question stringlengths 1 6.54k | choices listlengths 4 4 | answer stringclasses 4
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Test for ovarian reserve | [
"LH",
"LH/FSH ratio",
"FSH",
"Estradiol"
] | C | FSH Ovarian reserve is the capability of ovary to produce egg. The ovary is generally thought of as an egg bank from which the woman draws during the reproductive life. During the .flrst few days of each monthly cycle, under the influence of FSH and LH there is rapid growth of several follicles in the ovary. After a week or more of growth one of the follicles begin to outgrow. All the others and the remaining follicles involute (a process called atresia), and these follicles are said to become atretic. The process of atresia is impoant because it normally allows only one of the follicles to grow large enough, each month, to ovulate. This usually prevents more than one child from developing with each pregnancy. The single follicle reaches a diameter of 1-1.5 centimeters at the time of ovulation and is called the mature follicle. With advancing age the capability of the ovary to produce eggs declines. Methods of assessing ovarian reserve: With advancing age the capability of the ovary to produce egg declines i.e. ovarian reserve decrease with age. - Usually age is the best predictor of ovarian reserve but approximately 10% of women have an accelarated loss of ovarian reserve by their mid-30's. - So age alone does not tell the whole story. Consequently more refined methods .for predicting ovarian reserve have been developed. The methods for assessing ovarian reserve are classified into two groups:- a)Passive testing b)Dynamic testing The goal of both the approaches is to provide information regarding oocyte (egg) quality and quantity. Passive testing FSH level Early follicular phase FSH levels play an impoant role in pregnancy outcomes. As woman ages FSH becomes elevated in an attempt to force the aging ovary to respond. However, the exact mechanism responsible for this adaptive response remains unknown. A rise in early follicular phase FSH is also accompained by a decline in oocyte quality. High FSH has been correlated with poor ovarian reserve but it is difficult to establish absolute values that define how high an FSH level can be and still achieve pregnancy. Generally FSH level are expected to be below 10 lu/mlin women withreproductive potential - In one study it was .found out that 3 day FSH of less than 15 mlu/ml were twice as likely to conceive than women with FSH values between 15 and 24.9 mlu/ml. - Cycle day 3 is chosen because at this time the estrogen level is expected to be low, a critical feature as FSH levels are subject to a negative feedback. - Thus any determination of FSH needs to include corresponding estradiol level to indicate that the FSH level was drawn when estrogen level was low. Other methods for passive ovarian reserve testing Measurement of Inhibin B Inhibit B is an ovarian hormone that inhibits FSH release. Although present in ovulating women it is not normally .found in postmenopausal women. - Low inhibin levels suggests poor ovarian reserve. Transvaginal ultrasound Diminished ovarian reserve means that fewer follicles are available for stimulation and recruitment by _feility drugs. Transvaginal ultrasound allows the observation of ovaries and assess the number of follicles (ovarian volume). Dynamic ovarian reserve testing Clomiphene citrate challenge test ? Clomiphene is an antiestrogen which inhibits the negative feedback of estrogen on hypothalamus i.e. the hypothalamus gets false signals that the patient does nor have enough estrogen. In response, the hypothalamus induces the pituitary gland to produce more FSH and LH. This is turn initiates follicular growth to produce estrogen. Clomiphene is able to exe this effect only when the estrogen level is low or the ovarian reserve is low. In a normal woman with adequate ovarian reserve there is enough inhibin and estrogen to suppress FSH production through negative feedback and resist the effects clomiphene. - When undergoing clomiphene citrate challenge test, the .first step is to measure day 3 FSH and estrogen. Then 100 ing of clomiphene is administered on cycles day 5 through 9 and FSH and estrogen measurements are repeated on cycle day 10. In general, a high day 10 FSH suggests poor ovarian reserve. | train | med_mcqa | null |
A patient sustained a hyperextension injury to his knee. Which of the following ligament prevents excess - anterior gliding movement of femur on tibia? | [
"Anterior cruciate ligament",
"Posterior cruciate ligament",
"Medial collateral ligament",
"Lateral collateral ligament"
] | B | *ACL- prevents anterior gliding of tibia on femur *PCL- prevents posterior gliding of tibia on femur Ref: spos medicine 4th/e p.83 | train | med_mcqa | null |
Malaria protection comes from all Except | [
"G6PD deficiency",
"Thalassemia",
"Sickle cell anemia",
"Acanthocytosis"
] | D | The geographic distributions of sickle cell disease, hemoglobins C and E, hereditary ovalocytosis, the thalassemias, and glucose-6-phosphate dehydrogenase (G6PD) deficiency closely resemble that of falciparum malaria before the introduction of control measures.This similarity suggests that these genetic disorders confer protection against death from falciparum malaria. For example, HbA/S heterozygotes(sickle cell trait) have a sixfold reduction in the risk of dying from severe falciparum malaria. Hemoglobin S-containing RBCs impair parasite growth at low oxygen tensions, and P. falciparum-infected RBCs containing hemoglobins S and C exhibit reduced cytoadherence because of reduced surface presentation of the adhesin PfEMP1. Parasite multiplication in HbA/E heterozygotes is reduced at high. Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 248 Malaria; Page no: 1371 | train | med_mcqa | null |
Extraparenchymal causes of respiratory failure include (s) | [
"Cervical spine trauma",
"Pneumothorax",
"Bronchial obstruction",
"All"
] | D | Causes of Type 1 respiratory failure are : Acute asthma, pulmonary oedema, pneumonia, pneumothorax, ARDS, COPD, lung fibrosis, right to left shunts etc treatment: treat cause and high flow oxygen Causes of type 2 respiratory failure are : Acute severe asthma, Acute exacerbation of COPD, upper airway obstruction, Narcotic drugs, sleep apnoea, kyphoscoliosis, ankylosing spondylitis. Treatment: treat cause and low flow oxygen. Reference : Davidson, 23rd Edition, page no : 565. | train | med_mcqa | null |
All of the given drugs may be useful in acute exacerbation of bronchial asthma EXCEPT | [
"Cromolyn sodium",
"Hydrocortisone",
"Salbutamol",
"Ipratropium"
] | D | null | train | med_mcqa | null |
Pure gonadal dysgenesis will be diagnosed in the presence of : | [
"Bilateral streak gonads",
"Bilateral dysgenetic gonads",
"One side steak and other dysgenetic gonads",
"One side streak and other normal looking gonad"
] | A | Ans. is a i.e. Bilateral streak gonads Gonadal development is under the influence of sex chromosome.deg The testes determining gene is present on the Sex Determining Region of the Y chromosome (SRY)deg. Therefore when Y chromosome is present (even in presence of multiple X chromosomes) it leads to testes formation.deg When Y chromosome is absent and two complete X chromosomes are present, it leads to ovary formation.deg In females with 45X0 genotype : the gonads are replaced by fibrous tissue and are known as streak Gonads or Gonadal dysgensis and the syndrome is known as Turner Syndrome.deg The genes which protect against the physical malformations of Turner Syndrome are carried on sho arms of XX or XYchromosomesdeg and genes which protect against streak gonads are on the long arms of XX or XYdeg. dysgenesisdeg : In this disorder the individual has karyotype of 45X0 / 46XY and so there is a streak Gonad or no Gonad on one side (corresponding to 45X0) and a testis on the other side (corresponding to 46XY). Also know : Streak and dysgenetic Gonads have a high potential for neoplasia (especially dysgerminomadeg or Gonadoblastomadeg and Yolk sac tumordeg) if the owners karyotype contains a Y chromosome. | train | med_mcqa | null |
Most common site of glomus tumor is - | [
"Under fingernails",
"Under toenails",
"Neck",
"Axilla"
] | A | Ans. is 'a' i.e., Under fingernails Glomus tumor (Glomangioma)o Benign tumor arising from the smooth muscle cells of the glomus body which is an arteriovenous anastomosis involved in thermoregulation.o Most commonly present in the distal portion of the digits (under fingernails).o Histologically, there is presence of branching vascular channels and stroma containing nests aggregates of glomus cells arranged around vessels. | train | med_mcqa | null |
All the following agents may be used for the management of hypeensive crisis Except: | [
"Furosemide",
"Nitroglyarine",
"Indapamide",
"Esmolal"
] | C | Answer is C (Indapamide) Indapamide is a mild diuretic that may be used for treatment of mild to moderate hypeension. It is not effective in the treatment of hypeensive urgencies or emergencies. Drugs in the Management of Hypeensive Crisis Common Intravenous Agents (Used for Hypeensive Emergencies) Diuretics Furosemide Vosodilators Sodium Nitroprusside Nitroglycerine Fenoldapam Nicardipine Hydralazine Enolaprilant Adrenergic Inhibitors Phentolamine Esmolol Metaprolol Labetolol Urapidil Common Oral Agents (Used for Hypeensive Urgencies) Nifedipine (Not Recommended now) Nicardipine Israpidine Clonidine Coptopril Labetolol Hydralazine Nitroglycerine | train | med_mcqa | null |
Sensory supply to the region is by which nerve. | [
"Ulnar nerve",
"Radial nerve",
"Median nerve",
"Axillary nerve"
] | B | null | train | med_mcqa | null |
All of the following are used for myoclonic seizures except : | [
"Sodium valproate",
"Zonisamide",
"Carbamazepine",
"Topiramate"
] | C | null | train | med_mcqa | null |
Which of the following drug possess maximum action on nicotinic receptors? | [
"Bethanechol",
"Carbachol",
"Pilocarpine",
"Methacholine"
] | B | Drugs Acts on Action Indication Pilocarpine M3, Pupil Miosis Glaucoma Bethanechol M3, Bladder Increase outflow Atonic bladder Carbachol Nicotinic , muscarinic Methacholine M2 Cardiac suppression Tachycardia, Arrhythmias | train | med_mcqa | null |
All of the following are true about sargramustin except | [
"It is a G - CSF analog",
"It is used in cases of neutropenia",
"Chronic usage can lead to bone pain",
"It can also lead to flu like symptoms"
] | A | It is a GM - CSF analog.
