question stringlengths 1 6.54k | choices listlengths 4 4 | answer stringclasses 4 values | rationale stringlengths 0 22.5k ⌀ | split stringclasses 1 value | dataset stringclasses 6 values | subject stringclasses 1 value |
|---|---|---|---|---|---|---|
Menstrual regulation is done up to : | [
"10 weeks",
"18 weeks",
"6 weeks",
"20 weeks"
] | C | 6 weeks | train | med_mcqa | null |
A previously asymptomatic 62-year-old woman presents with sudden onset of severe midback pain. X-rays reveal an anterior compression fracture of T10. Other vertebral bodies show decreased mineral density and prominent vertical striations. Which of the following is the most likely diagnosis? | [
"multiple myeloma",
"metastatic breast cancer",
"vitamin D deficiency",
"osteoporosis"
] | D | The vertebral bodies in osteoporosis may become increasingly biconcave because of weakening of the subchondral plates. This results in "codfish" vertebra. When vertebral collapse occurs, the anterior height of the vertebra is usually decreased. Plain x-rays are insensitive diagnostic tools because up to 30% of bone mass can be lost without any apparent x-ray changes. Dual-energy x-ray absorptiometry (DEXA) and CT scan are more sensitive tests for bone loss, but their exact clinical role has not been clearly established. | train | med_mcqa | null |
A 5-year-old boy had been playing with his little race cars. Soon after he put a wheel from one of the cars in his mouth, he began choking and coughing. Where in the tracheobronchial tree is the most common site for a foreign object to lodge? | [
"The right primary bronchus",
"The left primary bronchus",
"The carina of the trachea",
"The beginning of the trachea"
] | A | The right main bronchus is the shorter, wider, and more vertical primary bronchus. Therefore, this is most often the location that foreign objects will likely be lodged. The left primary bronchus is not as vertical and therefore does not present the path of least resistance. (It must be understood, however, that in some cases of aspiration, the foreign body can pass into the left primary bronchus rather than the right bronchus!) The carina is a ridge separating the openings of left and right bronchi, the "fork in the road," so to speak. The trachea is a tubular structure supported by incomplete cartilaginous rings, and the likelihood that an object will be lodged there is minimal. It is unlikely that a foreign object would descend so far as to obstruct a tertiary bronchus, although this could happen. | train | med_mcqa | null |
Which of the following is not seen in Anterior mediastinum | [
"Thyroid tumour",
"Thymoma",
"Lymphoma",
"Neurogenic tumor"
] | D | * The anterior mediastinum is the poion of the mediastinum anterior to the pericardium and below the thoracic plane. * It forms the anterior pa of the inferior mediastinum * contains the thymus, lymph nodes, and may contain the poions of a retrosternal thyroid. Mediastinal Tumors and Other Masses Superior Mediastinum .- LymphomaThymoma Thyroid lesions Metastatic carcinoma Parathyroid tumors Anterior Mediastinum -= Thymoma Teratoma Thyroid lesions Parathyroid tumors Posterior Mediastinum-= Neurogenic tumors Neurogenic tumors -= Bronchogenic cyst Pericardial cyst Lymphoma REF : HARRISONS 21ST ED | train | med_mcqa | null |
The most common lid sign associated with Grave's ophthalmopathy is | [
"Von Graefe's sign",
"Dalrymple's sign",
"Stellwag's sign",
"Rosenbach's sign"
] | B | Ans. Dalrymple's sign | train | med_mcqa | null |
In a child, non-functioning kidney is best diagnosed by- | [
"Ultrasonography",
"VU",
"DTPA renogram",
"Creatinine clearance"
] | C | DTPA/MAG3 Renogram. This procedure allows the physician to monitor the function of the kidneys and the degree of any blockage in the flow of urine out of the kidneys. You will lie down on the imaging couch and a Gamma Camera will be placed over your abdominal area Ref Harrison20th edition pg 297 | train | med_mcqa | null |
Most common complication of pseudocyst of pancreas | [
"Rupture into peritoneum",
"Haemorrhage",
"Infection",
"Rupture into colon"
] | C | PSEUDOCYST A pseudocyst is a collection of amylase-rich fluid enclosed in a well-defined wall of fibrous or granulation tissue. Pseudocysts typically arise following an attack of mild acute pancreatitis, lie outside the pancreas, and represent an APFC that has not resolved and matured. Formation of a pseudocyst requires 4 weeks or more from the onset of acute pancreatitis. The Term 'pseudocyst' is often used more loosely, to include sterile WON that has failed to resolve, or a collection that has developed in the context of chronic pancreatitis or after pancreatic trauma. If carefully investigated, more than half of these will be found to have a communication with the main pancreatic duct. Pseudocysts are often single but, occasionally, patients will develop multiple pseudocysts. A pseudocyst is usually identified on ultrasound or a CT scan. It is impoant to differentiate a pseudocyst from an APFC; the clinical scenario and the radiological appearances should allow that distinction to be made. Occasionally, a cystic neoplasm may be confused with a chronic pseudocyst. EUS and aspiration of the cyst fluid is very useful in such a situation. The fluid should be sent for measurement of carcinoembryonic antigen (CEA) levels, amylase levels and cytology. Fluid from a pseudocyst typically has a low CEA level, and levels above 400 ng/mL are suggestive of a mucinous neoplasm. Pseudocyst fluid usually has a high amylase level, but that is not diagnostic, as a tumour that communicates with the duct system may yield similar findings. Cytology typically reveals inflammatory cells in pseudocyst fluid. If there is no access to EUS, then percutaneous FNA is acceptable (just aspiration, not percutaneous inseion of a drain). ERCP and MRCP may demonstrate communication of the cyst with the pancreatic duct system, demonstrate ductal anomalies, or diagnose chronic pancreatitis and thus help in planning treatment. Pseudocysts will resolve spontaneously in most instances, but complications can develop. Pseudocysts that are thick-walled or large (over 6 cm in diameter), have lasted for a long time (over 12 weeks), or have arisen in the context of chronic pancreatitis are less likely to resolve spontaneously,but these factors are not specific indications for intervention. Therapeutic interventions are advised only if the pseudocyst causes symptoms, if complications develop, or if a distinction has to be made between a pseudocyst and a tumour. There are three possible approaches to draining a pseudocyst: percutaneous, endoscopic and surgical. Percutaneous drainage to the exterior under radiological guidance should be avoided. It carries a very high likelihood of recurrence. More over, it is not advisable unless one is absolutely ceain that the cyst is not neoplastic and that it has no communication with the pancreatic duct (or else a pancreaticocutaneous fistula will develop). A percutaneous transgastric cystgastrostomy can be done under imaging guidance, and a double-pigtail drain placed with one end in the cyst cavity and the other end in the gastric lumen. This requires specialist expeise but, in experienced hands, the recurrence rates are no more than 15%. Endoscopic drainage usually involves puncture of the cyst through the stomach or duodenal wall under EUS guidance, and placement of a tube drain with one end in the cyst cavity and the other end in the gastric lumen. The success rates depend on operator expeise. Occasionally, ERCP and placement of a pancreatic stent across the ampulla may help to drain a pseudocyst that is in communication with the duct. Surgical drainage involves internally draining the cyst into the gastric or jejunal lumen. Recurrence rates should be no more than 5%, and this still remains the standard against which the evolving radiological and endoscopic approaches are measured. The approach is conventionally through an open incision, but laparoscopic cystgastrostomy is also feasible. Pseudocysts that have developed complications are best managed surgically. There is a small group of patients who, having suffered an attack of necrotising pancreatitis with duct disruption, go on to suffer repeated complications in the form of recurrent fluid collections, pseudocysts, pleural effusions or pancreatic ascites. Very often disruption of the main pancreatic duct in the neck, body or tail is compounded by a stricture or a stone in the head that cannot be treated endoscopically. In such patients, some form of surgical resection and/or a drainage procedure even though it may be technically challenging may be the only way to achieve lasting resolution. Ref: Bailey and love 27th edition Pgno : 1229 | train | med_mcqa | null |
