Ans- A Meyer-Overton rule Ref- Inhaled anaesthetic agents act in different ways at the level of the central nervous system. They may disrupt normal synaptic transmission by interfering with the release of neurotransmitters from pre-synaptic nerve terminal (enhance or depress excitatory or inhibitory transmission), by altering the re-uptake of neurotransmitters, by changing the binding of neurotransmitters to the post-synaptic receptor sites or by influencing the ionic conductance change that follows activation of the post-synaptic receptor by neurotransmitters. Both pre- and post-synaptic effects have been found. Direct interaction with the neuronal plasma membrane is very likely, but indirect action via production of a second messenger also remains possible. The high correlation between lipid solubility and anaesthetic potency suggests that inhalational anaesthetic agents have a hydrophobic site of action. Inhalational agents may bind to both membrane lipids and proteins. It is not clear which of the different theories are most likely to be the main mechanism of action of inhalational anaesthetic agents. The Meyer-Overton theory describes the correlation between lipid solubility of inhaled anaesthetics and MAC and suggests that anaesthesia occurs when a sufficient number of inhalational anaesthetic molecules dissolve in the lipid cell membrane. The Meyer-Overton theory postulates that it is the number of molecules dissolved in the lipid cell membrane, and not the type of inhalational agent, that causes anaesthesia. Combinations of different inhaled anesthetics may have additive effects at the level of the cell membrane. Exceptions to the Meyer-Overton rule Enflurane and isoflurane are structural isomers and have similar oil:gas partition coefficients. However, the MAC for isoflurane is only approximately 70% of that for enflurane; thus, it would appear that there are other factors which influence potency. These include: Convulsant properties Complete halogenation, or complete end-methyl halogenation of alkanes and ethers results in decreased anaesthetic potency and the appearance of convulsant activity. Specific receptors For a given MAC reduction, plasma levels of morphine, alfentanyl, sufentanyl and fentanyl vary around 5000 fold. Levels of these four agents in brain lipid vary 10 fold; thus, studies of the reduction in MAC by opioids suggests two sites of action: the opioid receptor and some hydrophobic site. D-medetomidine This alpha-2-agonist results in a marked reduction in MAC, whereas its optical isomer, with identical lipid solubility, has no effect. Hydrophilic site of action L. Pauling & S. Miller (1961) independently proposed that anaesthesia may result from the formation of clatharates of water in membranes. In this model, anaesthetic molecules act as seeds for crystals of water, which subsequently alter membrane ion transport. This is less likely than the unitary theory, as there is a poor correlation between the ability of agents to form clatharates and their anaesthetic potency. Traube (1904) and Clements & Wilson (1962) proposed that potency correlated with a reduction in surface tension. However, these latter physical properties are closely related to those properties which determine hydrophobicity. Hence, the Meyer-Overton theory does not describe why anaesthesia occurs. Mullins expanded the Meyer-Overton rule by adding the 'Critical Volume Hypothesis'. He stated that the absorption of anaesthetic molecules could expand the volume of a hydrophobic region within the cell membrane and subsequently distort channels necessary for sodium ion flux and the development of action potentials necessary for synaptic transmission. The fact that anaesthesia occurs with a significant increase in the volume of hydrophobic solvents and is reversible by compressing the volume of the expanded hydrophobic region of the cell membrane supports Mullins' 'Critical Volume Hypothesis'. The protein receptor hypothesis postulates that protein receptors in the central nervous system are responsible for the mechanism of action of inhaled anaesthetics. This theory is supported by the steep dose-response curve for inhaled anaesthetics. However, it remains unclear if inhaled agents disrupt ion flow through membrane channels by an indirect action on the lipid membrane, via a second messenger or by direct and specific binding to channel proteins. Another theory describes the activation of gamma-aminobutyric acid (GABA) receptors by the inhalational anaesthetics. Volatile agents may activate GABA channels and hyperpolarise cell membranes. In addition, they may inhibit certain calcium channels and therefore prevent the release of neurotransmitters and inhibit glutamate channels. Volatile anaesthetics therefore may share common cellular actions with other sedative, hypnotic and analgesic drugs. | train | med_mcqa | null |
All are methods of sterilization by dry heat except? | [
"Flaming",
"Incineration",
"Hot air oven",
"Autoclaving"
] | D | Ans. is 'd' i.e., Autoclaving | train | med_mcqa | null |
In a survey, many children are examined and were found to have urogenital abnormalities. Which congenital anomaly is associated with an increased risk of bladder carcinoma? | [
"Medullary sponge kidney",
"Bladder exstrophy",
"Unilateral renal agenesis",
"Double ureter"
] | B | Congenital anomalies associated with an increased risk of bladder cancer are:
patent urachus
exstrophy bladder
Both increase the risk for adenocarcinoma. | train | med_mcqa | null |
Sources of the nitrogen in urea cycle are | [
"Aspartate and ammonia",
"Glutamate and ammonia",
"Arginine and ammonia",
"Uric acid"
] | A | Sources of Nitrogen in urea are ammonia and aspartate. | train | med_mcqa | null |
Second gas effect is seen with - | [
"Ether",
"Nitrous oxide",
"Desflurane",
"Sevoflurane"
] | B | Ans. is 'b' i.e., Nitrous oxide Second gas effecto If another inhalation agent is (eg Halothane) is being given at the same time with N2O2 it also will be delivered to lung from the cylinder (due to negative intraalveolar pressure).Also Remembero Concentration effect and secondary gas effect - during inductiono Diffusion hypoxia - during recovering.o All these occur with N2O only (Xenon also causes these effects). | train | med_mcqa | null |
A pt. has a pituitary tumour and pheochromocytoma and a thyroid nodule. Which Ca is most likely to occur - | [
"Follicular Ca",
"Medullary Ca",
"Papillary Ca",
"Anaplastic Ca"
] | B | This pt. is suffering from MEN Syndrome.