Filagastrim & lenogastrim are G - CSF analogs. | train | med_mcqa | null |
What is the paial pressure for carbon-di-oxide in the inspired air? | [
"0.3 mm Hg",
"158 mm Hg",
"100 mm Hg",
"32 mm Hg"
] | A | Paial pressure of CO2 in inspired air (Pi CO2) - 0.3 mm Hg Carbon-di-oxide: Paial pressure of CO2 in inspired air (Pi CO2) 0.3 mm Hg Paial pressure of CO2 in alveolar blood (PA CO2) 40 mm Hg Paial pressure of CO2 in expired air (PE CO2) 32 mm Hg. | train | med_mcqa | null |
All are indications for penile angiography except: | [
"Painful priapism",
"Peyronie's disease",
"Erectile dysfunction",
"Arterio-venous malformation"
] | A | Priapism is of two types. A low-flow (ischemic), painful priapism and the other high-flow (non-ischemic), painless priapism.
Penile angiography is not indicated in the painful, low-flow priapism. It is indicated for the high-flow, non-ischemic priapism which is painless.
Priapism
Priapism is defined as prolonged erection in the absence of a sexual stimulus.
It can be classified into 2 types:
A. Low-flow (ischaemic) priapism.
features little or absent intracorporal blood flow
due to veno-occlusion
it represents a true compartment syndrome involving the penis
manifests as painful, rigid erection
cavernous blood gas values are consistent with hypoxia, hypercapnia, and acidosis
ischaemic priapism beyond 4th hour requires emergency intervention (decompression of the corpora cavernosa is recommended for counteracting the ischemic effects)
B. High-flow (non-ischemic) priapism
due to unregulated arterial blood flow
presents with semi-rigid, painless erection
Penile or perineal trauma is frequently associated
cavernous blood gas values do not reveal hypoxia or acidosis
Penile angiography is indicated in high-flow priapism and not in low-flow, painful priapism.
Campbell Urology 8/e p845 writes-
"Penile arteriography has use as an adjunctive study to identify the presence and site of a cavernous artery fistula in the patient with nonischemic priapism. At this time, arteriography is not routinely used for diagnosis and is otherwise usually performed as part of an embolization procedure."
About other options
Peyronie's disease
It is also k/a penile fibromatosis
It is due to fibrous plaques in one or both corpus cavernosum. They may later calcify or ossify.
It affects middle-aged and older men.
Patients present with complaints of painful erection, curvature of the penis, and poor erection distal to the involved area. The penile deformity may be so severe that it prevents satisfactory vaginal penetration.
Examination of the penile shaft reveals a palpable dense, fibrous plaque of varying size involving the tunica albuginea.
Spontaneous remission occurs in about 50% of cases. Initially, observation and emotional support are advised. If remission does not occur, p-aminobenzoic acid powder or tablets or vitamin E tablets may be tried for several months. However these medications have limited success. Surgery is done in refractory cases-Excision of the plaque with replacement with a dermal or vein graft or tunica vaginalis graft. Penile prosthesis can be inserted after plaque incision.
We are not quite sure about use of penile angiography in Peyronie' s disease.
Campbell's Urology 8/e p826 writes about Peyronie's disease -
"Currently, the use of vascular testing is variable. Some centers perform duplex Doppler testing on all patients with Peyronie's disease; other centers do not perform vascular testing at all, despite that patients are routinely operated on for Peyronie's disease and, in some cases, receive prostheses as the primary treatment option. At our center, vascular testing is done on all patients who are prospective surgical candidates. Initially, these patients are examined with color Doppler ultrasonography. If the peak systolic velocity, end-diastolic velocity, and resistive index are normal, the patients are not further tested. If the end-diastolic velocity and the resistive indices are not normal, our patients are tested with DICC"
What is DICC?
DICC or Dynamic Infusion Cavernosometry and Cavernosography are widely accepted as the reference diagnostic techniques for evaluation of veno-occlusive dysfunction.
Cavernosometry refers to a method of determining cavernosal pressure response to standardized rates and volumes of fluid infusion in order to define the presence and degree of venous leak.
Cavernosography refers to a radiographic demonstration of the corpora cavernosa and their venous effluents after intracavernosal injection of dilute contrast agent.
Cavernosometry and cavernosography as angiographic techniques which along with arteriography constitute the gold standard for diagnosis of vasculogenic impotence.
But Campbell's urology mentions DICC separate from selective penile angiography.
Thus we are not very sure about Peyronie's disease. But we are dead sure, painful priapism is not an indication for penile angiography
Erectile dysfunction
"Penile arteriography is another invasive test mainly used prior to penile surgical revascularization in young men with posttraumatic surgical revascularization in young men with posttraumatic or congenital arteriogenic erectile dysfunction with on vascular risk factors, or in studying cases of high flow priapism."- Handbook of Sexual and Gender Identity Disorders By David L Rowland, Luca Incrocci p55
A-V malformation
Well, penile A-V malformation is quite rare. I could not find any documented evidence for use of penile angiography in A-V malformation, but its use is quite self-evident. | train | med_mcqa | null |
What is the venous hematocrit level at which you will diagnose polycythemia in a newborn? | [
"55%",
"60%",
"65%",
"70%"
] | C | Definition of polycythemia: a. Venous haematocrit of over 65%. b. Venous haematocrit of over 64% at 2 hours age. c. An umbilical venous or aerial haematocrit over 63% or more. The mean venous haematocrit of term infants is 53 in cord blood, 60 at 2 hours of age, 57 at 6 hours of age and 52 at 12-18 hours of age. As the haematocrit increases, there is increased viscosity and decreased blood flow. When haematocrit increases to more than 60% there is a fall in O2 transpo. Definition of hyperviscosity: Viscosity greater than 14.6 centipose at a shear rate of 11.55 as measured by a viscometer. (normal is 1.4-1.8 centipoise). | train | med_mcqa | null |
Which drug inhibits absorption of cholesterol from intestine? | [
"Resins",
"Ezetimibe",
"Niacin",
"Orlistat"
] | B | ANSWER: (B) EzetimibeREF: Harrison's 18th ed ch: 356Cholesterol ivithin the lumen of the small intestine is derived from the diet (about one-third) and the bile (about two-thirds) and is actively absorbed by the enter ocyte through a process that involves the protein N PCI LI.Ezetimibe is a cholesterol absorption inhibitor that binds directly to and inhibits NPCILI and blocks the intestinal absorption of cholesterol. Ezetimibe (10 mg) inhibits cholesterol absorption by almost 60%, resulting in a reduction in delivery of dietary sterols in the liver and an increase in hepatic LDL receptor expression.The mean reduction in plasma LDL-C on Ezetimibe (10 mg) is 18%, and the effect is additive when used in combination with a statin. Effects on triglyceride and HDL-C levels are negligible, and no cardiovascular outcome data have been reported.When used in combination with a statin, monitoring of liver transaminases is recommended. The only role for Ezetimibe in monotherapy is in patients who do not tolerate statins; the drug is often added to a statin in patients who require further LDL-C reduction. | train | med_mcqa | null |
Which of the following is role of progestogens? | [
"Inhibits ovulation",
"Protects against endometrial cancer",
"Causes prompt withdrawal bleeding",
"All"
] | D | Ans. d. All. (Ref. William's Obstetrics - 21st ed., - 1531; KD Tripathi 5th1- 282, 283)PROGESTINS# Progestin is weak inhibitor of GH secretion from pituitary, decrease frequency of LH pulses & prevents ovulation.# Progestin is palliative in about 50% cases of advanced Ca endometrium.# It is used as prophylaxis for prevention of Ca endometrium.# Irregular bleeding/amenorrhea can occur, if progestin is given continuously.# Progesterone only pills are ideal contraceptive in sickle cell disease. | train | med_mcqa | null |
Epithelium of "Trigone of bladder" is derived from | [
"Vesicourethral Canal",
"Mesoderm",
"Splanchnopleuric Mesoderm",
"Urachus"
] | B | The urinary bladder is derived from the cranial pa of the vesicourethral canal (endoderm).The epithelium of the trigone is derived from absorbed mesonephric ducts (mesoderm)Reference: Inderbir Singh Embryology; 10th edition; Page no: 292 | train | med_mcqa | null |
Fracture neck of femur in children is treated by | [
"Spica in internal rotation and adduction",
"Spica in abduction and internal rotation",
"Spica in abduction and external rotation",
"Spica in Hexion and adduction"
] | B | null | train | med_mcqa | null |
The below sign is seen in: | [
"Granuloma Inguinale",