Which of the following is present in the posterior cranial fossa in a five year old child? | [
"Foramen rotundum",
"Foramen lacerum",
"Jugular foramen",
"Foramen spinosum"
] | C | Except jugular foramen, all other foramen (Option 1,2 and 4) are present in middle cranial fossa. | train | med_mcqa | null |
All are true about nephrotic syndrome in children except? | [
"It is not associated with hypeension",
"Minimal change disease in children <10 year",
"Massive proteinuria > 3.5gm%/ 24 hours",
"Low complement levels"
] | D | Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia, and edema. Massive proteinuria > 3.5gm%/ 24 hours Persistently low C3 levels are indicative of Acute Glomerulonephritis Minimal change disease- most common cause of nephrotic syndrome in children (2-8 yrs) | train | med_mcqa | null |
A 47-year-old HIV-positive man is brought to the emergency room because of weakness. The patient has HIV nephropathy and adrenal insufficiency. He takes trimethoprim-sulfamethoxazole for PCP prophylaxis and is on triple-agent antiretroviral treatment. He was recently started on spironolactone for ascites due to alcoholic liver disease. Physical examination reveals normal vital signs, but his muscles are diffusely weak. Frequent extrasystoles are noted. He has mild ascites and 1+ peripheral edema. Laboratory studies show a serum creatinine of 2.5 with a potassium value of 7.3 mEq/L. ECG shows peaking of the T-waves and QRS widening to 0.14.Once the patient is stabilized and the T-waves have normalized, it is important to review the potential causes of his hyperkalemia and to take steps to prevent this from happening again. As you consider the pathophysiology of each confounding factor, which of the following statements is true? | [
"Trimethoprim-sulfamethoxazole, which this patient was taking to prevent Pneumocystis infection, causes hypokalemia and therefore deterred this patient from presenting sooner.",
"Spironolactone, a commonly used diuretic for treating ascites in the setting of cirrhosis, acts as a competitive aldosterone inhibitor ... | B | Spironolactone, a potassium sparing diuretic by way of competitive inhibition of aldosterone at the collecting duct of the nephron, can lead to significant hyperkalemia in the setting of chronic kidney disease. Trimethoprim-sulfamethoxazole can also cause hyperkalemia by interfering with potassium exchange in the distal nephron. Heparin, including low-molecular-weight types, directly affects the zona glomerulosa of the kidney, reducing aldosterone production; it can lead to severe hyperkalemia in patients with already damaged kidneys. Adrenal insufficiency also leads to decreased aldosterone synthesis and hyperkalemia. Pseudo-hyperkalemia occurs precisely as described in option c, however, this patient had clinical signs and ECG changes consistent with true hyperkalemia. | train | med_mcqa | null |
All are associated with MEN-2 except - | [
"Pheochromocytoma",
"Islet cell hyperplasia",
"Medullary carcinoma thyroid",
"Parathyroid adenoma"
] | B | MEN type 2 (MEN 2), which is also called Sipple's syndrome, is characterized by the association of medullary thyroid carcinoma (MTC), pheochromocytomas, and parathyroid tumors. Three clinical variants of MEN 2 are recognized: MEN 2A, MEN 2B, and MTC only. Reference : page 2340 Harrison's Principles of Internal Medicine 19th edition | train | med_mcqa | null |
According to "rule of nines", burns involving perineum are: | [
"1%",
"9%",
"18%",
"27%"
] | A | Ans. A: 1% Rule of 9's for Adults: 9% for each arm, 18% for each leg, 9% for head, 18% for front torso, 18% for back torso 1% for perineum Rule of 9's for Children: 9% for each arm, 14% for each leg, 18% for head, 18% for front torso, 18% for back torso Lund-Browder diagrams improve the accuracy of the % TBSA for children. Palmar hand surface is approximately 1% TBSA | train | med_mcqa | null |
The fetal blood is separated from syncytiotrophoblast with all the following except | [
"Fetal blood capillary membrane",
"Mesenchyme of intervillous blood space",
"Cytotrophoblast",
"Decidua parietalis"
] | D | The decidua over the abembryonic pole is the decidua capsularis.
The chorionic cavity becomes larger. the decidua capsularis is stretched and degenerates.
The chorion leave now comes into close contact with the uterine wall on the opposite side, resulting in the formation of the decidua parietalis. | train | med_mcqa | null |
A patient was found to have high LDL, increased total cholesterol. But normal levels of LDL-Receptors. What is the most probable cause: | [
"Apo B100 mutation",
"Apo E defect",
"LCAT Deficiency",
"Lipoprotein lipase Deficiency"
] | A | This is Familial defective Apo B100, also known as Autosomal Dominant Hypercholesterolemia IIa. There is a mutation in the gene encoding Apo B100, specifically in LDL-receptor binding domain of Apo B100. | train | med_mcqa | null |
Progesterone pills act by which of the following mechanism? | [
"Thickening of cervical mucus",
"Inhibiting ovulation",
"Causing aseptic inflammation in endometrium",
"Destruction of embryo"
] | A | Ans. a (Thickening of cervical mucus). (Ref. Dutta, Obstetrics.4th/586, William Obstetrics 21st/1531)MINIPILLS (Progesterone Only Pills)# E.g., levenorgestrol 30 meg, norethistrone 350 meg.- They act by thickening the cervical mucus.- It is very useful as a emergency contraception.# Advantages- Side-effects attributed to estrogen are totally eliminated.- Lactational pill- No "on and off " regimen.- May be used by patients witha) Hypertension, Fibroid, DM,b) Epilepsy, Smoking, Thromboembolism.- Ideal for patients with sickle cell disease as progesterone is thought to treat bony crises.# Side-effects- Amenorrhea, at times breakthrough bleeding- All side effects are attributed to progesterone may be evident- Simple cyst of ovary# Failure rate = 0.5-2 HWY. | train | med_mcqa | null |
A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to damaged in this patient: | [
"Musculocutaneous nerve",
"Median nerve",
"Ulnar nerve",
"Radial nerve"
] | B | B i.e. Median Nerve | train | med_mcqa | null |
Vena comitans | [
"Veins accompanying nerves",
"Veins accompanying lymph vessels",
"Veins accompanying aeries",
"Veins accompanying veins"
] | C | Vena comitans are the Veins accompanying aeries. Vena comitans is a vein that is usually paired, with both veins lying on the sides of an aery. They are found in close proximity to aeries so that the pulsations of the aery aid venous return. | train | med_mcqa | null |
Which of the following is omega 6 fatty acid | [
"α - Linolenic acid",
"γ - Linolenic acid",
"Timnodonic acid",
"Cervonic acid"
] | B | Omega 6 fatty acids
Linoleic acid
γ Linolenic acid
Arachidonic acid.
Omega 3 fatty acids
α - linolenic acid
Timnodonic acid (Eicosapentaenoic acid)
Cervonic acid (Decosahexaenoic acid) | train | med_mcqa | null |
How many mm from the limbus is the safest site of intravitreal injection? | [
"1-2 mm",
"2-3 mm",
"3-4 mm",
"4-5 mm"
] | C | (Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 171)Intravitreal injection (distance from Limbus)For aphakics-3mmFor pseudophakes-3.5mmFor phakics-4mm | train | med_mcqa | null |
In the treatment of undiagnosed megaloblastic anemia, vitamin B12 and folic acid should be given together because : | [
"Vitamin B12 acts as a cofactor for dihydrofolate reductase",
"Folic acid alone causes improvement of anemic symptoms but neurological dysfunction continues.",
"Vitamin B12, deficiency may result in methylfolate trap",
"Folic acid is required for conversion of methylmalonyl CoA to succinyl CoA."