MEN (Multiple endocrine neoplasias) or MEA (Multiple endocrine adenomatosis) syndromes are characterized by the familial occurrence of multiple endocrine neoplasms.
3 types of MEN Syndrome are recognized.
a) MEN I (or Wermer's Syndrome*) consists of -
Pituitary adenoma (or hyperplasia)*
Parathyroid adenoma (or hyperplasia)*
Pancreatic islet cell hyperplasia, adenoma or carcinoma
Other less common manifestations :
foregut carcinoids
pheochromocytoma
subcutaneous or visceral lipomas
b) MEN HA ( or Sipple syndrome)
Medullary carcinoma of thyroid (MCT)*
Pheochromocytoma*
Parathyroid adenoma (or hyperplasia)*
Hirschsprung disease*
Cutaneous lichen amyloidosis*
c) MEN H B
Medullary carcinoma of thyroid (MCT)*
Pheochromocytoma *
Marfanoid features*
Mucocutaneous and gastrointestinal neuromas*
Thus this pt. is suffering from MEN II A or II B syndrome (Pituitary tumor in this pt. is still confusing the question, but still; answer is definitely MCT). | train | med_mcqa | null |
In a chronic smoker which hemoptysis, he also gave a history of hypeension and obesity. Lab data showed raised ACTH levels, which are not suppressed by dexamethasone. The cause of Cushing's syndrome in the patient is - | [
"MEN1",
"Pituitary adenoma",
"Adrenal coical adenoma",
"Ectopic ACTH secreting tumor"
] | D | - History of chronic smoking and hemoptysis along with raised ACTH levels not suppressible by dexamethasone points to ectopic ACTH producing small cell carcinoma of lung. | train | med_mcqa | null |
Dysguesia is side effect of | [
"Captopril",
"Enalapril",
"Ramipril",
"Lisinopril"
] | A | Ans. a (Captopril). (Ref. Harrison's medicine, 16th ed., Table 230-8, Pg 1474)ADVERSE EFFECTS OF CAPTOPRIL =# Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems (fetal renal damage), Rash, Increased renin, Lower angiotensin II. Also hyperkalemia, Leukopenia>Pancytopenia, Urticarial rash and ARF in bilateral RASEducational point:# Fosinopril excreted more in bile than others.# Losartan is an angiotensin II receptor antagonist. It is not an ACE inhibitor and does not cause cough. | train | med_mcqa | null |
Investigution of choice for spinal TB- | [
"X-ray",
"CT Scan",
"MRI",
"PET Scan"
] | C | Ans. is 'c' i.e., MRIInvestigations in musculoskeletal systemo Investigation of choice for AVN Hip - MRIo Best initial test for osteomyelitis -Plain x-rayo Best second line test for osteomyelitis (if there is high clinical suspicion and x-ray is negative) - MRIo Most accurate diagnostic test for osteomyelitis -Bone biopsy and culture.o Best view for scaphoid fracture - Oblique (scaphoid) view of wrist,o Best view for C1-C2 vertebrae & junction - Open mouth odontoid (Pegs) view,o Investigation of choice for ACL & PCL injury - MRIo Investigation of choice to detect calcification - CT scano Investigation of choice for prolapsed intervertebral disc - MRIo Investigation of choice for spinal tuberculosis - MRIo Investigation of choice for traumatic paraplagia - MRIo Gold standard and investigation of choice for osteoporosis - Dual energy x-ray absorptiometry (DEXA). | train | med_mcqa | null |
Recently aseptic meningitis was discovered as an adverse effect of which of the following drug? | [
"Ibuprofen",
"Paracetamol",
"Ketorolac",
"Nimesulide"
] | A | Ibuprofen is a common nonsteroidal anti-inflammatory drug that is the most frequent cause of aseptic meningitis induced by drugs. The incidence of this type of aseptic meningitis is increasing, mainly among patients with underlying autoimmune connective tissue disorder Ref: G n G 13th ed. | train | med_mcqa | null |
Not a cause of objective tinnitus ? | [
"Palatal myoclonus",
"Glomus tumor",
"Carotid aery aneurysm",
"Presbyacusis"
] | D | Ans. is 'd' i.e., Presbyacusis Tinnitus Tinnitus is ringing sound or noise in the ear. The characteristic feature is that the origin of this sound is within the patient. | train | med_mcqa | null |
Acute organic psychosis may be associated with all of the following diseases EXCEPT | [
"Head injury",
"Arteriosclerosis",
"Meningitis",
"Delirium tremens"
] | B | (B) Arteriosclerosis # Causes of Organic Amnestic syndrome: Head trauma. Surgical procedure (bilateral temporal lobectomy). Hypoxia. Posterior cerebral artery stoke (bilateral). Herpes simplex encephalitis. Space occupying lesions in the regions of III ventricle (E.g. neoplasms). | train | med_mcqa | null |
In a child , Neck holding comes at what age ___________ | [
"2 months",
"3 months",
"4 months",
"5 months"
] | B | Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. Reference: GHAI Essential pediatrics, 8th edition | train | med_mcqa | null |
Mechanism of action of dantroline is? | [
"Inhibits Ca++ secretion from sarcoplasm",
"Binds to ryanodine receptors to block release of Ca++",
"Inhibits GABA",
"Inhibits Gamma motor neuron"
] | B | Ans. (b) Binds to ryanodine receptors to block release of Ca++Ref: Lippincott 5thed 344 | train | med_mcqa | null |
Earliest and often the only presentation of TB kidneys is: | [
"Increased frequency of urine",
"Colicky pain",
"Hematuria",