"Lymphogranuloma venerum",
"Herpes",
"Syphilis"
] | B | The figure shows "Groove sign" which is seen in Lymphogranuloma venerum. Enlarged buboes that are seen above and below inguinal ligament that appears like a groove. | train | med_mcqa | null |
Amongst various treatment modalities for nocturnal enuresis, the relapse rates have been observed to be lowest for: | [
"Desmopressin",
"Imipramine",
"Bell alarm systems",
"Oxybutinin"
] | C | Bell alarm system have lower relapse rates than other pharmacologic therapy like desmopressin, imipramine. 'Direct comparisons of bell and bed compared to pharmacologic therapy or the former because of lower relapse rates'. Ref: Nelson 18th Edition, Page 2250; A sho textbook of psychiatry- Niraj Ahuja 5th Edition, Page 176, 177 | train | med_mcqa | null |
A couple, with a fimily history of beta thalassemia major in a distant relative, has come for counseling. The husband has HbA2 of 4.8% and the wife has HbA2 of 2.3%. The risk of having a child with betathalassemia major is - | [
"50%",
"25%",
"5%",
"0%"
] | D | Ans. is 'd' i.e., 0% | train | med_mcqa | null |
"Metastatic" calcification is most often seen in: | [
"Lymph nodes",
"Lungs",
"Spleen",
"Liver"
] | B | Lungs | train | med_mcqa | null |
Which Branched-chain amino acid is purely ketogenic- | [
"Lysine",
"Leucine",
"Isoleucine",
"Valine"
] | B | Ans. is 'b' i.e., Leucine o Branched-chain amino acids are leucine, Isoleucine, and Valine. Leucine is purely ketogenic. Isoleucine is both ketogenic and glucogenic. Valine is glucogenic. | train | med_mcqa | null |
Which of the following induction agent produce cardiac stability- | [
"Ketamine",
"Etomidate",
"Propofol",
"Midazolam"
] | B | Ans. is 'b' i.e., Etomidate Effects of Etomidate on cardiovascular systemEtomidate has minimal effects on the cardiovascular system.It causes mild reduction in peripheral vascular resistance which may cause a slight decline in arterial blood pressure.Myocardial contractility and cardiac output are usually unchanged. Etomidate does not release histamine. Cardiovascular effect of Propofol:The major cardiovascular effect of propofol is a decrease in arterial blood pressure due to a drop in systemic vascular resistance (inhibition of sympathetic vasoconstrictor activity, cardiac contractility and preload).Propofol markedly impairs the normal arterial baroreflex response to hypotension. Sometimes there may be a marked drop in preload.Cardiovascular effect of barbiturates (Thiopental)The cardiovascular effect of barbiturates vary markedly depending on the volume status, bas line autonomic tone and preexisting cardiovascular disease.Normally, intravenously administered barbiturates cause a fall in blood pressure.Cardiac output is maintained due to increase in heart rate and increased myocardial contractility from compensatory baroreceptor reflexes.However, in the absence of adequate baroreceptor response (e.g., hypovolemia, congestive heart failure, b adrenergic blockade) cardiac output and arterial blood pressure may fall dramatically due to uncompensated pooling and unmasked direct myocardial depression.Effect of ketamine on cardiovascular systemKetamine causes central stimulation of sympathetic system which causes increased arterial blood pressure, heart rate and cardiac output. There is also increase in pulmonary artery pressure and myocardial work.Because of these effects, ketamine should be avoided in patients with coronary artery disease, uncontrolled hypertension, congestive heart failure and arterial aneurysms. | train | med_mcqa | null |
Accidental drowning is ruled out if : | [
"The body is tied up inside a gunny bag",
"Hand and feet are tied by a ligature in way that is inconsistent with suicidal drowning",
"Heavy weight are attached in such a way that suicide drowning is excluded",
"All of the above"
] | D | D i.e. All Accidental (>suicidal) is the most common type of drowningQ In suicidal drowning body should be free from marks of any injury indicating an assault or struggle (violence)e. In cases of women the body is usually fully dressed and clothes are tied in such a manner that their private pas are not exposed. Sometimes a determined suicide may tie his legs & hands together or attach weights to his body, take poison, or cut throat before immersion. However, it should be examined whether tie could have been made by person himself. - If the body is found with heavy weights attached to it or hand & legs tied with rope, it must be either homicide or suicide and with children homicide alone. Homicidal drowning is very rare except in infants & children. Mark of severe violence applied to head, strangulation, throttling, or bruises are strongly presumptive of homicide. Post moel injuries by fishes, crabs, frogs etc. lack signs of vital reaction. | train | med_mcqa | null |
Ammonia exposure in eye, treatment is | [
"Anaesthetic + saline eye washes",
"Call expert ophthalmologist",
"Slit microscopy and cleaning",
"Antibiotic drops"
] | D | (D) Antibiotic drops # INJURIES BY CAUSTICS such as lime usually occur from fresh mortar or whitewash entering the eye or from laboratory alkalis.> These may cause considerable damage to the eye because they penetrate and cause necrosis of the surface epithelium in a few seconds with occlusion of the limbal vasculature.> This leads to a diminished vascularity of the anterior segment, corneal opacification and melting, cataract and symblepharcn.> Ammonia and sodium hydroxide are particularly harmful, as they cause necrosis of the cornea.> Immediately after the accident there is intense conjunctivitis and chemosis, but the cornea often looks clear, and it is therefore difficult to ascertain the severity of the injury.> A drop of fluorescein solution will reveal the extent of the denuded area of epithelium.> Circumferential limbal ischaemia and the degree of corneal clarity provide some indication of the final visual status of the patient.> Limbal ischaemia leads to severe damage of the limbal stem cells. This causes persistent corneal epithelial defects and conjunctivization of the corneal epithelium.> Treatment In injury caused by caustics the excess of deleterious material must be removed at the earliest by a copious and immediate irrigation with normal saline. An intra venous infusion line is useful in directing a steady, con trolled flow of saline onto the ocular surface. All fornices should be washed and irrigation continued till the pH returns to normal or for a minimum of 30 minutes. There should be no delay in instituting therapy and, if saline is not immediately available, the eye should be copiously irrigated at once with water. Particles of lime must be perseveringly picked out with forceps after instillation of a local anaesthetic. An antibiotic ointment or drops and cycloplegics should be instilled. Corticosteroids are potent agents in reducing the inflammatory reaction and prevent the formation of excessive granulation tissue, which determines the development of symblepharon. They can be used topically as drops or ointment for the first 10 days, together with acetazolamide tablets to lower the intraocular pressure. Thereafter, steroids are stopped as they impair healing and may precipitate corneal melting.> Ascorbic acid and tetracyclines are given topically and systemically to enhance collagen formation.> To inhibit collagenolysis and stromal damage, 10% sodium citrate, 5% N-acetylcysteine or 1% medroxyprogesterone eye drops are useful adjuncts.> Symblepharon may be prevented by sweeping a glass rod well coated with a lubricant round the upper and lower fornices, so that they are well packed with ointment.> This procedure should be repeated several times a day, depending upon the severity of the case.> The fitting of a contact lens separates the two mucosal surfaces and prevents their adhesion.> Revascularization of the limbus and re-epithelialization of the ocular surface can be stimulated by a limbal cell transplant or amniotic membrane graft. | train | med_mcqa | null |
Afferent nerve fibre affected by local anesthesia first | [
"Type A",
"Type Il - B",
"Type C",
"Type II"
] | C | C i.e. Type C | train | med_mcqa | null |
Oral therapy of choice in MRSA skin infection is | [
"Dicloxacillin",
"Clindamycin",
"Quinupristin",
"Dalfopristin"
] | B | Ans. is 'b' i.e., Clindamycin | train | med_mcqa | null |
Which of the following is not a radiological feature of rickets: March 2010 | [
"Metaphyseal cupping",
"Physeal widening",
"Frenkel's line",
"Triradiate pelvis"
] | C | Ans. C: Frenkel's Line | train | med_mcqa | null |
A patient presented with pain in left eye associated with visual distrubance, also a history of blunt trauma to eye 4 month back, first investingation of choice is - | [
"Intraocular tension",
"Ophthalmoscopy",
"Perimetry",
"Ultrasound"
] | A | Patient is presenting late onset visual disturbance after trauma. Causes of delayed visual disturbance after trauma are retinal detachment, cataract and glaucoma.