] | B | Vitamin B12 is required for conversion of methionine to homocysteine and for the formation of succinyl CoA from methylmalonyl CoA.
Deficiency of vitamin B12 results in megaloblastic anemia, GI manifestations and neurological abnormalities (due to demyelination).
Folic acid alone will correct the symptoms of megaloblastic anemia but it does not prevent neurological abnormalities, which continue to proceed.
Neurological abnormalities manifest initially in the form of loss of posterior column sensations (vibration, proprioception etc.), but later on, can result in subacute combined degeneration of the spinal cord. | train | med_mcqa | null |
Anterior uveitis is characterized by all except | [
"Aqueous flare",
"Shallow anterior chamber",
"Circumcorneal congestion",
"Miosis"
] | B | Various shape & size of anterior chamber in anterior uveitis
Normal
Funnel-shaped: In-ring synechiae
Deep : In complete posterior synechiae | train | med_mcqa | null |
Spinal anaesthesia in children is given at which level? | [
"Li - L2",
"L2-L3",
"L3- L4",
"L4-L5"
] | D | Ans. is 'd' i.e., L4 L5 Spinal anaesthesia In spinal anaesthesia LA is injected into subarachnoid space (space between pia matter and arachnoid matter). Structure pierced during SA (from outside in) - Skin - Subcutaneous tissue- Supraspinous & intraspinous ligament-Ligamentum falvum - Duramater- Arachnoidmater. Site of spinal anaesthesia L2.3 or L34 interveebral space in adult (In adult spinal cord ends at lower border of Ll veebrae). L4.5 interveebral space in children (spinal cord ends at lower border of L3 veebrae in children). Spinal anaesthesia leads to creation of a zone of differential blockade, ie motor fibres are blocked two levels lower and autonomic fibres are blocked two levels higher than the sensory blockade due to different sensitivity of different fibres. | train | med_mcqa | null |
Role of molecular oxygen in ETC - | [
"Transfer of reducing equivalent to CoQ",
"Transfer of reducing equivalent from cytosol to mitochondria",
"To act as last electron acceptor",
"Generation of ATP"
] | C | Ans. is 'c' i.e., To act as last electron acceptor Structural organizations of components of ETCo Components of respiratory chain do not function as discrete carriers of reducing equivalent but are organized into four complexes each of which acts as a specific oxidoreductase. Coenzyme Q and cytochrome C are not parts of any complex and are not fixed in the inner mitochondrial membrane. The other components are fixed in the membrane. These components are arranged in order of increasing redox potential. Therefore, reducing equivalents (electrons) flow in one direction, I - II - III - IV, only because redox couple with low redox potential is better electron donor where as the one with high redox potential is electron acceptor. Thus, reducing equivalents (electrons) flow through the chain from the components of more negative redox potential to the components of more positive redox potential.Complex I (NADH - CoQ reductase) catalyzes the transfer of electron from NADH to coenzyme Q (CoQ).Complex II (Succinate - CoQ reductase or succinate dehydrogenase) transfers electrons from succinate to coenzyme Q.Complex III (CoQ - cytochrome C reductase), transfers electron from CoQ to cytochrome C.Complex IV (cytochrome C oxidase) transfers electrons from cytochrome C to O,.o Molecular is the last electron acceptor in ETC.o The flow of reducing equivalents (electrons) is in following sequence. Most of the substrate transfer their reducing equivalents to NAD to form NADH, reaction is catalyzed by dehydrogenases. Reduced NADH is oxidized by NADH dehydrogenase (NADH-CoQ reductase), an enzyme which contains FMN as a coenzyme and also a Fe-S protein. NADH transfers reducing equivalents to FMN which, intum, transfers reducing equivalents to FeS. FeS transfers reducing equivalents to coenzyme Q (CoQ). Further transfer is in sequence of Cyt b - Fe-S - Cvt C 1, - Cytc --> Cyt a - Cyt a3 - O2o Succinate transfer its reducing equivalents to FADH2 which transfer them to Fe-S. Fe-S transfer these reducing equivalents to coenzyme Q (CoQ). Further sequence is same. | train | med_mcqa | null |
Why is a combination of Ranitidine and Sucralfate better avoided in patient with peptic ulcer disease? | [
"Ranitidine combines with sucralfate and prevents its action",
"Sucralfate inhibits ranitidine absorption",
"Ranitidine increases the gastric pH so sucralfate is not able to act",
"Combination of these two drugs produces serious side effects like agranulacytosis"
] | C | Sucralfate polymerizes at pH < 4 by cross linking of molecules, assumes a sticky gel like consistency, and then preferentially and strongly adheres to ulcer base. Ranitidine would increase the gastric pH (lower acidity) and prevent action of sucralfate by preventing its polymenzation which occurs at pH values < 4. Ref: KD Tripathi, 5th Edition, Page 596 ; Katzung, 9th Edition, Page 1043 | train | med_mcqa | null |
All are risk factors for preterm delivery except : | [
"Absence of fetal fibronectin at < 37 weeks",
"Previous history of preterm baby",
"Asymptomatic cervical dilatation",
"Chylamydial infection of genital tract"
] | A | Absence of fetal fibronectin at < 37 weeks | train | med_mcqa | null |
A 63-year-old man becomes febrile and begins expectorating large amounts of mucopurulent sputum. Sputum cultures are positive for Gram-positive diplococci. Which of the following mediators of inflammation provides potent chemotactic factors for the directed migration of inflammatory cells into the alveolar air spaces of this patient? | [
"Bradykinin",
"Histamine",
"Myeloperoxidase",
"N-formylated peptides"
] | D | Chemotactic factors are substance that stimulalte cellular migration The most potent chemotactic factors for leukocytes at the site of injury are:- Complement proteins (e.g., C5a) Bacterial and mitochondrial products, paicularly low molecular weight N-formylated peptides Products of arachidonic acid metabolism (especially LTB4) -Plasmin is a fibrinolytic enzyme generated by activated Hageman factor (clotting factor XII). | train | med_mcqa | null |
A 60 year old male had a sudden fall in toilet. His BP was 90/50 mm Hg and pulse was 100/mm. His relatives reported that his stool was black/dark in colour. Further careful history revealed that he is a known case of hypertension and coronary artery disease and was regularly taking aspirin, atenolol and sorbitrate. The most likely diagnosis is: | [
"Gastric ulcer with bleeding",
"Acute myocardial infarction with cardiogenic shock",
"Acute cerebrovascular accident",
"Pulmonary embolism"
] | A | Ans. a. Gastric ulcer with bleeding (Ref: Harrison 19/e p1918, 18/e p2444)In the given question, the 60-year old patient is presenting with black stool (melena) due to G.I. blood loss, history of aspirin use. So the diagnosis is most probably NSAID induced peptic ulcer disease."GI bleeding is the most common complication observed in PUD. It occurs in ~15% of patients and more often in individuals >60 years of age. The mortality rate is as high as 5-10%. The higher incidence in the elderly is likely due to the increased use of NSAIDs in this group. Up to 20% of patients with ulcer-related hemorrhage bleed without any preceding warning signs or symptoms."- Harrison 18/e p2444 | train | med_mcqa | null |
Normal expiratory reserve volume of adult? | [
"500 ml",
"3000 ml",
"1200 ml",
"4500 ml"
] | C | Ans. is 'c' i.e., 1200 ml(Ref: Ganong 24n/e p.629)Inspiratory reserve volume - 3000 mlExpiratory reserve voulume -1200 ml | train | med_mcqa | null |
Which of the following statements regarding the flow of lymph from lower limb is true? | [
"|ed with change from supine to standing position",
"|ed in increased capillary permeability",
"|ed in deep vein valve incompetence",
"|ed by massage of foot"