"Renal calculi"
] | A | Genitourinary TB may involve any poion of the genitourinary tract. Local symptoms :- Urinary frequency, dysuria, nocturia, hematuria, and flank or abdominal pain is common presentations. However, patients may be asymptomatic. Urinalysis - pyuria and hematuria. Culture-negative pyuria in acidic urine raises the suspicion of TB. IV pyelography, abdominal CT, or MRI may show deformities and obstructions, and calcifications and ureteral strictures are suggestive findings. Culture (of three morning urine specimens) yields a definitive diagnosis in nearly 90% of cases. | train | med_mcqa | null |
Kaposi's variceliform is mainly associated with: | [
"Atopic dermatitis",
"AIDS",
"Congenital immunodeficiency",
"Psoriasis"
] | A | Kaposi's variceliform is associated with Atopic dermatitis Eczema herpeticum - Generalised HSV eruptions. Seen mainly in infants of atopic dermatitis. Seen as vesciculo-pustular eruptions in which lesions show umbilication and often becomes hemorrhagic. There may be peripheral or central nervous system involvement. In AIDS Kaposi Sarcoma is seen, not kaposi's variceliform | train | med_mcqa | null |
Which of the following results in the least veical transmission of HIV? | [
"Forceps delivery",
"Normal delivery",
"Breast feeding",
"Cesarean Section"
] | D | Caesarean section before onset of labour and rupture of membranes approximately halves the risk of mother-to-child transmission. Timing Transmission rate During pregnancy 5-10% During labour and delivery 10-15% During breastfeeding 5-20% Overall without breastfeeding 15-25% Overall with breastfeeding to six months 20-35% Overall with breastfeeding to 18-24 months 30-45% | train | med_mcqa | null |
The test of choice to detect perivalvular abscesses? | [
"MRI",
"CT scan",
"2D-echo",
"TEE with color Doppler"
] | D | PERIVALVULAR INFECTION This complication, which is most common with aoic valve infection. Trans-esophageal Echo (TEE) with color Doppler is the test of choice It is rapid,noninvasive with excellent specificity for vegetations as the transducer in esophagus is in close proximity to the aoic root and septum | train | med_mcqa | null |
Which is false regarding endotracheal tube cuff? | [
"Infant endotracheal tubes does not have cuffs",
"Cuff is meant to keep the tube firmly in the trachea",
"Lateral pressure exeed should not exceed 30 cm water",
"Cuff provides an aiight seal and facilitate controlled ventilation"
] | B | Cuff has no role in fixation of the tube. The cuff is inflated to seal the airway to deliver mechanical ventilation. A cuff pressure between 20 and 30 cm H2O is recommended to provide an adequate seal and reduce the risk of complications. The objective was to maintain the ETT cuff pressure within a range of 20 to 30 cm H2O. | train | med_mcqa | null |
Lowest recurrence in nocturnal enuresis is seen with- | [
"Bed alarms",
"Desmopressin",
"Imipramine",
"Oxybutynin"
] | A | Ans. is 'a' i.e., Bed alarms Enuresis Enuresis is defined as the voluntary or involuntary repeated discharge of urine into clothes or bed after a developmental age when bladder control should be established (mostly mental age of 5 years). o Diagosis of enuresis requires voiding of urine twice a week for 3 consecutive months or clinically significant distress in child's life as a result of wetting. o Most common cause of diurnal enuresis is micturition deferral (waiting until the last minute to void). Treatment o First line treatment for enuresis is behavioral therapy. It consists of rewarding the child for being dry at night, child should void before retiring and the use of conditioning devices (e.g. bed alarm that rings when the child wets a special sheet). o Consistent dry bed training with positive reinforcement has a success rate of 85% and bed and pad alarm systems have a success rate of approximately 75% with relapse rate that are lower than those with pharmacotherapy. o Pharmacotherapy is second line treatment and should be reserved for those patients who have failed behavioural therapy. Imipramine and desmopressin are two impoant drugs useful for enuresis. o Fast action of desmopressin (orally or intranasaly) suggests a role for special occass ons when rapid control of enuresis is required. However, recurrence rate is very high. o Imipramine is associated with cardiac conduction disturbances and is deadly in overdose. | train | med_mcqa | null |
A clinical sign indicating the onset of the menopause is: | [
"The onset of menses near age 50",
"An increase in plasma FSH levels",
"An excessive presence of corpora lutea",
"An increased number of cornified cells in the vagina"
] | B | Ans. B. An increase in plasma FSH levelsOne of the first clinical measures for menopause is an increase in the serum concentration of FSH (and LH), indicative of the lack of ovarian function. Menses starts at age 12, not age 50, and its onset at this time would not indicate menopause. Excessive corpora lutea would likely indicate multiple ovulations or a failure of luteal regression. Increased vaginal cornification is an indicator of estrogen secretion, which does not occur in menopause. Menstrual cycles become irregular at menopause. | train | med_mcqa | null |