"Late effects, including cataract, retinal detachment and glaucoma, all may result in visual loss. Therefore, continued follow-up care is important to preserve vision after an injury". — Ocular trauma
The symptoms of retinal detachment usually start as floaters in front of eye followed by visual disturbances. Condition is painless.
Cataract causes gradual vision disturbances, but is painless.
So, we are left with glaucoma only, which is one of most common cause of delayed vision disturbance after ocular trauma. Therefore, IOP measurement is the best answer here. | train | med_mcqa | null |
Which one of the following condition is not associated with Celiac sprue | [
"Turner syndrome",
"Down syndrome",
"Klinefelter syndrome",
"Type 1 diabetes"
] | C | There is also an association of Celiac sprue with other immune disease LA including type 1 diabetes, thyroiditis, Sjogrens syndrome, as well as ataxia autism, depression, down syndrome, turner syndrome | train | med_mcqa | null |
The most common way in which tuberculosis is acquired is via the | [
"Skin",
"Gastrointestinal tract",
"Respiratory tract",
"Genital tract"
] | C | Organisms may be transmitted in a number of ways, such as by air, food, hands, sexual contact, and infected needles. However, for each disease or disease category, there is usually a portal of entry not always unique to the organism. The respiratory tract is a common portal of entry to such airborne organisms as M. tuberculosis. This is why respiratory precautions must be taken when patients are harboring viable M. tuberculosis.The gastrointestinal tract is usually infected from ingestion of contaminated food or water (Shigella, Salmonella, Campylobacter) or by an alteration of the normal microbial flora such as with C. difficile disease. The skin is a tough integument and intact, is resistant to most infectious organisms except those that may break down human skin. Breaches of the skin as by wounds, burns, and the like predispose patients to a variety of infections such as tetanus caused by wound contamination with spores of C. tetani, or direct infection by Staphylococcus, Streptococcus, or Gram-negative rods (such as Serratia or Pseudomonas).The genital tract may become infected either by sexual contact or by alteration of the genital environment as often occurs with yeast infections. Several bacteria such as N. gonorrhoeae, Chlamydia, and Treponema pallidum are transmitted by direct sexual contact with infected partners. | train | med_mcqa | null |
Drug of choice for ovulation induction - | [
"Clomiphene",
"FSH",
"LH",
"Hcg"
] | A | Ans. is 'a' i.e., Clomiphene o Ovulation should be induced with clomiphene citrate 50 mg/day from day 2 to day 6 of the cycle, for 5 days,o Dose can be increased upto lOOmg, if response is not satisfactory,o If clomiphene fails in 6-8 cycles, FSH & HCG Therapy is recommended.o To avoid peripheral suppressive oestrogenic action on cervical mucus & improve the fertility' rate, letrozole 2.5mg (non steroidal aromatase inhibitor) is found superior to clomiphene. | train | med_mcqa | null |
What is posthumous birth | [
"Birth of a child after the father dies",
"Father dies after child is born",
"Mother dies after child is born",
"Any of the above"
] | A | Posthumous birth means baby is born after father's death. | train | med_mcqa | null |
In treatment of Parkinsonism, L–Dopa is combined with carbidopa mainly : | [
"To decrease dose requirement of L–Dopa",
"To decrease side effects of L–Dopa",
"To decrease effectiveness of L–Dopa",
"To increase crossing of L–Dopa through BBB"
] | D | null | train | med_mcqa | null |
In case of benign mixed parotid tumours T/t of choice is - | [
"Superficial Parotidectomy",
"Total parotidectomy",
"Leave facial nerve and remove all gland",
"Radical Parotidectomy"
] | A | Ans is 'a' ie Superficial parotidectomy Schwaz writes - "Treatment of benign neoplasms is surgical excision of the affected gland or, in the case of the parotid, excision of the superficial lobe with facial nerve dissection and preservation. The minimal surgical procedure for neoplasms of the parotid is superficial parotidectomy with preservation of the facial nerve. 'Shelling out' of the tumor mass is not recommended because of the risk of incomplete excision and tumor spillage." | train | med_mcqa | null |
Which one of the following causes intestinal pseudo obstruction? | [
"Hypothyroidism",
"Tricyclic antidepressant",
"Parkinsonism",
"All the above"
] | D | Intestinal pseudo obstruction is caused by the following 1) Disorders of the nervous system (Familial autonomic dysfunction, Hirschsprung disease, Chagas disease) 2) Diseases affecting muscles and nerves (Muscular dystrophy, SLE, Ehlers-Danlos syndrome, hypokalemia) 3) Disorders of the endocrine system (DM, Hypothyroidism, Hyperparathyroidism), and 4) Medication (Narcotics, Laxatives, Tricyclic antidepressants, Phenothiazines).Ogilive's syndrome is acute intestinal pseudo obstruction. | train | med_mcqa | null |
The cell type most typically seen in the Keratic precipitates of non-granulomatous uveitis is: | [
"Polymorphonuclear cells",
"Lymphocytes",
"Plasma cells",
"Epitheloid cells"
] | B | Ans. Lymphocytes | train | med_mcqa | null |
Most common nerve involvement in fracture surgical neck humerus: | [
"Axillary nerve",
"Radial nerve",
"Ulnar nerve",
"Median nerve"
] | A | A i.e. Axillary nerve Injury Common Nerve Involvement Anterior shoulder dislocation Fracture surgical neck humerus Axillary (circumflex humeral) nerveQ Axillary nerveQ Fracture shaft humerus Fracture supracondylar humerus Medial condyle humerus Radial nerveQ Radial or median nerve Ulnar nerve Monteggia fracture dislocation Posterior interosseous nerve Vockman's ischemic contracture Lunate dislocation Median nerve Median nerveQ Hip dislocation Sciatic nerve Knee dislocation Peroneal nerve | train | med_mcqa | null |
Which of the following antiglaucoma drug can cause stenosis of nasolacrimal duct | [
"Timolol",
"Apraclonidine",
"Latanoprost",
"Adrenaline"
] | A | Timolol caused stenosis of nasolacrimal duct & obstructs the drainage leading to maximum systemic absorption of drug.
Apracloinidine: Lid retraction.
Adrenaline: Conjuctival pigmentation.