] | D | Normally. the fluid in lymph is massaged by muscle contractions of the organs and contraction of aerioles and venules, with which they are often associated which increases the flow through lymph vessels lacking valves and smooth muscle Thus by massaging foot lymph flow can be increased Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No: 550 | train | med_mcqa | null |
Which among the following is a non-freezing cold injury? | [
"Frost bite",
"Chilblains",
"Trench foot",
"Frost nip"
] | C | Cold injury: An injury caused by exposure to extreme cold that can lead to loss of body pas and even to death. Freezing: Examples of cold injury are chilblain, frostbite, and frostbite. Non-freezing cold injury (NFCI) is an injury to the hands or feet resulting from exposure to wet conditions and temperatures just above freezing, typically found in soldiers. EX: Trench (immersion) foot Ref : Park 23rd edition Pgno : 748 | train | med_mcqa | null |
The enzyme trypsin is specific for peptide bonds of: | [
"Basic amino acids",
"Acidic amino acids",
"Aromatic amino acids",
"Next to small amino acid residues"
] | A | Ans. A. Basic amino acidsTrypsin is an endopeptidase which cleave protein chains at internal peptidebonds, but each preferentially hydrolyses bonds adjacent to a particular type of amino acid residue. Trypsin cuts just next to basic residues (lysine or arginine); chymotrypsin cuts next to aromatic residues (phenylalanine, tyrosine or tryptophan). | train | med_mcqa | null |
In ADHD the comorbid condition is | [
"Learning disability",
"Schizhophrenia",
"OCD",
"Seizure"
] | A | Ans: a (Learning disability)ADHD :Cardinal features- Extreme and persistant restlessness,- Sustained and prolonged motor activity,- Difficulty in maintaining attention,- Impulsiveness and difficulty in withholding responses.Symptoms should atleast last for 6 monthsICD 10 requires that symptom should start before 6 yrs of ageComorbidityConduct disorder,Depressive disorder,Anxiety disorder,Learning disabilityLanguage impairmentTreatment1. Support and psychological Rx2. Medicationsstimulant drugs- if severe restlessness and attention deficitMethyl phenidates/e - irritablity .depression, poor appetite, insomnia, slowing of growthAmoxetines/e- nausea,abd pain,loss of apetite, sleep disturbance, severe liver damage | train | med_mcqa | null |
If we say that here is no significant association between two variable and if truly an association exists. Then it is called: | [
"Type I error",
"Type II error",
"Systematic error",
"Random error"
] | B | Null hypothesis (H0) there is No significant association In the given question, In reality an association exists, So Null hypothesis is false We say no significant association exists, so we are accepting Null hypothesis Hence its Type II error | train | med_mcqa | null |
All are the features of absence seizures except | [
"Usually seen in childhood",
"3-Hz spike wave in EEG",
"Postictal confusion",
"Precipitation by hyperventilation"
] | C | The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by drowsiness, confusion, nausea, hypeension, headache or migraine, and other disorienting symptoms Ref Harrison20th edition pg 2567 | train | med_mcqa | null |
The most common cause of Kaposi sarcoma? | [
"HHV7",
"HHV8",
"HHV9",
"HHV6"
] | B | Human herpesvirus type 8 is believed to be the cause of most cases of Kaposi's sarcoma. Roseola Infantum (Exanthem Subitum)has more than one cause: the most common is human herpesvirus type 6 and, less frequently, human herpesvirus type 7. Ref:Harrison's Principles of Internal Medicine, 18e, Chapter 119.Introduction to Infectious Diseases. | train | med_mcqa | null |
In chronic secretory otitis media, the treatment of choice is: | [
"Coical mastoidectomy",
"Radical mastoidectomy",
"Grommet tube inseion",
"Antibiotics and antihistaminic for 6 weeks"
] | C | Otitis media with effusion (glue ear) or non-suppurative otitis media or sero mucinous otitis media or exudative otitis media is a very common condition in children and majority of children experience at least one episode in their life. Primary cause is poor Eustachian tube function in children. As the O2 is continuously absorbed by the middle ear mucosa it results in negative middle ear pressure unless the Eustachian tube opens to replenish the ear. Negative pressure leads to transudation of fluid into the middle ear and if the hypoxia continues a mucoid exudate is produced by the glands of middle ear mucosa (glue ear). Majority of children need no treatment. but, if required, surgery is the only effective way of curing glue ear and both ventilation tube (grommet) and adenoidectomy are effective. Myringotomy should be followed by grommet inseion to maintain the aeration of middle ear. It should be left in situ for weeks or months or until it is spontaneously extruded. | train | med_mcqa | null |
Probable indicators of reversal of neuromuscular blockade are all Except | [
"Lift head for 5 seconds",
"Sustain hand grip for 5 seconds",
"Leg lift for 10 seconds",
"Ability to perform sustained tongue depressor test"
] | C | Clinical pointers for the reversal of neuromuscular blockade are:-Lift head for 5 seconds Lift leg for 5 secondsSustained hand grip for 5 seconds(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 203) | train | med_mcqa | null |
Proliferative diabetic retinopathy is treated by | [
"Pan retinal photocoagulation",
"Pars plana vitrectomy",
"Grid laser photocoagulation",
"Focal retinal photocoagulation"
] | A | Panretinal photocoagulation (PRP) is the preferred form of treatment of proliferative diabetic retinopathy(PDR). ... In cases where macular edema and PDR coexist, laser treatments are performed: first, laser treatment is used for the macular edema; then for PDR, the PRP is spread over 3 to 4 sessions Ref AK khurana 6/e p278 | train | med_mcqa | null |
Which amino acid spares the use of methionine - | [
"Cysteine",
"Glycine",
"Histidine",
"Arginine"
] | A | Ans. is 'a' i.e., Cysteine "Adequate dietary source of cysteine 'spares ' methionine".o Methionine is an essential amino acid.o Methionine is required for synthesis of cysteine (thus cysteine is non-essential amino acid)o Thus, cysteine can spare the requirment of methionine in diet. | train | med_mcqa | null |
Temperature used in Pasteurization is: | [
"72 for 20 min",
"63 for 30 min",
"100 for 10 min",
"94 for 20 min"
] | B | In Pasteurization, the milk is heated at either 63 for 30 min (holder method) or 72 for 15-30 sec followed by rapid cooling (flash process). Pasteurization of milk is an example of sterilization by moist heat. Pasteurization of milk (Sterilization by Moist heat): Low temperature-Long time Method (LTLT) High temperature sho time (HTST) Involves heating the milk to 63oC (144.5oF) and holding this for 30 minutes Involves heating the milk to 72oC (161.5oF) This method is typically used by milk banks which perform either the Holder method of pasteurization or the similar Vat method of pasteurization This process involves heating the milk faster and to a higher temperature than used with the Holder and Vat methods, and holding this for only a few seconds. Ultra-high temperature (UHT) method Involves heating the milk at a temperature of 138oC or 280oF and holding it for atleast two seconds. Milk labelled ultra-pasteurized or UHT must be treated with the UHT method By these processes all non-sporing bacteria such as Mycobacteria, Brucella and Salmonella are destroyed. Coxiella Brunetti is relatively heat resistant and may survive the holder method. Ref: Ananthanarayan and Panicker 10th edition &;Pgno: 30 | train | med_mcqa | null |
Moist heat burn which is present ? | [
"Charring",
"Blister",
"Ulcer",
"Slough"
] | B | .blisters are characteristic of moist burn | train | med_mcqa | null |
Tripeptide used for oxidation-raduction reaction - | [
"Creatinine",
"Glutathione",
"Melanin",
"None"