Which of the following is the finding in lymphoid tissues in individual with common variable hypogammaglobulinemia | [
"Decreased B cell count",
"Increased B cells count",
"Normal B cell count",
"Absent B cells"
] | C | Ref Robbins 8/e p233,9/e p241 Making a definitive diagnosis of primary hypogammaglobulinemia There is no single diagnostic test; CVID is a diagnosis of exclusion. Laboratory testing shows hypogammaglobulinemia (low IgG plus either low IgA or IgM, or both) and low specific antimicrobial antibody responses despite immunization. | train | med_mcqa | null |
Secondary vesical calculus refers to stones formed due to | [
"Hypercalciuria",
"Injury",
"Infection",
"Migrating from kidney"
] | C | Secondary vesical calculus - occurs in the presence of infection. E.coli is the common organism. Usually phosphate stone. Occurs in bladder only. Primary vesical calculus - occurs in sterile urine. Usually oxalate stone(Jack stone). Usually comes down from kidney through ureter into the bladder and enlarges here. Most vesical calculi are formed de novo within the bladder, but some initially may have formed within the kidneys as a dissociated Randall plaque or on a sloughed papilla and subsequently may have passed into the bladder, where additional deposition of crystals cause the stone to grow. * Most renal stones that are small enough to pass through the ureters are also small enough to pass through a normally functioning bladder and an unobstructed urethra. * In older men with bladder stones composed of uric acid, the stone most likely formed in the bladder.* Stones composed of calcium oxalate are usually initially formed in the kidney.* In adults, MC type of vesical stone (seen in >50% of cases) is composed of uric acid. * Less frequently, bladder calculi are composed of calcium oxalate, calcium phosphate, ammonium urate, cystine, or magnesium ammonium phosphate (when associated with infection). Endemic Bladder Calculi * In children, stones are composed mainly of ammonium acid urate, calcium oxalate, or an impure mixture of ammonium acid urate and calcium oxalate with calcium phosphate.* The common link among endemic areas relates to feeding infants human breast milk and polished rice.* These foods are low in phosphorus, ultimately leading to high ammonia excretion.* These children also usually have a high intake of oxalate-rich vegetables (increased oxalate crystalluria) and animal protein (low dietary citrate). * Vesical calculi may be single or multiple, especially in the presence of bladder diveicula, and can be small or large enough to occupy the entire bladder. They range from soft to extremely hard, with surfaces ranging from smooth and faceted to jagged and spiculated ("jack" stones). * Most bladder stones are secondary, more common in older males (>50 years), usually because of bladder outlet obstruction.* MC type: Uric acid (sterile urine) > Struvite stones (Infected urine)* Bladder stones are usually solitary, multiple in 25% patients.Etiology* Bladder outlet obstruction (MC cause)* Neurogenic bladder* Foreign body (Foley's catheter, forgotten DJ stents)* Bladder diveiculaClinical Features* Typical symptoms are intermittent, painful voiding and terminal hematuria with severe pain at the end of micturition.* Pain may be referred to the tip of the penis or to the labia majora.Diagnosis* A large percentage of bladder stones are radiolucent (uric acid).* USG bladder: Identifies the stone with its characteristic shadowing and stone moves with changing body position.Treatment* Small stones: Removed or crushed transurethrally (Cystolitholapexy)* Larger stones: Disintegrated by transurethral electrohydraulic lithotripsy or Cystolithotomy Stones of Genitourinary Tract * MC renal stone: Calcium oxalate* MC primary bladder stone: Ammonium urate* MC bladder stone: Uric acid >Struvite* MC prostate stone: Calcium phosphate Ref : Bailey and Love 25/e p1323 | train | med_mcqa | null |
False about bacterial vaginosis : | [
"Itching",
"Grey discharge",
"Clue cells found",
"Fishy odour discharge"
] | B | White milky,non viscous discharge adherant to vaginal wall ph >4.5 fish odour when mixed with 10%KOH clue cells present minimal vulval irritation seen SHAW'S TEXTBOOK OF GYNAECOLOGY,Pg no:131,15th edition | train | med_mcqa | null |
An 8-month-old infant had stridor with respiratory difficulty which worsened on crying. On examination, laryngoscopy showed a red mass in the subglottic area. All the following are used in the treatment EXCEPT | [
"CO 2 laser vaporization",
"Coicosteroids",
"Tracheostomy",
"Radiotherapy"
] | D | History and examination suggest diagnosis is juvenile papilloma - They are viral in origin and multiple, often involving infants and young children. * They are mostly seen on the true and false cords and the epiglottis, glistening white, irregular growth, pedunculated * Or sessile, friable and bleeding easily | train | med_mcqa | null |