Latanoprost: Iris pigmentation, growth of eyelashes. | train | med_mcqa | null |
All float in a saturated salt solution except -a) Clonorchis sinensisb) Fertilised eggs of ascarisc) Larva of strongyloidesd) Trichuris trichura | [
"a",
"bc",
"ad",
"ac"
] | D | null | train | med_mcqa | null |
Bone adjacent to periodontal ligament that contains a great number of sharpey's fibres is known as | [
"Lamina dura",
"Bundle bone",
"Lamina propria",
"Lamina densa"
] | B | null | train | med_mcqa | null |
Vascular injury during childhood is common in fracture of: | [
"Lower end of humerus",
"Lower end of radius",
"Upper end of femur",
"Upper end of radius"
] | A | A i.e Lower end of humerus | train | med_mcqa | null |
A 33-year-old lady present! with polydipsia and polyuria. Har symptoms started soon after a road traffic accident 6 months ago. The blood pressure is 120/80 mm Hg with no postural drop. The daily urinary output Is 6-8 liters. Investigation showed, Na 130 mEq/L, KJ.5 mEq/L, urea 15mg/dL, sugar-65 mg/dL. The plasma osmolality is 268 mosmol/L and urine osmolatity 45 mosmol/L. The most likely diagnosis is- | [
"Psychogenic polydipsia",
"Nephrogenic diabetes insipidus",
"Resolving acute tubular necrosis",
"Central diabetes insipidus"
] | A | here there is no thirst and polydipsia due to psychosis | train | med_mcqa | null |
Hepatomegaly with liver pulsations indicates | [
"TR",
"MR",
"Pulmonary hypeension",
"MS"
] | A | Ref Harrison 19 th ed pg 1548 AyatoSys pulsqtpuls of liver and marked hepatomegaly are characteristic features of tricuspid regurgitation. | train | med_mcqa | null |
Involvement of lateral wall of pelvis in vaginal carcinoma, stage ---- | [
"I",
"II",
"III",
"IV"
] | C | Vaginal cancer staging Stage 0 Vaginal intraepithelial neoplasia (VAIN) Stage I Carcinoma limited to the vaginal wall Stage II Carcinoma extending beyond the vagina, but not extending to the pelvic side walls Stage III Carcinoma extends up to the pelvic walls Stage IVA Carcinoma extending beyond the true pelvis/or involving the bladder and/or rectum, or evidence of distal metastasis Stage IVB Spread to the distal metastasis Reference: Shaw's Textbook of Gynaecology 16th edition page no 482 | train | med_mcqa | null |
Tachycardia due to nitrates in a patient with angina pectoris is blocked by? | [
"Digoxin",
"Dobutamine",
"Beta blocker",
"Calcium channel blocker"
] | C | Ans. is 'c' i.e., Beta blocker Use of beta blocker and long acting nitrate combination is rational in classical angina because : Tachycardia due to nitrate is blocked by beta blocker The tendency of beta blocker to cause ventricular dilatation is countered by nitrate The tendency of beta blocker to reduce the total coronary flow is opposed by nitrate | train | med_mcqa | null |
A 34-year-old man presents with a 5-day history of a painful sore on his hand. Physical examination reveals a 0.5-cm abscess on the extensor surface of the left hand that drains a thick, purulent material. Diapedesis of leukocytes into and around this patient's infected wound occurs primarily at which of the following anatomic locations? | [
"Lymphatic capillaries",
"Postcapillary venules",
"Precapillary aerioles",
"Small dermal aeries"
] | B | One of the earliest responses following tissue injury occurs within the microvasculature at the level of the capillary and postcapillary venule. | train | med_mcqa | null |
Mechanism of action of paclitaxel is : | [
"Topoisomerase inhibition",
"Increases the polymerization of tubulin",
"Inhibits protein synthesis",
"Alkylation of DNA"
] | B | Taxanes (paclitaxel and docetaxel) act by increasing the polymerization of tubulin whereas vinca alkaloids (vincristine, vinblastine and vinorelbine) cause inhibition of tubulin polymerization. Both of these drugs act by causing the disruption of mitosis and are active in M-phase of the cell cycle. | train | med_mcqa | null |
Most common ovarian tumour to undergo torsion: | [
"Pseudomucinous cystadenoma",
"Papillary cystadenoma",
"Dermoid cyst",
"Mucinous cyst"
] | C | Dermoid cyst | train | med_mcqa | null |
A child presents with a white patch over the tonsils,diagnosis is best made by culture in - | [
"Loeffler medium",
"LJ medium",
"Blood agar",
"Tellurite medium"
] | D | null | train | med_mcqa | null |
An HIV patient complains of visual disturbances. Examination of fundus of the eye bilateral retinal exudates and perivascular haemorrhages. Which of the following virus is the most likely causative agent? | [
"Cytomegalovirus",
"Epstein-Barr virus",
"Herpes simplex virus",
"Human herpes virus 8"
] | A | Patient is showing is features of CMV chorioretinitis. Chorioretinitis is the most frequent clinical manifestation of CMV. Fundus examination shows perivascular hemorrhage, exudates, necrotizing retinitis, and rhegmatogenous retinal detachment. Ref: Ocular Therapeutics Handbook: A Clinical Manual By Bruce E. Onofrey, 2nd Edition, Page 431 | train | med_mcqa | null |
Nelson's syndrome is most likely seen after: | [
"Hypophysectomy",
"Adrenalectomy",
"Thyroidectomy",
"Orchidectomy"
] | B | Answer is B (Adrenalectomy): Adrenalectomy predisposes to development of Nelson's syndrome. Nelson syndrome Nelson syndrome is a disorder characterized by rapid enlargement of a preexisting ACTH pituitary adenoma after adrenalectomy. This syndrome occurs because following adrenalectomy, the suppressive effect of coisol on ACTH secretion and tumor growth is removed resulting in increased ACTH secretion and tumor growth. Patients with Nelson's syndrome present with hyperpigmentation and with manifestation of an expanding intrasellar mass lesion (visual field defects, headache, cavernous sinus invasion etc.) These tumors represent one of the most aggressive and rapidly growing of all pituitary tumors. ACTH levels are markedly elevated. Preoperative Radiotherapy may be indicated to prevent development of Nelson's syndrome after adrenelectomy. | train | med_mcqa | null |
Which of the following statements about Hepatitis C is TRUE? | [
"DNA virus",
"Most common indication for Liver transplantation",
"Does not cause Liver cancer",
"Does not cause co infection with hepatitis B"
] | B | Progression to cirrhosis or hepatocellular carcinoma is a major cause of morbidity and the most frequent indication of liver transplantation in adults in united states. Ref: Kliegman, Behrman, Jenson, Stanton (2008), "Nelson Textbook of Pediatrics", Chapter 355, "Viral Hepatitis", Volume 2, Page 1687; Harrison's Principles of Internal Medicine, 17th Edition, Pages 1939, 1963, 1984; Current Gastroenterology, 2nd Edition, Page 556 | train | med_mcqa | null |
The role of vitamin K in epoxide cycle is | [
"Carboxylation of glucatamate",
"Dehydrogenation of glucatamate",
"Carboxylation of glutamate",
"Dehydrogenation of aspaate"
] | C | Carboxylation of glutamate is the role of VitK in epoxide cycle. Vitamin K is necessary for coagulation. Factors dependent on vitamin K are Factor II (prothrombin); Factor VII (SPCA); Factor IX (Christmas factor); Factor X (Stua Prower factor) All these factors are synthesized by the liver as inactive zymogens. They undergo post-translational modification; gamma-carboxylation of glutamic acid residues. These are the binding sites for calcium ions. The gamma-carboxy glutamic acid (GCG) synthesis requires vitamin K as a co-factor Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 462 image satyanarayana 4th ed page 131 | train | med_mcqa | null |
HIV window period indicates : | [
"time period between infection and onset of first symptoms",
"time period between infection and detection antibodies",
"time period between infection and minimum multiplication of organism",
"time period between infection and maximum multiplication"
] | B | it takes 2-8 weeks to months for antibodies to appear in hiv infection the period is called window period or seronegative infective stage during this period individual is highly infectious hiv infection can be detected during this period by p24 antigen assay and pcr ref : ananthanaryana 9th ed | train | med_mcqa | null |
The action potential of the the sinoatrial node | [
"Reuslts from the activation of rapid Na+ channels",
"Results from opening of the slow Ca2+ channels",
"Is equivalent in height and conduction velocity to that of the atrial muscle",
"Results from an increase in conductance to K+"
] | B | The action potential of the sinoatrial node and atrioventricular node results from the opening of the slow Ca2+ channels and the influx of Ca2+(some Na+ may also enter through these slow Ca2+channels). An action potential is elicited when the membrane potential reaches threshold. Spontaneous depolarization is an intrinsic property of nodal tissue and can occur in the absence of nerves. The low resting potential results in a small action potential that propagates slowly. The rapid Na+ channels are inactivated in nodal tissue. An increase in the conductance to K+ would hyperpolarize the membrane. | train | med_mcqa | null |
In a patient pO2 is 85 mmHg, pCO2 is 50 mmHg, pH is 7.2, and HCO3- is 36mmol/L. The condition is | [
"Respiratory acidosis with compensatory metabolic alkalosis",
"Uncompensated respiratory acidosis",
"Respiratory alkalosis with compensatory metabolic acidosis",
"Respiratory acidosis with compensatory metabolic acidosis"
] | A | pH is decreased (<7.35) so it is acidosis. The CO2 levels are increased (>45 mmHg), which is in line with the change in pH (in acidosis CO2 is expected to raise), thus the primary problem is respiratory. The HCO3- levels are increased (>30mmol/L), which is opposite to change in pH (i.e., there is acidosis and HCO3- levels are high), thus , there is compensatory metabolic alkalosis. Thus this is a case of respiratory acidosis with compensatory metabolic alkalosis. Ref: Oxford handbook of medicine 5th edition Pgno: 684 | train | med_mcqa | null |
An oncologist is reviewing a CT scan of a 74-year-old man with newly diagnosed hepatocellular carcinoma. He locates the affected quadrate lobe of the liver that: | [
"Lies between the IVC and ligamentum venosum",
"Receives blood from the right hepatic aery",
"Drains bile into the left hepatic duct",
"Is a medial superior segment"
] | C | QUADRATE LOBE: Quadrangular lobe, present behind 4b, not seen anteriorly. It lies between the gallbladder fossa and the ligamentum teres hepatis, a medial inferior segment, and is a pa of the left lobe. The quadrate lobe of the liver drains bile into the left hepatic duct and receives blood from the left hepatic aery. | train | med_mcqa | null |
Monoclonal antibody that neutralizes anthrax toxin | [
"Raxibacumab",
"Cetuximab",
"Panitumumab",
"Alemtuzumab"