] | B | Ans. is 'b' i.e., Glutathione o Glutathione is a tripeptide0 made up of glutamate, cysteine and glycine (y-glutamyl-cysteiny 1-glycine).o Glutathione is present in all mammalian cells except neurons.o The sulphydryl (-SH) group of cysteine residue0 is the reactive portion of glutathione which can undergo oxidation and reduction.o Thus, glutathione may exist as the reduced (G-SH) or oxidized form (G-S-S-G) and can play a role in some oxidation- reduction reactions.o In oxidized form two molecules of glutathione are linked by disulfide bond. | train | med_mcqa | null |
In prostatic metastasis, the site most commonly involved is - | [
"Perivesical nodes",
"Obturator nodes",
"Pre-sacral nodes",
"Paraaoic nodes"
] | B | Lymphatic metastases are most often identified in the obturator lymph node chain."-Smith's Most common metastatic sites of prostate carcinoma are lymph nodes & bones Lymphatic metastasis occurs most commonly to - obturator lymph nodes Other lymph nodes involved are common iliac presacral periaoic Also Remember Most common bony metastasis occurs in (in decreasing order) lumbar spine (most common) proximal femur pelvis thoracic spine ribs sternum skull humerus The bone lesions of metastatic CaP are typically osteoblastic. Visceral metastases most commonly involve the lung, liver, and adrenal gland. Ref : Smith's Urology 17/e 359 | train | med_mcqa | null |
A patient present with frontal abscess. Foul smelling pus is aspirated. Pus shows red fluorescence on ultraviolet examination.The most likely organism causing the frontal abscess is - | [
"Bacteroides",
"Peptostreptococcus",
"Pseudomonas",
"Acanthamoeba"
] | A | null | train | med_mcqa | null |
False about Henoch Schonlein Purpura:- | [
"Type 3 Hypersensitivity",
"Palpable purpura due to thrombocytopenia",
"Mild glomerulonephritis",
"Polyarthralgia"
] | B | Palpable purpura is due to Vasculitis. | train | med_mcqa | null |
All are true about indirect ophthalmoscope except: | [
"Image is real and inveed",
"Details of fundus can be seen even with slightly hazy media",
"Magnification is more than direct ophthalmoscope",
"Used for seeing periphery of fundus"
] | C | C i.e. Magnification is more than direct ophthalmoscope Magnification of direct ophthalmoscope is 15 times where as of indirect ophthalmoscope is 4-5 times. Q | train | med_mcqa | null |
Skin graft vestibuloplasty prevent relapse by: | [
"Forming a barrier to reattachment of muscle to periosteum",
"Promoting osteogenesis to establish a bone barrier to loss of sulcus depth",
"Causing an inhibitory effect on fibroblasts in the underlying tissue",
"None of the above"
] | A | null | train | med_mcqa | null |
McNaughten Rule is concerned with : | [
"Criminal responsibility",
"Litigation",
"Rape",
"Suicide"
] | A | A i.e. Criminal responsibility | train | med_mcqa | null |
Complications of total thyroidectomy are all, EXCEPT: | [
"Hypocalcaemia",
"Hypercalcaemia",
"Hoarseness of voice",
"Parathyroid loss"
] | B | Nerves, parathyroids, and surrounding structures are all at risk of injury during thyroidectomy. Injury to the RLN may occur by severance, ligation, or traction, but should occur in Hypercalcemia is not a complication of total thyroidectomy. Ref: Lal G., Clark O.H. (2010). Chapter 38. Thyroid, Parathyroid, and Adrenal. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e. | train | med_mcqa | null |
The most important sign of significance of renal artery stenosis on an angiogram is – | [
"A percentage diameter stenosis > 70%",
"Presence of collaterals",
"A systolic pressure gradient > 20 mm Hg across the lesion",
"Post–stenotic dilatation of the renal artery"
] | B | The presence of arterial collaterals indicates that renal artery stenosis is hemodynamically significant. The diameter of stenotic segment may also give an indication of hemodynamic significance, but is only reliable if the stenosis is either very severe or minimal . | train | med_mcqa | null |
Treatment of red degeneration of fibroid in pregnancy: | [
"Analgesics",
"Laparotomy",
"Termination of pregnancy",
"Removal at cesarean section"
] | A | Ans. is a, i.e. AnalgesicsRef. Shaw 14/e, p 326; Dutta Obs. 6/e, p 309; Jeff coate 7/e, p 502Management of Red degeneration of fibroid.Patient is managed conservatively QPatient is put to bed rest and given analgesics Q (to relieve the pain), sedatives Q and, if required antibiotics QIf because of mistaken diagnosis laparotomy is done, abdomen is closed without doing anythingMyomectomy should never be contemplated during caesarean section as vascularity of fibroid is increased during pregnancy (due to increased estrogen) leading to increased blood loss during cesarean section. Q | train | med_mcqa | null |
A patient with intestinal malabsorption is found to markedly improve when flour products (bread, noodles, etc.) are removed from his diet. At the height of the patient's disease, marked histologic changes would be seen at which of the following sites? | [
"Distal large bowel",
"Distal small bowel",
"Entire large bowel",
"Proximal small bowel"
] | D | The patient has celiac disease, which is apparently an acquired hypersensitivity to the gluten (such as gliadin) in wheat. Unlike tropical sprue (which may be related to enterotoxigenic E. coli infection), which involves the entire small bowel, celiac sprue is usually limited to the proximal small bowel. This may occur because the gluten antigens have not yet been digested at this point in their journey through the bowel. A gluten-free diet usually restores the small bowel mucosa. | train | med_mcqa | null |
Risk factors for Retinal detachment are –a) Diabetic retinopathy b) Myopia c) Hypermetropiad) CRVOe) Retinopathy of prematurity | [
"abe",
"bcd",
"cde",
"acd"
] | A | Proliferative diabetic retinopathy and retinopathy of prematurity cause tractional retinal detachment.
Myopia causes rheugmatogenous retinal detachment. | train | med_mcqa | null |
SIADH- all are features except - | [
"Decreased sodium, maintaining the concentrating ability of the urine osmolality (> 100 mOsm)",
"Normal sodium balance maintained indicating excess urinary sodium is due to efficient sodium intake",
"Hypouricemia",
"Low blood pressure due to volume depletion"
] | D | The serum sodium concentration is normally regulated by -
The balance of water intake.
Renal excretion of sodium and
ADH mediated water conservation by distal renal tubule.
These processes are mediated by -
Stimulation of thirst
Secretion of ADH
Feedback mechanisms of the renin angiotensin aldosterone system and variation of renal handling of filtered sodium.
Disorders in any one of the these components of sodium balance can result in sodium imbalance.
Action of ADH
ADH is secreted by the posterior pituitary gland.
Its effect in kidney is mediated by the vasopressin. (V2 receptors) on the basolateral surface of the principal cells of the collecting duct.
The key action of ADH in the kidney is increasing the permeability of water. It allows water to be reabsorbed from the medullary interstitium thus enhancing water reabsorption.
In SIADH the A.D.H. level is inappropriately elevated
The inappropriately elevated level of vasopressin enhances the reabsorption of water thereby leading to.
Production of concentrated urine.
Inability to excrete water and consequently
Hyponatremia
Clinical features of SIADH
- Hyponatremie (sodium < 135 mEq/L)
- Inappropriately elevated urine osmolality (> 150 mosm/kg)
- Excessive urine sodium excretion ( Na > 30 mEq/L)
- Decreased serum osmolality- (< 280 mosm/kg)
These findings occur in
- Absence of diuretic therapy
- In the presence of euvulemia without edema
- In the setting of otherwise normal cardiac, renal, adrenal, hepatic and thyroid function.
Remember,
. The key to pathophysiological signs, symptoms and eventual treatment of SIADH is an understanding that the hyponatremia is a result of excess water and not a sodium deficiency.
Laboratory features of SIADH
Hyponatremia (sodium < 135 mEq/L)
B.U.1V. and serum uric acide tends to fallQ because of plasma dilution and increased excretion of nitrogenous products.