The axillary sheath is an extension of this fascia around the subclan aery and brachial plexus. Fascia around nerve bundle of brachial plexus is derived from? | [
"Preveebral fascia",
"Pretracheal fascia",
"Investing layer",
"Superficial cervical fascia"
] | A | The brachial plexus and the subclan aery course between the anterior and middle scalene muscles, and as the nerve plexus and aery emerge from those muscles, they carry an extension of the preveebral fascia along to form the axillary sheath. | train | med_mcqa | null |
Alpha 1 antitrypsin deficiency is associated with- | [
"Panacinar-emphysema",
"Centriacinar-emphysema",
"Paraseptal-emphysema",
"Irregular-emphysema"
] | A | Ans. is 'a' i.e., Panacinar-emphysema Pathogenesis of Emphysemao The most accepted theory in the pathogenesis of emphysema is protease - antiprotease mechanism which is responsible in the pathogenesis of two common forms of emphysema, i.e. centriacinar and panacinar.o The alveolar wall destruction results from an imbalance between proteases (mainly elastase) and antiproteases in the lung.o Proteases (elastase) cause destruction of alveolar wall, while antiproteases prevent this damage,o a1 antitrypsin is the major antiprotease (antieiastase) secreted by neutrophils during inflammation.A. Pathogenesis of panacinar emphysemao Panacinar emphysema is associated with congenital deficiency of a1.-antitrypsin.o This results in unchecked overactivity of neutrophil elastase that causes destruction of alveolar wall,o As a,-antitrypsin is deficient throughout the acinus, the acini are uniformly involved from the respiratoiy bronchiole to the terminal blind alveoli.o Neutrophils are the major cells in the pathogenesis of panacinar emphysemaB. Pathogenesis of centriacinar emphysemao Centriacinar emphysema is associated with smoking.o Nicotine acts as a direct chemoattractant for neutrophils and macrophages,o So, in centriacinar emphysema, both neutrophils and macrophages play central role,o Smoking enhances activity of neutrophil and macrophage elastase.o Macrophage elastase is not inhibited by a1-antitrypsin and indeed can proteolvticallv digest this antiprotease,o Beside protease - antiprotease mechanism, oxidant - antioxidant imbalance also plays an important role in the pathogenesis of smoking related emphysema.o Normally, the lung contains a healthy complement of antioxidants (superoxide dismutase, glutathione),o Tobacco smoke contains abundant reactive oxygen species (free radicals) which deplete these antioxidant mechanisms.o Free radicals cause tissue damage as well as they inactivate a(-antitrypsin, resulting in functional a,- antitrypsin deficiency even in patients without enzyme deficiency. | train | med_mcqa | null |
Simple random sampling- | [
"Provides least number of possible samples",
"Haphazard collection of ceain number for a sample",
"Picking every 5th or 10th at regular intervals",
"Sample represent, a corresponding strata of universe"
] | B | . | train | med_mcqa | null |
Base metal alloys are useful for | [
"Cast partial dentures",
"Crowns",
"Orthodontic wires",
"all of the above"
] | D | null | train | med_mcqa | null |
DMPA causes all the following Except | [
"Weight gain",
"Irregular cycles",
"Amenorrhoea",
"Thromboembolism"
] | D | Depomedroxyprogesterone AcetateDMPA, a suspension of microcrystals of a synthetic progestin. The regimen of 150 mg every 3 months is highly effective, producing pregnancy rates ofabout 0.3 per 100 women per year.The most impoant medical reason women discontinue use of DMPA and other progestin-only methods is persistent irregular vaginal bleeding. Eventually, total amenorrhea develops in most women who take DMPA; with continued administration, amenorrhea develops in 50% of women by 1 year and in 80% by 3 years.Ref: Berek and Novak&;s Gynecology; 15th edition; Chapter 10 | train | med_mcqa | null |
The classical flexion and rotation deformities at hip and knee joints, as a sequela of poliomyelitis, are due to the contracture of. | [
"Tensor fascia lata",
"Gastrocnemius",
"Tendo Achilles",
"Hamstrings"
] | A | Ans. is 'a' i.e., Tension fascia lata The flexion and rotation deformities at the hip and knee joint in poliomyelitis are due to iliotibial band contracture.As the iliotibial band is a direct extension of tensor facial lata muscle its pull on the hip and knee joint are actually due to contracture of the tensor facialata muscle.The common deformities seen in polio are-At hip - Flexion abduction and external rotationAt knee - Flexion, genu valgum and triple deformity At foot - Talipes equinovarusAlso, rememberThe test required for iliotibial band contracture - Ober's test * | train | med_mcqa | null |
Saturated fatty acids containing up to 16 carbon atoms are assembled in | [
"Mitochondria",
"Rough endoplasmic reticulum",
"Smooth endoplasmic reticulum",
"Cytoplasm"
] | D | Cytoplasm
The end product of cytosolic fatty acid synthesis cycles is saturated 16-carbon palmitic acid.