] | A | Raxibacumab is Intended for the prophylaxis and treatment of inhaled anthrax. | train | med_mcqa | null |
Pantothenic acid containing coenzyme is involved in: | [
"Carboxylation",
"Acetylation",
"Decarboxylation",
"Dehydrogenation"
] | B | Pantothenic acid containing coenzyme is Coenzyme A, which is involved in Acetylation reactions. Biochemical Role of Pantothenic Acid- Acyl carrier protein: Role in fatty acid synthesis CoA: has role in TCA, haem synthesis, lipogenesis, fatty acid oxidation. Active group of CoA is a free SH group or Thiol to which acyl groups can be covalently linked to form thio ester bond. E.g. Acetyl CoA . | train | med_mcqa | null |
A 25-year female presented with mild pallor and moderate hepatosplenomegaly. Her hemoglobin was 92g/L and fetal hemoglobin level was 65%. She has not received any blood transfusion till date. She is most likely to be suffering from - | [
"Thalassemia major",
"Thalassemia intermedia",
"Hereditary persistent fetal hemoglobin, homozygous state",
"Hemoglobin D, homozygous state"
] | B | null | train | med_mcqa | null |
An elderly male presented with headache, fever and hemiparasis of right side. On further examination and investigation, a diagnosis of brain abscess was made. Which of the following antibacterial/ antibacterials is effective in this patient: | [
"Gentamycin",
"Doxycycline",
"Streptomycin",
"A combination of cephalosporin and metronidazole"
] | D | Ans. d. A combination of cephalosporin and metronidazole (Ref: Harrison 19/e p900, 18/e p3429-3430; Sabiston 19/e p1913; Schwartz 9/e p1550; Bailey 26/e p609-610, 25/e p628-629)Empirical therapy of community-acquired brain abscess in an immunocompetent patient typically includes a third-or fourth-generation cephalosporin (e.g. cefotaxime, ceftriaxone or cefepime) and metronidazole.''Optimal therapy of a brain abscess involves a combination of high dose parenteral antibiotics and neurosurgical drainage. Empirical therapy of community-acquired brain abscess in an immunocompetent patient typically includes a third-or fourth-generation cephalosporin (e.g. cefotaxime, ceftriaxone or cefepime) and metronidazole."- Harrison 18/e p3429Brain AbscessIntracerebral abscess may occur as a result of direct spread from air sinus infection, following surgery or from hematogenous spread especially associated with respiratory infection, endocarditis or dental infectionQ.Increased risk of abscess in: Cyanotic heart disease, immunocompromised (diabetes, solid organ transplant, hematological malignancy or long-term steroids)QOrganisms: Streptococci (MC), Bacteroides, Pseudomonas, Hemophilus and EnterobacteriaceaeEtiologyLocationOtitis media, mastoiditis* Temporal lobeQ >CerebellumParanasal sinusitis, dental infections* Frontal lobesQHematogenous* Parietal lobeQClinical Features:Presentation is with focal signs, seizures and raised ICP, as with other mass lesions, but the time course is often shortQ.Patients may be febrile or have a raised peripheral white cell count or inflammatory markers.Diagnosis:CT scan: Ring-enhancing mass lesion (may be multiple in case of hematogenous spread)Q Treatment:Surgical drainage + IV antibiotics for at least 6 weeksQ.Multiple small abscesses may be treated medically with antibiotics targeted against organismsSteroids are reserved for cases with significant edema or mass effectQOwing to the high risk of seizures, patients should also be treated with anticonvulsants.Optimal therapy of a brain abscess involves a combination of high dose parenteral antibiotics and neurosurgical drainage.Empirical therapy of community-acquired brain abscess in an immunocompetent patient typically includes a third-or fourth-generation cephalosporin (e.g. cefotaxime, ceftriaxone or cefepime) and metronidazole. | train | med_mcqa | null |
Which of the following muscle acts as unlocker of knee? | [
"Gracilis",
"Popliteus",
"Saorius",
"Biceps femoris"
] | B | Popliteus rotates the tibia medially on the femur or, when the tibia is fixed, rotates the femur laterally on the tibia. At the beginning of flexion of the fully extended knee, lateral femoral rotation by popliteus muscle unlocks the joint.Must know:Locking of knee joint is due to the the action of quadriceps femoris, that brings about medial rotation of femur on tibia in later stages of extension. Ref: Snells, Clinical anatomy, 7th Edition, Page 650. | train | med_mcqa | null |
In reye's syndrome hepatic change - | [
"Microvesicular steatosis",
"Macrovesicular steatosis",
"Both",
"None"
] | A | causes for steatosis: alcoholic abuse,protein malnutrition, starvation, anoxia, toxins and reyes syndrome GENERAL AND SYSTEMIC PATHOLOGY RAMDAS NAYAK PG NO.19 | train | med_mcqa | null |
Infections transmitted by blood ? | [
"HIV",
"Malaria",
"Toxoplasma",
"All"
] | D | Ans. is'd' i.e., All | train | med_mcqa | null |
Ketone bodies not utilized by: | [
"Brain",
"RBC",
"Heart",
"Skeletal muscle"
] | B | Major fuel in different organs | train | med_mcqa | null |
What is the definitive finding of G6PD? | [
"Bite cells",
"Intravascular hemolysis",
"Splenomegaly",
"Hemoglobinuria"
] | A | a. Bite cells(Ref: Nelson's 20/e p 2335-2356, Ghai 8/e p 339)Bite cells are characteristic finding of G6PD deficiency while others can be seen in any intravascular hemolysis. | train | med_mcqa | null |
Infection of index finger spread to | [
"Mid-palmar space",
"Radial bursa",
"Thenar space",
"Dorsum of hand"
] | C | Infection of thumb and index finger spreads to thenar space. Infection from middle, ring and little finger spreads to midpalmar space. | train | med_mcqa | null |
True about hepatitis A viurs ? | [
"Causes cirrhosis",
"Helps HDV replication",
"Common cause of hepatitis in children",
"Causes chronic hepatitis"
] | C | Ans. is 'c' i.e., Common cause of hepatitis in children HAV is the most common cause of hepatitis in children. HAV does not cause chronic hepatitis or cirrhosis. HBV (no HAV) helps in HDV replication. | train | med_mcqa | null |
Which of the following drugs has been linked with increased cardiac moality: | [
"Rofecoxib",
"Metoprolol",
"Losaan",
"Nicorandil"
] | A | Answer is A (Rofecoxib) Rofecoxib (selective COX-2 inhibitor) induces a Prothrombotic state and has been linked to increased incidence of thrombotic events including myocardial infarction, stroke and venous thrombosis. `Selective COX-2 inhibitor Rofecoxib increases the risk of myocardial infarctions' - `Placebo controlled trials with three structurally distinct COX-2 inhibitors - Celecoxib, valdecoxib (withdrawn) and rofecoxib (withdrawn) revealed an increase in the incidence of myocardial infarction, stroke and thrombosis'. Rofecoxib and Valdecoxib were withdrawn from the market in 2004 and 2005 respectively due to increased risk of thrombogenic cardiovascular events (myocardial infarction, stroke and thrombosis) Mechanisms of Drug-Induced Myocardial lschemia and Acute Coronary Syndrome Mechanism Examples Increased Myocardial Oxygen Demand * Increased hea rate Directly: Cocaine, adrenergic adrenergic I3-agonists, sympathomimetics, withdrawal of J3-antagonists Indirectly: potent vasodilators (Nifedipine, minoxidil, hydralazine) * Increased myocardial contractility Directly: Cocaine, adrenergic n-agonist, sympathomimetics, withdrawal of (3-antagonists Indirectly: potent vasodilators (Nifedipine, minoxidil, hydralazine) * Increased left ventricular systolic wall tension Cocaine, phenylephrine Decreased Myocardial Oxygen Supply (temporary, non-total occlusion) * Increased coronary vascular resistance (vasospasm, thrombosis) Cocaine, anti-migraine agents (ergot alkaloids, triptans) * Decreased coronary diastolic perfusion pressure Enalapril, nifedipine, minoxidil, hydralazine, nitroprusside, adenosine, dipyridamole Drug-Induced Acute Coronary Syndromes * Acute coronary syndrome associated with acute drug therapy - Coronary aery thrombosis, superimposed on a damaged atherosclerotic plaque - Coronary aery vasospasm (with or without a superimposed coronary aery thrombosis) * Acute coronary syndrome associated with chronic drug therapy (Increased cardiovascular risk) Cocaine, oral contraceptives, estrogens, COX-2 inhibitors, NSAIDs Cocaine, anti-migraine agent (ergot alkaloids, triptans) Cocaine, estrogens, COX-2 inhibitors, NSAIDs, HIV agents/protease inhibitors, oral contraceptives, rosiglitazone | train | med_mcqa | null |
The purpose of double blinding in clinical trails is to- | [
"Achieve comparability between study and control groups",
"Avoid observer bias",
"Avoid subject bias",
"Avoid observer and subject bias"
] | D | There may be bias in randomized control trials. Randomization cannot guard against these so of bias, nor the size of the sample. In order to reduce these problems, a technique known as blinding is adopted. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 91 | train | med_mcqa | null |
Which of the following is caused by bilateral parietal lesions leading to visuomotor difficulty? | [
"Balint's syndrome",
"Hallervorden spatz syndrome",
"Alzheimer's disease",
"Coicobasal degeneration"
] | A | Balint&;s syndrome is an uncommon and incompletely understood triad of severe neuropsychological impairments: inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes (oculomotor apraxia), and inability to move the hand to a specific object by using vision (optic ataxia).Balint&;s syndrome occurs most often with an acute onset as a consequence of two or more strokes at more or less the same place in each hemisphere. Therefore, it occurs rarely. The most frequent cause of complete Balint&;s syndrome is said by some to be sudden and severe hypotension, resulting in bilateral border zone infarction in the occipitoparietal region | train | med_mcqa | null |
Which of the following is true about resuscitation of a baby born through Meconium stained liquor (MSL)? | [
"Intrapaum suction of mouth and nose may be done",
"Postnatal tracheal suctioning of all non-vigorous neonates should be done",
"At least one person skilled in endotracheal intubation should be available at the time of resuscitation",
"All babies born through MSL should be kept in the neonatal ICU for at leas... | C | Resuscitation of a baby born through MSL: At least one person skilled in endotracheal intubation should be available at the time of resuscitation. Intrapaum suction of mouth and nose- NOT recommended Postnatal tracheal suctioning of all non-vigorous neonates- NOT recommended Vigorous neonates - handed over to the mother immediately, after performing the initial steps of resuscitation. | train | med_mcqa | null |
First force applied for extraction of tooth is: | [
"Buccal.",
"Lingual.",
"Apical.",
"Palatal."