Serum potassium and Bicarbonate levels are normal in SIADH (hypokalemia and metabolic acidosis suggests, diuretic therapy or vomiting)
Low serum osmolality.
Remember,
These characteristic features of SIADH
There is increase in urinary concentration of sodium in the presence of hyponatremia.
There is increase in urine osmolarity in the presence of with decrease in serum osmolarity. | train | med_mcqa | null |
Most common ovarian tumor in less than 20 years is: | [
"Epithelial tumour",
"Germ cell tumour",
"Metastatic tumour",
"Sexcord stromal tumour"
] | B | null | train | med_mcqa | null |
Legionnaire's disease is caused most commonly by- | [
"Legionella pneumophila",
"Legionella micdadei",
"Pittsburgh agent",
"None of the above"
] | A | Ans. is 'a' i.e., Legionella pneumophila * Most common species infecting man is L pneumophila (most common serogroup 1). Other important species is L. micdadei (Pittsburgh pneumonia agent) which is partial acid fast.* At least 14 serogroups of L. pneumophila have been identified.* L. pneumophila serogroup 1 (SG 1) accounts nearly all severe infections.* L. pneumophila serogroup 6 is more commonly involved in hospital - acquired legionnaire's disease. | train | med_mcqa | null |
The most virulent plasmodium species causing malaria is: March 2013 (c) | [
"Vivax",
"Ovale",
"Falciparum",
"Malariae"
] | C | Ans. C i.e. Falciparum malaria Plasmodium falciparum It is a protozoan parasite, one of the species of Plasmodium that cause malaria in humans. It is transmitted by the female Anopheles mosquito. Malaria caused by this species (also called malignant or falciparum malaria) is the most dangerous form of malaria, with the highest rates of complications and moality. Almost every malarial death is caused by P. falciparum | train | med_mcqa | null |
vit B12 is found maximum in | [
"Animal products",
"Green leafy vegetables",
"Roots and tubers",
"All"
] | A | ref : lipincott | train | med_mcqa | null |
The posterior 1/3 of the tongue is supplied by....nerve | [
"Hypoglossal",
"Chorda tymapni",
"Lingual",
"Glossopharyngeal"
] | D | D i.e. Glossopharyngeal | train | med_mcqa | null |
Most sensitive imaging for ductal carcinoma insitu breast is | [
"Mammography",
"MRI",
"PET",
"USG"
] | B | Screening with MRI is superior to mammography in detecting invasive breast cancer in younger women, where the sensitivity of mammography is low due to presence of mammographically dense breast parenchyma. Ref: Grainger 5th edition Pgno: 1190, 1188 | train | med_mcqa | null |
All are known to produce parenchymatous conjunctival xerosis except | [
"Vitamin A deficiency",
"Stevens-Johnson syndrome",
"Trachoma",
"Diphtheric membranous conjunctivitis"
] | A | Xerosis of conjunctiva Depending upon the etiology, conjunctival xerosis can be divided into two groups, parenchymatous and epithelial xerosis. 1. Parenchymatous xerosis: It occurs following cicatricial disorganization of the conjunctiva due to local causes which can be in the form of (i) widespread destructive interstitial conjunctivitis as seen in trachoma, diptheric membranous conjunctivitis, Steven-Johnsons syndrome, pemphigus or pemphigoid conjunctivitis, thermal, chemical or radiational burns of conjunctiva, (ii) exposure of conjunctiva to air as seen in marked degree of proptosis, facial palsy, ectropion, lack of blinking (as in coma), and lagophthalmos due to symblepharon. 2. Epithelial xerosis: It occurs due to hypovitaminosis -A. Epithelial xerosis may be seen in association with night blindness or as a pa and parcel of the xerophthalmia (the term which is applied to all ocular manifestations of vitamin A deficiency which range from night blindness to keratomalacia. Epithelial xerosis typically occurs in children and is characterized by varying degree of conjunctival thickening, wrinkling and pigmentatiion. Reference :- A K KHURANA 7th ed; page:-84 | train | med_mcqa | null |
Insulin causes lipogenesis by all, EXCEPT: | [
"Increasing acetyl CoA carboxylase activity",
"Increasing the transpo of glucose into the cell",
"Inhibits PDH",
"Decreased intracellular cAMP level"
] | C | Insulin increases the activity of PDH (Pyruvate dehydrogenase). Insulin increases the recruitment of GLUT to the surface of various cells and thus increases the uptake of insulin various cells. Insulin has got inhibitory effect on adenylyl cyclase activity and so cause dephosphorylation. Insulin increases the activity of acetyl CoA carboxylase activity and thus has got stimulatory effect on lipogenesis. Also Know: Pyruvate Dehydrogenase is also regulated by Acyl-CoA: Acyl-CoA causes an inhibition of pyruvate dehydrogenase by inhibiting the ATP-ADP exchange transpoer of the inner mitochondrial membrane, which leads to increased intramitochondrial (ATP)/(ADP) ratios and therefore to conversion of active to inactive pyruvate dehydrogenase, thus regulating the availability of acetyl-CoA for lipogenesis. Fuhermore, oxidation of acyl-CoA due to increased levels of free fatty acids may increase the ratios of (acetyl-CoA)/(CoA) and (NADH)/(NAD+) in mitochondria, inhibiting pyruvate dehydrogenase. Insulin Also Regulates Lipogenesis by Other Mechanisms: Insulin stimulates lipogenesis by several other mechanisms as well as by increasing acetyl-CoA carboxylase activity. It increases the transpo of glucose into the cell (eg, in adipose tissue), increasing the availability of both pyruvate for fatty acid synthesis and glycerol 3-phosphate for esterification of the newly formed fatty acids, and also conves the inactive form of pyruvate dehydrogenase to the active form in adipose tissue, but not in liver. Insulin also--by its ability to depress the level of intracellular cAMP--inhibits lipolysis in adipose tissue and reducing the concentration of plasma-free fatty acids and, therefore, long-chain acyl-CoA, which are inhibitors of lipogenesis. Ref: Botham K.M., Mayes P.A. (2011). Chapter 23. Biosynthesis of Fatty Acids & Eicosanoids. 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 |
Mechanism of action in pathogenesis of Pseudomembranous colitis by CI difficle ? | [
"Due to invasiveness",
"Due to endotoxin",
"Due to exotoxin",
"Due to NM blockade"
] | C | Ans. is 'c' i.e., Due to exotoxin Pathogenesis of pseudomembranous colitis is due to production of two large toxins by C. difficile : i) Toxin A (an enterotoxin) Is a potent neutrophil chemoattractant Causes disruption of cell cytoskeleton by glycosylation of GTP - binding proteins that regulate the actin cell cytoskeleton. ii) Toxin B (a cytotoxin) Causes disruption of cell cytoskeleton by similar mechanism. | train | med_mcqa | null |
Inter Parietal suture is:- | [
"Serrate",
"Denticulate",
"Squamous",
"Plane"
] | A | Types of sutures are as follows:- 1) Serrate Suture:- The edges of bones present saw toothed appearance e.g. sagittal suture between two parietal bones. 2) Denticulate suture:-The margins present teeth with tips being broader than the roots e.g. lambdoid suture. 3) Squamous suture:- Here the edges of bones are united by overlapping e.g. suture between the parietal bone and squamous pa of temporal bone. 4) Plane suture:- The borders are plane and joined by sutural ligaments e.g. suture between palatine bones of two maxilla. Note: Schindylesis:-Ridged bone fits into the groove present on a neighboring bone e.g. Vomerosphenoid suture | train | med_mcqa | null |
TH1 cells produced by? | [
"Memory T cells",
"Cytotoxic T cells",
"Helper T-cells",
"Suppressor T cells"