Elongation of pre-existing fatty acid :-
(i) Microsomnal (endoplasmic reticulum) :- Elongation of palmitic acid (16-C) into longer chain fatty acids
(ii) Mitochondrial :- Elongation of short and medium chain fatty acids containing fewer than 16 carbon atoms | train | med_mcqa | null |
Sq. cell tumor of urinary bladder is due to ? | [
"Stone",
"Schistosomiasis",
"Chr. cystitis",
"All"
] | D | Answer is 'a' i.e. Stone 'b' i.e. Schistosomiasis & 'c' i.e. Chronic cystitis | train | med_mcqa | null |
All of the following are true for Turners syndrome except: March 2012 | [
"Height is more than 145 cm",
"Webbing of neck",
"Increased carrying angle",
"Coarctation of aoa may be seen"
] | A | Ans: A i.e. Height is more than 145 Turner syndrome Adult stature in Turner syndrome patients is less than 145 cm Associated congenital defects are common in hea (coarctation of aoa) Lymphedema, Sho stature, Webbed neck, Low posterior hairline, Cubitus valgus (increased carrying angle), Finger deformities, Sho 4th metacarpal, 45 X0 karyotype Down syndrome MC trisomy, Brachycephalic skull, Hypotonia, Palpebral fissure slopes upwards, Marked epicanthic folds, Brushfield's spots, Increased nuchal fold thickness, Iliac index less than 60, Simian crease (single palmar crease), MC associated cardiac lesions: VSD Duodenal atresia, CML & transient myeloproliferative disorders are seen May be associated with Alzheimer's dementia, MC cause of down syndrome: Maternal non-disjunction Klinefelter syndrome 47 XXY MC cause of hypergonadotrophic hypogonadism, Subnormal intelligence Fragile X syndrome Large forehead, Large head, Macro-orchidism, Moderately to severely retarded | train | med_mcqa | null |
The operation of choice for the below condition | [
"Division of annular ring",
"Gastrojejunostomy",
"Duodenojejunostomy",
"Pancreaticoduodenal tom"
] | C | The treatment of annular pancreas is duodenojejunostomy or gastrojejunostomy either of which bypasses the obstruction.
According to Bailey and Love duodenoduodenostomy or duodenojejunostomy are usual operation. Obstructing pancreatic ring must not be simply divided. Since this may not relieve the obstruction and pancreatic fistula may result.
Annular pancreas is formed by a thin band of normal pancreas tissue that completely encircles the second portion of duodenum and is continuous with head of pancreas anteriorly and posteriorly. 40% patients have associated duodenal stenosis or atresia.
Symptoms of duodenal obstruction (gastric distention and vomiting) occur in about one third of cases in the first week of life and about one half of cases in the first year. Rests are asymptomatic until adulthood, when abdominal pain, nausea and vomiting may occur. | train | med_mcqa | null |
Which of following does not lie on the mandible: | [
"Pogonion",
"Porion",
"Menton",
"Gnathion"
] | B | null | train | med_mcqa | null |
Stocking and glove neuropathy is seen in : | [
"Vinblastine",
"Paclitaxel",
"Etoposide",
"Mitoxantrone"
] | B | null | train | med_mcqa | null |
What is the concentration of oxygen supplied by oxygen concentrator:- | [
"90% and 96%",
"100%",
"30 and 60%",
"60% and 90%"
] | A | oxygen concentrator They are also known as pressure swing adsorbers. They can be considered as an alternative to a traditional supply where no reliable liquid oxygen supply is available, such as an off-shore site or a site where the safety criteria for liquid installations cannot be met. These devices can be small, designed to supply oxygen to a single patient or they can be large enough to supply oxygen for a medical gas pipeline system. The components of this system are: Duplex compressors and molecular sieves, receivers, dryers, vacuum pumps, filters, line pressure regulators, control system, oxygen performance monitoring system and back up cylinder manifold. Oxygen concentrators operate on the principle of adsorbing (under pressure) other gases in the atmosphere onto the surface of an adsorbent material, known as zeolite. Because oxygen is not adsorbed by the zeolite, it is free to pass through into the storage for use. Zeolite is hydrated aluminium silicates of the alkaline eah metals in a powder or granular form. The zeolite is sealed in a vessel known as sieve bed. The sieve beds operate in pairs, one adsorbs whilst the other regenerates. Ambient air is filtered and pressurised to about 137 kPa by a compressor and then exposed to a zeolite molecular sieve column, forming a very large surface area, at a ceain pressure. The sieve selectively retains nitrogen and other unwanted components of air. These are released into the atmosphere after heating the column and applying a vacuum. The changeover between the columns is made by a time switch. The process is capable of producing oxygen concentrations of about 95%. The remainder is made up of mainly argon with a small percentage of nitrogen. During closed circuit anaesthesia, argon accumulation could occur. Therefore, to avoid this, higher fresh gas flows are required. As the process generates a great deal of heat, hence ventilation and cooling are mandatory. If the plant fails, the emergency cylinder manifold will feed into the pipeline at higher concentrations (99.5%) than the plant's operating norm of 95%. This may have an effect on down line equipment, paicularly in the critical care areas. This low-flow (2-4 L/min), low-pressure system can provide continuous oxygen to the chronic obstructive pulmonary disease patients. A typical unit operates on mains supply and can provide up to 5 L/min of oxygen at a concentration of 94%. It can be piped around the home in small wall mounted outlets . | train | med_mcqa | null |