] | C | null | train | med_mcqa | null |
Which of the following is considered the regulated step in steroid hormone synthesis in the zona fasciculata? | [
"Cholesterol to pregnenolone",
"Coicosterone to aldosterone",
"11-Deoxycoisol to coisol",
"Pregnenolone to progesterone"
] | A | The conversion of cholesterol to pregnenolone is considered the rate-limiting and regulated step in steroid biosynthesis in the zona fasciculata, which secretes the glucocoicoid, coisol. ACTH binds to a membrane-associated receptor and increases cAMP formation. The subsequent activation of protein kinases and phosphorylation results in increased expression of LDL receptors and activation of cholesterol esterase. The increase in LDL receptors increases the delivery of cholesterol to the zona fasciculata. The activation of cholesterol esterase increases the liberation of intracellular cholesterol from cholesterol esters. ACTH also induces a mitochondrial protein called steroidogenic acute regulatory (StAR) protein. StAR functions to shuttle cholesterol from the outer mitochondrial membrane to the inner mitochondrial membrane, where the cholesterol side chain cleavage enzyme conves it to pregnenolone. Also Know: Coicosterone is conveed to aldosterone in the zona glomerulosa, but not in the zona fasciculata. This is also a regulated step. Angiotensin II acts a membrane-associated receptor to increase the activity of aldosterone synthase (a combination of two enzymes with 18b-hydroxylase activity) and, hence, increase aldosterone synthesis and secretion. 11-deoxycoisol is conveed to coisol primarily in the zona fasciculata, but also in the zona reticularis. The enzyme responsible is 11b-hydroxylase, a mitochondrial enzyme. 11b-hydroxylase is not regulated by ACTH. Pregnenolone is conveed to progesterone in all steroid secreting tissues. The enzymes responsible are 3b-ol dehydrogenase and D4,5-isomerase. These enzymes are cytoplasmic, and are not regulated by ACTH. Ref: Weil P. (2011). Chapter 41. The Diversity of the Endocrine System. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds),Harper's Illustrated Biochemistry, 29e. | train | med_mcqa | null |
Two same charged proteins can be separated by | [
"Agarose",
"DEAE Cellulose",
"Sephadex",
"None of these"
] | C | Sephadex is used to separate low and high molecular weight molecules. Sephadex is a faster alternative to dialysis (de-salting), requiring a low dilution factor (as little as 1.4:1), with high activity recoveries. Sephadex is also used for buffer exchange and the removal of small molecules during the preparation of large biomolecules, such as ampholytes, detergents, radioactive or fluorescent labels, and phenol (during DNA purification).Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 451 fig no:35.8 | train | med_mcqa | null |
In a case of carcinoma cervix involvement of parametrium, lower 1/3 of vagina and no free space on P/R examination means stage : | [
"Ila",
"Ilb",
"Illa",
"Illb"
] | B | Ilb | train | med_mcqa | null |
Process of redistribution is seen with: | [
"Ketamine",
"Thiopentone",
"Morphine",
"Barbiturates"
] | B | Ans. B. ThiopentoneProcess of redistribution is seen with thiopentone, if given intravenously, it reaches the brain and distributed due to high lipid solubility. Therefore, its anesthetic effect is quite rapid. It gains comes out of the brain and gets distributed into blood vessels. | train | med_mcqa | null |
A 35 year old female, mother of a Down's syndrome child, became pregnant. Amniocentesis is done to rule out Down's syndrome in the second child. What is the appropriate time for doing amniocentesis? | [
"6-Apr",
"12-Aug",
"17-Dec",
"20-28"
] | C | Amniocentesis generally is carried out at 15 to 17 weeks of gestation but can be offered earlier (12-14 weeks). The underlying risk of amniocentesis when performed at 15 weeks of gestation and beyond is increased risk of miscarriage. This risk is estimated at 1 in 200 (0.5%). Ref: Manipalviratn S., Trivax B., Huang A. (2007). Chapter 5. Genetic Disorders & Sex Chromosome Abnormalities. In A.H. DeCherney, L. Nathan (Eds),CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10e. | train | med_mcqa | null |
Topical drug that can cause Heterochromia Iridis | [
"Timolol",
"Olopatadine",
"Latanoprost",
"Brimonidine"
] | C | Latanoprost, a PG analogue can cause heterochromia iridis in patients. | train | med_mcqa | null |
The mode of secretion of sebaceous gland is | [
"Merocrine",
"Holocrine",
"Apocrine",
"Eccrine"
] | B | Sebaceous Glands
Sebaceous glands, producing an oily secretion, are widely distributed all over the dermis of the skin, except for the palms and soles.
Sebaceous glands are holocrine in nature, i.e. they produce their secretion by complete fatty degeneration of the central cells of the alveolus, which are then replaced by the proliferating peripheral cells. The secretion is under hormonal control, especially the androgens. The oily secretion of sebaceous glands is called sebum.
Reference: BD Chaurasia’s Handbook of GENERAL ANATOMY Fourth Edition page no 180 | train | med_mcqa | null |
Which of the following has epiphysis at BASE: | [
"Distal phalanx",
"Middle phalanx",
"Thumb metacarpal",
"Third metacarpal"
] | C | Epiphysis is present on the heads of all metacarpals, except first metacarpal (Thumb) epiphysis is at the base. If Epiphysis is present at the head of the first metacarpal bone it is called as aberrant epiphysis which is a detion from the normal (and rarely found). | train | med_mcqa | null |
Opsoclonus is a feature of? | [
"Carcinoma lung",
"Retinoblastoma",
"Focal seizure with dyscognitive changes",
"Extrapyramidal damage in Wilson disease"
] | A | Opsoclonus - Involuntary jerky movement of eye - Disordered eye movement involuntary chaotic saccades in all direction of gaze Lesion Fastigial nucleus in cerebellum Leading cause of opsoclonus in Adult population is Carcinoma lung / breast Carcinoma In Pediatric- Neuroblastoma | train | med_mcqa | null |
Acute anuria may occur in all of the following except | [
"Acute pancreatitis",
"Use of intravenous dextran in anaemic patients",
"Performing intravenous urogram in patient with multiple myeloma",
"Use of furosemide in patients receiving cephalosporin"
] | B | Acute pancreatitis is an inflammatory condition of the pancreas most ... Signs of shock: tachycardia, hypotension, oliguria/ anuria; Possibly jaundice in patients with biliary pancreatitis. Ref ganong's review of medical physiology 25e p786 | train | med_mcqa | null |
Tyrosine kinase receptor is activated by ? | [
"Growth hormone",
"Insulin",
"TSH",
"Glucagon"
] | B | Ans. is 'b' i.e., Insulin | train | med_mcqa | null |
Acceptable ambient temperature of summer in terms of thermal comfort is? | [
"20 to 23°C",
"23 to 27°C",
"27-28°C",
"28 to 32°C"
] | B | Thermal comfort is defined as the state of mind that expresses satisfaction with the thermal environment.
It is influenced by physical and physiological factors.
According to this definition comfort is a subjective sensation. Based on ASHRAE definition the zone of thermal comfort is the span of conditions where 80%
of sedentary or slightly active persons find the environment thermally acceptable.