] | C | Ans. is 'c' i.e., Helper T cells * T-cells constitutes 60%-70% of the circulating peripheral lymphocytes. Based on their surface markers, target cells and functions the following T cell category have been identified :-A) Helper T-cells (Inducer T-cells)# These cells constitute 60% of total T-cells. These have CD4 surface marker and bind to MHC class II (MHC class II restricted). There are following types of CD4 cells (Helper T-cells) :-1) Effector cells (Effector CD4 helper T-cells)* There are divided into :-i) TH-1 cells# These are activated by IFN-y and themselves produce IL-2, IFN-y and IL-12. These are the primary cells involved in delayed hypersensitivity, cell mediated immunity, macrophage activation and killing of intracellular microbes (M. tuberculosis, M. leprae).# These cells also induce destruction of target cells by activating T-cells to become cytotoxic T-cells and by activating NK cells.ii) TH-2 cells# These are activated by IL-4 and themselves produce IL-4, IL-5, IL-6 and IL-13. These cells facilatate synthesis of all antiboides except IgG2 b. These cells induce synthesis of IgE more efficiently and cause activation of mast cells and eosinophils. Therefore these cells provide defence against Helminthic parasites.iii) TH-17 cells# These cells are powerful recruiters of neutrophils and monocytes to play a role in severe inflammatory diseases. These cells produce IL-17, IL-22 and chemokines which recruit neutrophils and monocytes. TH-17 cells produce IL-21, which amplifies the TH-17 (self) response.2) Memory cells (Memory CD4 helper T-cells)* Provide memory, i.e., retain the antigenic affinity of the originally activated T cells and are used to act as later effector cells during a second immune response.B) Cytotoxic T-cells (Cytolytic T-cells)# These cells constitute 30% of total T-cells. These cells have CD8 surface marker and are MHC class I restricted.# They kill and lyse target cells including tumor cells, virus infected cells and allograft; and participate in type II Hypersensitivity.C) Suppressor T-cells# These cells have CD8 surface marker and are MHC class I restricted. These cells down regulate immune response. | train | med_mcqa | null |
Child born to mothers with Phenylketonuria will have all except | [
"Mental retardation",
"Macrocephaly",
"Growth retardation",
"Congenital heart disease"
] | B | Child born to mothers with Phenylketonuria will have :
Microcephaly
Growth retardation
Mental retardation
Congenital heart disease | train | med_mcqa | null |
The caloric test for vestibular functions, tests mainly which of the following? | [
"Ocular movements",
"Bilateral vestibular loss",
"Lateral semicircular canals",
"Tympanic perforation"
] | C | The caloric test is a gold standard investigation for unilateral vestibular deficit. It uses non-physiologic stimulus like water for air to induce endolymphatic flow in the semicircular canals by creating a temperature gradient from one side of the canal to another. It specifically tests the horizontal or the lateral semicircular canals because it develops the highest temperature gradient due to its location near the external auditory canal. The test has low sensitivity in bilateral loss. It tests only low frequencies. | train | med_mcqa | null |
Which intravenous anaesthetic agent has analgesic effect also | [
"Thiopentone",
"Propofol",
"Etomidate",
"Ketamine"
] | D | Ketamine does not elicit pain on injection, instead produces profound analgesia. Thiopentone at a concentration greater than 2.5% can produce pain on injection and venous thrombosis. Propofol is formulated as a lipid emulsion which causes pain on injection. A new aqueous prodrug, Fospropofol is associated with less pain on injection. Etomidate, although causes pain on injection, the lipid formulation of etomidate is associated with a much less frequent incidence of pain. | train | med_mcqa | null |
Characteristic hallucination of schizophrenia is | [
"Auditory hallucinations commanding the patient",
"Auditory hallucinations giving running commentary",
"Auditory hallucinations criticizing the patient",
"Auditory hallucinations talking to patient"
] | B | Ans. B. Auditory hallucinations giving running commentaryThird-person hallucinations, e.g. voices heard arguing, commenting or discussing the patient or giving a running commentary on one's action; are characteristic of schizophrenia.In schizophrenia auditory hallucinations are the most common type of hallucinations. First-person hallucination:- Audible self-thoughtsSecond person hallucination:- Voices address the person directly or commanding one's action andThird-person hallucinations:- voices heard arguing, commenting or discussing the patient or giving a running commentary on his action or thought. Only the "third person hallucinations' are characteristic of schizophrenia. | train | med_mcqa | null |
Gallstones may be complicated by which of the following? 1. Pancreatitis 2. Choledocholithisasis 3. Acute cholecystitis 4. Carcinoma stomach 5. Carcinoma pancreas | [
"1,2 & 3",
"2,3 & 4",
"1,3 & 5",
"2,3 & 5"
] | A | Effects and complications of gallbladder stones are: In Gallbladder In Bile ducts In the intestine Silent stone Acute cholecystitis Chronic cholecystitis Mucocele Empyema Perforation Gangrene Carcinoma Obstructive jaundice Cholangitis Acute pancreatitis Acute intestinal obstruction (Gallstone ileus) Ref: Bailey & Love 25/e, Page 1120. | train | med_mcqa | null |
All the following are true regarding superfecundation, EXCEPT: | [
"It is the feilization of 2 ova discharge at the same by 2 separate acts of coetus",
"Is associated with foetus papyraceus",
"The development of the twins in the uterus is equal",
"The spermatozoa causing the feilization may be from 2 different men"
] | C | In case of superfecundation the development of the twins in uterus is parallel but not equal. It depends on the relative blood supplies from the separately formed placentae. Also know Superfoetation - is the feilization of a second ovum in a woman who is already pregnant. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page - 334 | train | med_mcqa | null |
All of the following are characteristics of case control study except - | [
"Quick results are obtained",
"Measures incidence rate",
"Proceeds from effect to cause",
"Inexpensive study"
] | B | Ans. is 'b' i.e., Measures incidence rate o Incidence rate can not be measured by case-control study as denominator (population at risk is not available).ADVANTAGES1. Relatively easy to carry out.2. Rapid and inexpensive (compared with cohort studies).3. Require comparatively few subj ects.4. Particularly suitable to investigate rare diseases or diseases about which little is known.5. No risk to subjects6. Allows the study of several different aetiological factors (e.g., smoking, physical activity and personality characteristic in myocardial infarction).7. Risk factors can be identified. Rational prevention and control programmes can be established.8. No attrition problems, because case control studies do not require follow'-up of individuals into the future.9. Ethical problems minimal.DISADVANTAGES1. Problems of bias relies on memory or past records, the accuracy of which may be uncertain; validation of information obtained is difficult or sometimes impossible.2 Selection of an appropriate control group may be difficult.We cannot measure incidence, and can only estimate the relative risk (odds ratio).Do not distinguish between causes and associated factors.Not suited to the evaluation of therapy or prophylaxis of disease.Another major concern is the representativeness of cases and controls. | train | med_mcqa | null |
IOC for sub-arachnoid hemorrhage | [
"CT scan",
"MRI",
"Lumbar puncture",
"MRA"
] | A | Ans. (a) CT scanRef.: Harrison 19th ed. /1786* The diagnosis of subarachnoid hemorrhage (SAH) usually depends on a high index of clinical suspicion combined with radiologic confirmation via urgent computed tomography (CT) scan without contrast.* Traditionally, a negative CT scan is followed with lumbar puncture (LP). However, non-contrast CT followed by CT angiography (CTA) of the brain can rule out SAH with greater than 99% sensitivity. | train | med_mcqa | null |
Definition of family is? | [
"Biologically related members living together",
"Biologically related members living under single roof",
"Group of people living together and sharing a kitchen",
"Biologically related people living together and sharing a kitchen"