True about hyperkalemia - | [
"Stop hea in systole",
"Insulin-Glucose is given",
"ECG is diagnostic",
"Serum potassium more than 5.2 mmol\\/L"
] | C | Classically, the electrocardiographic manifestations in hyperkalemia progress from tall peaked T waves (5.5-6.5 mM), to a loss of P waves (6.5-7.5 mM) to a widened QRS complex (7.0-8.0 mM), and, ultimately, a to a sine wave pattern (>8.0 mM). However, these changes are notoriously insensitive, paicularly in patients with chronic kidney disease or end-stage renal disease. ( ref: harrisons principles of internal medicine, 19E page 310) | train | med_mcqa | null |
The deep cerebellar nuclei have their effect on other brain centers by | [
"Comparison of inhibitory effects by Purkinje cells and excitatory effects of afferent collateral axons",
"Summation of mossy fibers and climbing fibers synapsing on deep cerebellar nuclei",
"Temporal synaptic effects of granular and parallel fiber input",
"Excitatory Purkinje influences and inhibitory granul... | A | All input to the coex of the cerebellum collateralizes and sends axon branches to both the coex and the deep cerebellar nuclei. The activity of the deep cerebellar nuclei depends on the integrated response of the direct excitatory input from the collaterals and the inhibitory influence of the Purkinje cells of the cerebellar coex. | train | med_mcqa | null |
Drug most useful in the treatment of obsessive compulsive disorder is: | [
"Amoxapine",
"Fluoxetine",
"Doxepin",
"Dothiepin"
] | B | Fluoxetine | train | med_mcqa | null |
Which component of sulfasalazine is responsible for the therapeutic effect in rheumatoid ahritis | [
"Intact sulfasalazine molecule",
"Sulfapyridine",
"5-aminosalicylic acid",
"Both 'B' and 'C'"
] | B | Sulfasalazine:- It is a compound of sulfapyridine and 5-amino salicylic acid (5-ASA); exes antiinflammatory activity and is useful in ulcerative colitis, RA patients. mechanism of action:- Sulfapyridine split off in the colon by bacterial action and absorbed systemically appears to be the active moiety (contrast ulcerative colitis, in which 5-ASA acting locally in the colon is the active component). Generation of superoxide radicals and cytokine elaboration by inflammatory cells may be suppressed. Ref:- kd tripathi; pg num:-211 | train | med_mcqa | null |
Root value of radial nerve is: | [
"C3,4,5,6,7",
"C4,5,6,7,8",
"C5,6,7,8; T1",
"C6,7,8; T1,2"
] | C | Radial nerve is the continuation of posterior cord. Root value of posterior cord is C5,6,7,8 ,T1 (has 5 root values) Posterior cord is formed by posterior divisions of upper, middle and lower trunks. It supplies posterior compament of upper limb. | train | med_mcqa | null |
b blocker/s which should be avoided in glaucoma is/are? | [
"Pindolol",
"Carvedilol",
"Labetelol",
"All the above"
] | D | Ans. is 'd' i.e., All the above * Beta blockers are used in the management of glaucoma. But certain ($- blockers with membrane stabilizing (Local anaesthetic) action should be avoided in glaucoma as these drugs possess Na+ channel blocking (local anaesthetic) activity.* Membrane stabilizing (Na+ channel blocking) activity contributes to antiarrhythmic action and should be avoided in glaucoma due to risk of corneal anaesthesia.* Such Drugs are:# Pindolol# Acebutolol# Carvedilol# Betaxolol# Propranolol# Metoprolol# Labetalol *Note: Propranolol and carvedilol have maximum membrane stabilizing (local anaesthetic) action. | train | med_mcqa | null |
False about glycolysis? | [
"Net ATP from anaerobic glycolysis is 3 ATP",
"occurs in cytosol of all the cells",
"Net ATP from aerobic glycolysis is 7ATP",
"none of the above"
] | A | Glycolysis takes place in cytosol of all the cells Glucose is conveed to two 3-carbon units,pyruvate Net ATP from Aerobic glycolysis is 7 ATP Net ATP from anerobic glycolysis is 2 ATP 2 ATP molecules are utilised in glycolysis | train | med_mcqa | null |
Elemental iron supplementation in Iron deficiency anemia is – | [
"300 – 400 mg",
"150 – 200 mg",
"100 – 150 mg",
"< 100 mg"
] | C | null | train | med_mcqa | null |
Accumulation! of following causes fatty liver - | [
"Cholesterol",
"Triglycerides",
"Phospholipids",
"Cholesterol esters"
] | B | Ans. is 'b' i.e., Triglycerides Fattv livero Fatty liver is the excessive accumulation of fat primarily neutral fat, i.e. triglyceride (triacylglycerol) (PGI93) in the liver. Fat (triglycerides) is stored in adipose tissue. Liver is not a storage organ. It contains about 5% fat. In pathological conditions, this may go up to 25-30% and is known as fatty liver or fatty infiltration of liver. Fatty liver may be due to two main reasons -Increased production (over production) of triacylglycerolso It may be due toi) High free fatty acid influx from adipose tissue, e.g. Starvation, diabetes mellitesii) High fat diet:- due to increased supply of fatty acid from diet, capacity of liver for lipoprotein formation is outweighed.iii) Alcoholism:- Due to increased hepatic TGs synthesis.Impairment in exportation of triacylglycerol in YrLDLo Liver incorporates TGs in VLDLs which are then exported to blood. IfVLDL synthesis is impaired, exportation of TGs is impaired and they accumulate in liver causing fatty liver. Causes are:-Inhibition of protein (apoprotein synthesis)Block in the synthesis ofphospholipids that are found in VLDL A failure in the formation mechanism of lipoprotein itselffrom lipid and apoprotein. | train | med_mcqa | null |