In terms of climatic condition the acceptable ambient temperature of comfort would be slightly higher in the summer than in the winter, being 23-27°C, respectiviely. | train | med_mcqa | null |
Drug of choice for hookworm infestation is : | [
"Piperazine citrate",
"Bephenium hydroxynaphthoate",
"Mebendazole",
"Albendazole"
] | D | null | train | med_mcqa | null |
Which of the following drug undergoes Hoffman's elimination? | [
"Atracurium",
"Pancuronium",
"Mivacurium",
"Vecuronium"
] | A | Ans. (A) Atracurium(Ref: KDT 8th/e p380)Atracurium and cis-atracurium undergo Hoffmann's elimination (spontaneous non-enzymatic molecular rearrangement) and are the agents of choice for patients with hepatic or renal insufficiency.Atracurium is metabolized to laudanosine that is responsible for seizures. Cis-atracurium is relatively safe in this regard. | train | med_mcqa | null |
All of the following are true about CRASH-2 trial except: | [
"Dose of tranexamic acid is 1 gm IV over 10 minutes followed by 1 gm over 8 hours",
"Given to all trauma patients suspected to have significant hemorrhage including SBP <110 mm Hg or PR >110/min",
"Should be administered within 3 hours of injury",
"Tranexamic acid reduces the risk of moality from bleeding in ... | D | CRASH-2 TRIAL* Recommends use of Tranexamic acid in hypotensive trauma patients* 1 gm I/V over 10 minutes followed by 1 gm over 8 hours* Advantages- Reduces the risk of moality from bleeding in both blunt & penetrating trauma* Indications for Tranexamic acid- All trauma patients suspected to have significant hemorrhage including SBP < 110 mmHg or PR > 110/min- Administrated within 3 hours of injury | train | med_mcqa | null |
Gillmore needle is used for | [
"Testing the strength of plaster of paris",
"Evaluating the setting time of plaster of paris",
"Testing the metal hardness",
"Testing the purity of noble metals"
] | B | null | train | med_mcqa | null |
Which vitamin is given in Type 2B Familial Hyperlipidemia: | [
"Pantothenic acid",
"Riboflavin",
"Nicotinic acid",
"Thiamine"
] | C | Nicotinic acid in high doses : Antihyperlipidemic Inhibits hormone sensitive Lipase So triglycerides from adipose tissue are not broken down and free fatty acids do not reach blood and liver. This leads to | VLDL and LDL. HDL levels | by decreasing its catabolic rate.. Treatment Increased TG Increased cholesterol Fibrates Statins Omega -3 FA Bile acid sequestrants High dose Nicotinic acid LDL apharesis(selective removal of LDL from blood) | train | med_mcqa | null |
Test not used for diagnosis of syphilis | [
"VDRL",
"TPI",
"Reagin Test",
"Frei Test"
] | D | D i.e. Frie - test - Most specific test is TPI > FTA -ABSQ Non treponemal test becomes non reactive after t/t; the Treponemal test often remain reactive & therefore not helpful in determining the infection status of person with past syphilis Q. Response to treatment in early syphilis is seen by sequential VDRL or RPR titerQ as they become negative after treatment. CSFVDRL is highly specific but insensitive test; may be nonreactive in symptomatic progressive neuro syphilis. It's sensitivity is highest in meningovascular syphilis & paresis. | train | med_mcqa | null |
Colon cut off sign is seen in - | [
"Chronic pancreatitis",
"Colon carcinoma",
"Ischemic colitis",
"Acute pancreatitis"
] | D | Ans. is 'd' i.e., Acute pancreatitis PancreatitisA. Acute pancreatitiso Acute pancreatitis is a sudden inflammation of the pancreas. Alcoholism and gall stone are the most common causes of acute pancreatitis.o Radiological features of acute pancreatitis are : -1) Plain abdominal x-rayi) Air in the duodenal C-loopii) Senital loop sign : - A focal dilated proximal jejunal loop in the left upper quadrant.iii) Colon cut off sign : - Distention of the colon upto the transverse colon with a paucity of gas distal to the splenic flexure.iv) Gasless abdomen due to vomiting.v) Renal Halo sign : - Radiolucent sign about the left kidney.2) Contrast enhanced computerized tomograpy (CECT) is now considered the imaging modality of choice for the diagnosis and staging of acute pancreatitis due to its superb capacity for demonstrating early inflammatory changes, extrapancreatic fluid collections and panceatic necrosis. CT findings of acute pancreatitis are : -i) Focal or diffuse enlargement of the pancreas due to edema.ii) Irregular or shaggy (fuzzy) contour of pancreatic margins.iii) Heterogenous enhancement of the gland.iv) Blurring of peripancreatic fat planes with streaky soft tissue stranding densites.v) Thickening of fascial planes.vi) The presence of intraperitoneal or retroperitoneal fluid collection. The fluid collections most commonly are found in the peripancreatic and anterior pararenal spaces.B. Chronic pancreatitiso Chronic pancreatitis is chracterized by progressive pancreatic damage that eventually leads to impairment of both exocrine and endocrine functions of pancreas. Most common cause of chronic pancreatitis is alcoholism. o Radiological features of chronic pancreatitis.1) Plain abdominal x-ray :- Calcification in pancreas is pathognomonic for chronic pancreatitis. Calcification primarily represents intraductal calculi. Calcification is punctate or coarse, and it may have a focal, segmental or diffuse distribution.2) Upper gastrointestinal barium study : - Reverse 3 sign in duodenum (similar appearance may be seen in pancreatic carcinoma) due to traction on medial wall of the duodenum. The C loop of duodenum may be widened bacause of mass effect from an enlarged pancreatic head.3) Endoscopic retrograde cholangiopancreatography (ERCP) : - ERCP is the investigation of choice for chronic pancreatitic. ERCP findings of chronic pancreatitis are : -i) Diffuse pancreatic duct dilatation.ii) Beaded appearance due to alternating dilatation and stenosis - "Chain of lakes" appearance or 'string of pearl' appearance or 'hourglass' appearance.iii) Rat tail stricture of CBD: - Long smooth narrowing of the CBD with graded tapering of the distal segment due to periductal fibrosis.iv) Small, round or oval, pancreatic parenchymal cavities.v) Intraluminal filling defects due to protein plugs or calculi. | train | med_mcqa | null |
Which of the following is known as suicidal enzyme? | [
"Lipoxygenase",
"Cyclooxygenase",
"Thromboxane synthatase",
"5' nucleotidase"
] | B | Suicidal enzyme is one, which undergoes self-destruction in order to terminate its own acitivity, e.g. Cyclooxygenase. Suicidal Inhibition is conversion of a substrate by the enzyme into a metabolite, which is a potent inhibitor of the enzyme; example: Xanthine oxidase conves allopurinol to alloxanthine (oxypurinol), which is a more potent inhibitor of allopurinol. Cycloorygenase is known as suicide enzyme because it catalyzes its own destruction. REF: Lippincott book of biochemistry 6th ed. | train | med_mcqa | null |
Gottron papules' seen in dermatomyositis all are true except | [
"seen on knuckles",
"Violaceous papules",
"Bullous lesions",
"Seen in 1/3 of patients"
] | C | Gottrons papules are violaceous papules on bony prominences of hands , elbows, knees and feet. present in 1/3of patients. gottrons sign presence of symmetric violaceous or erythematous macules in same distribution as that of gottrons papules. IADVL textbook of dermatology page 1248 | train | med_mcqa | null |
Which is not a criteria for overcrowding ? | [
"No. of persons",
"Sex separation",
"Door and window",
"Floor space"
] | C | Ans. is 'c' i.e., Door and window | train | med_mcqa | null |
Breslow thickness is used in | [
"Melanoma",
"Squamous cell carcinoma",
"Basal cell carcinoma",
"Actinic keratosis"
] | A | In melanoma, the probability of metastasis correlates with the depth of invasion, which by convention is the distance from the superficial epidermal granular cell layer to the deepest intradermal tumour cells; this measurement is known as the Breslow thickness.The probability of metastatic spread and prognosis, to predict an outcome is based on the following variables:(1) tumour depth (the Breslow thickness); (2) number of mitoses; (3) evidence of tumour regression (presumably due to the host immune response); (4) ulceration of overlying skin; (5) the presence and number of tumour infiltrating lymphocytes; (6) gender; and (7) location (central body or extremity)Since most melanomas initially metastasize to regional lymph nodes, additional prognostic information may be obtained by performing a sentinel lymph node biopsyRobbins Pathology 9e pg: 1150 | train | med_mcqa | null |
True about klinefelter syndrome:a) XXYb) X0c) Male hypogonadismd) Female hypogonadisme) ↑FSH | [
"acd",
"ace",
"cde",
"ade"
] | B | null | train | med_mcqa | null |
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