A 25-year-old woman develops painful swelling of both hands and wrists. She is also very stiff in the morning. Physical examination reveals erythema, swelling and joint line tenderness of the proximal interphalangeal, MCP, and wrists joints. Her RF is positive, ANA is negative, and x-rays of the hands show early erosive joint changes. Which of the following medications is most likely to prevent progression of disease? | [
"D-penicillamine",
"antimalarial",
"methotrexate",
"NSAID or aspirin"
] | C | Methotrexate, 7.5-20 mg once weekly, is the most commonly recommended disease modifying drug, because its effect is more rapid and patients are able to tolerate it for longer periods of time. Maximum improvement with methotrexate occurs after 6 months of therapy. Toxicity includes GI upset, oral ulceration, and liver function abnormalities. GI upset in particular may be ameliorated by concurrent folic acid administration. Pneumonitis has also been reported. | train | med_mcqa | null |
Enzyme imiglucerase (Cerezyme) is used in the treatment of- | [
"Gaucher's disease",
"Galactosemia",
"Niemann Pick disease",
"Trans-maxillary approach"
] | A | Ans. is 'a' i.e., Gaucher's disease o Imiglucerase (Cerezyme) is used in the treatment of Gaucher's disease. | train | med_mcqa | null |
MELD score doesn't include: | [
"INR",
"S. bilirubin",
"S. creatinine",
"Blood urea"
] | D | MELD - Model for End Stage liver disease Components of MELD Score (mnemonic - CBI) C - CREATININE B - BILIRUBIN I - INR (International Normalised Ratio) | train | med_mcqa | null |
In Radionuclide imaging the most useful radiopharmaceutical for skeletal imaging is: | [
"Gallium 67",
"Technetium sulphur colloid",
"Technetium-99m",
"Technetium--99m linked to Methylene disphosphonate"
] | D | Technetium--99m linked to Methylene diphosphonate Normal Bone Scan Tracer uptake greatest in axial skeleton Background activity of soft tissue Kidneys routinely visualized Skull can appear uneven (variations in calvarial thickness) Sites of persistently increased symmetric uptake are- Acromial and Coracoid processes of the scapulae, Medial ends of the clavicles, Junction of the body Manubrium of the sternum The sacral alae | train | med_mcqa | null |
Setting time is the elapsed time from the start of mixing to the point at which the needle no longer makes a discernible circular indentation in the cement. The standard parameters of defining setting time are all except: | [
"Setting time should be measured with a 1-mm diameter needle indenter",
"Setting time should be measured at a load of 400 g",
"Setting time should be measured at a temperature of 37°C",
"Setting time should be measured at a relative humidity of less than 90%"
] | D | Setting time—The elapsed time from the start of mixing to the time at which the setting reaction essentially stops as measured by reaching a desired hardness or consistency; setting time can be measured with a 1-mm diameter needle indenter at a load of 400 g at a temperature of 37°C and a relative humidity greater than 90%.
Setting time is the elapsed time from the start of mixing to the point at which the needle no longer makes a discernible circular indentation in the cement.
Ref: Phillip’s Science of Dental Materials ed 12 pg 308 | train | med_mcqa | null |
Investigation of choice for diagnosis of congenital hyperophic pylori stenosis: | [
"USG",
"Barium meal",
"Barium meal follow through",
"CT scan with contrast"
] | A | Ans. USG | train | med_mcqa | null |
All muscles of tongue are supplied by hypoglossal nerve except ? | [
"Palatoglossus",
"Genioglossus",
"Hyoglossus",
"Both 2 and 3"
] | A | Palatoglossus muscle is supplied by: superior laryngeal nerve vagal accessory complex | train | med_mcqa | null |
A primi comes in second state of labour with ROP presentation. The management is : | [
"Immediate cesarean section",
"Forceps application",
"Watchful expectancy",
"Internal podalic version"
] | C | Watchful expectancy | train | med_mcqa | null |
A child can make a 3 cube tower at the age of | [
"36 months",
"15 months",
"20 months",
"24 months"
] | B | At 15 monthsMotor: Walks alone; crawls upstairs.Adaptive: Makes the tower of 3 cubes; makes a line with crayon; inses raisin in the bottle.Language; Jargon; follows simple commands; may name a familiar object (e.g. ball).Social: Indicates some desires or needs by pointing; hugs parents. | train | med_mcqa | null |
History of dislike for sweet food items is typically present in - | [
"Diabetes mellitus",
"Glycogen storage disease",
"Hereditary fructose intolerance",
"None"
] | C | null | train | med_mcqa | null |
Vital staining was introduced by: | [
"Enlow",
"Wolff",
"John Hunter",
"Petrovic"
] | C | Vital staining is an experimental method of measuring growth. It was introduced by John Hunter in the eighteenth century. The method consists of injecting dyes that stain the mineralizing tissues. These dyes get deposited in the bones and teeth and the animals are sacrificed and tissues studied histologically. Hunter studied the growth of mandible in the pig. | train | med_mcqa | null |
A patient presents with intense chest pain of 2 hrs duration ECG shows ST depression in leads I and V1 to V4. There is associated T inversion and CPK-MB is elevated. Which of the following should be included in his management | [
"Nitroglycerine drip",
"Aspirin",
"i.v. metoprolol",
"All of the above"
] | D | null | train | med_mcqa | null |
Thunderclap headache is a feature of | [
"TIA",
"Completed stroke",
"ICH",
"SAH"
] | D | Ans. (d) SAHRef: Sabiston 20th Page 1904* Subarachnoid hemorrhage usually results in a sudden severe thunderclap headache. A patients describes the worst headache of my life. | train | med_mcqa | null |
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