] | D | ANSWER: (D) Biologically related people living together and sharing a kitchenREF: Park 22nd ed page 634FAMILY:The family is Primary unit of all societies. It is a group of biologically related individuals living together and eating from a common kitchen. It differs from household. All members of household are not biologically related, e.g servants. A family is a biological unit, a cultural unit and an epidemiological unitFamily of origin : one in which an individual is bornFamily of procreation: in which one sets after marriageBASIC MODEL OF A NUCLEAR FAMILY CYCLEPhases of family cycleEvents No. descriptionBeginning of phaseEnd of phaseI. FormationMarriageBirth of 1st childII. ExtensionBirth of 1st childBirth of last childIII. Complete extensionBirth of last child1st child leaves homeIV. Contraction1st child leaves homeLast child leaves homeV. Complete contractionLast child leaves home1st spouse diesVI. Dissolution1st spouse diesDeath of survivor (extinction)TYPES OF FAMILY:Nuclear family {elementary family): consists of married couple and their children while they are still dependent.New families: <10 years durationExtended family (Three generation family): Representatives of three generations live together related to each other by common descent. It is different from joint familyJoint family:Many families live togetherAll male members are related by bloodThe property is common and expenses are from common purseAuthority is with senior male member | train | med_mcqa | null |
Nullity of marriage is considered when ? | [
"Adultery in first 7 years",
"Infeility of husband",
"Assault in first 7yrs",
"Age > 55years"
] | B | Ans. is 'b' i.e., Infeility of husband Under section 12 of Hindu Marriage Act 1955 or section 24 of Special Marriage Act 1954, a wife may seek divorce on the ground that her husband was impotent at the time of marriage and continues to be impotent therefore he is incapable of fulfilling the rights of consummation of marriage by an act of sexual intercourse. Conditions for nullity of marriage Any marriage can be declared null and void under following conditions:? 1) Bigamy, i.e. one spouse has made one more marriage 2) Impotence 3) If either pay is underage 4) If one spouse is having unsound mind at the time of marriage, virulent form of leprosy or veneral disease in a communicable form. 5) If one spouse has not been heard of as being alive for a period of 7 years or undergoing a sentence of imprisonment for 7 years. 6) If the consent has been obtained by coercion or fraud. 7) If the woman already pregnant with some one else's child at the time of marriage. | train | med_mcqa | null |
Ideal screening test should be | [
"Safe",
"Reliable",
"Valid",
"All of the above"
] | D | The criteria for screening are based on two consideration :
Disease to be screened, and
Screening test to be applied.
A) Disease to be screened
The disease should be an important health problem with a recognizable latent or asymptomatic stage.
There should be a test (screening test) which can detect the disease prior to clinical stage, with also availability of a diagnostic (confirmatory) test.
There should be an effective treatment which should reduce morbidity and mortality if started early. B) Screening test to be applied
The screening test to be applied should fulfil following criteria 1) Acceptibility
The test should be acceptable to the people whom it is aimed. 2) Repeatability (reliability)
The test must give consistent results when it is repeated more than once on the same individual under same condition, i.e. results of test must by precise (exact).
Thus, repeatability is also known as precision, reliability or reproducibility. 3) Validity (accuracy)
It refers to what extent the test accurately measures which is purports to measure.
Validity has two componens : i) Sensitivity ii) Specificity.
A test should have high sensitivity and specificity | train | med_mcqa | null |
All of the following are true regarding Bells palsy is all except: | [
"Herpes simplex virus is commonly implicated",
"Steroids are the treatment of choice",
"Unilateral facial weakness",
"Immediate nerve decompression is required"
] | D | Ans. d. Immediate nerve decompression is required (Ref: Dhingra 4th/94-95)Immediate nerve decompression is not required in Bell's palsy, initially steroids are given and recovery occurs in 85-90% cases. Nerve decompression relieves pressure on the nerve fibers and improves the microcirculation of nerve, done in non-responding cases.Bell's PalsyBell's palsy is responsible for 60-75% of facial paralysis.Defined as idiopathic, peripheral paralysis or paresis of acute onsetBoth sexes are affected equallyAny age group may be affected though incidence increases with agePositive family history in 6-8% casesIncreased risk of Bell's palsy in diabetics (angiopathy) and pregnant women (retention of fluid)Etiology:Viral Infections:Herpes simplexHerpes zosterEbstein-Barr virusVascular ischemia:Primary ischemia is induced by cold or emotional stressSecondary ischemia caused by increased capillary permeability leading to exudation of fluid, edema and compression of microcirculationHereditary:Narrow fallopian canal due to hereditary predispositionAutoimmune DisordersClinical Features:Onset is suddenPatient is unable to close his eyes, on attempting to close the eye, eye ball turns up and out (Bell's phenomenon)Saliva dribbles from angle of mouthFace becomes asymmetricalTears flow down from the eye (epiphora)Pain in ear may precede or accompany the nerve paralysisSome complains of noise intolerance (stapedial paralysis) or loss of taste (involvement of chord tympani)Paralysis may be complete or incompleteBell's palsy is recurrent in 3-10% cases.Diagnosis:Diagnosis is by exclusion. All other known causes should be excluded.Nerve excitability tests are done daily or alternate days and compared with normal side to monitor nerve degeneration.Localizing the site of lesion (topodiagnosis) helps in establishing the etiology and also the site of surgical decompression of the nerve, if that becomes necessary. Treatment:General:ReassuranceRelief of pain by analgesicsCare of the eyePhysiotherapy or massage of the facial muscles gives psychological support to the patient Medical:Steroids:Prednisone is the drug of choice.If the patient presents within 1 week, the adult dose of prednisone is 1 mg/kg/day divided in morning and evening doses for 5 days.Patient is seen on 5th day, if paralysis is incomplete or recovering, dose is tapered over next 5 days.If paralysis is remains complete, the same dose is continued for another 10 days and thereafter tapered in next 5 days (total of 20 days).Surgical Treatment:Nerve decompression relieves pressure on the nerve fibers and improves the microcirculation of nerve. Vertical and tympanic segments of nerve are decompressed. Prognosis:Full recovery in 85-90% casesIncomplete recovery in 10-15% casesRecurrent facial palsy may not recover fullyPrognosis is good in incomplete Bell's palsy (95% complete recovery) and in those where recovery starts within 3 weeks of onset (75% complete recovery). | train | med_mcqa | null |
True statement about H. pylori is | [
"Helicobacter pylori are characterized by curved gram-positive bacilli, multiple polar flagella, microaerophilic, and urease activity",
"Clinical manifestations include Type A gastritis",
"It is transmitted fecal-oral route",
"The most rapid test to detect H. pylori is the PCR"
] | C | Helicobacter pylori are characterized by curved gram-negative bacilli, multiple polar flagella, microaerophilic, and urease activity.Clinical manifestations include Type B gastritis, gastric ulcers, gastric adenocarcinoma, gastric MALT lymphomas conjunctivitis, or gastroenteritis.It is transmitted fecal-oral route.The most rapid test to detect H. pylori is the urease test or urea breath test.Antimicrobial treatment include a proton pump inhibitor (such as omeprazole), antibiotics, and bismuth. | train | med_mcqa | null |
A 23 Year old female presents with anemia and jaundice for 2 years. Peripheral smear shows spherocytes. The best investigation to be done is : | [
"Reticulocyte Count",
"Reticulocyte Count",
"Coombs Test",
"Bone Marrow Aspiration"
] | C | Answer is C (Coombs test) Presence of anemia and jaundice together with spherocytes in peripheral smear is consistent with the diagnosis of both 'hereditary spherocytosis' and 'immunohemolytic anemias'. Coomb's test is the single best next investigation here as it will establish the above distinction. According to Harrisons text: 'Hereditary spherocytosis must be distinguished primarily from the spherocytic hemolytic anemias associated with RBC antibodies.' Coonzb's test is positive in immune spherocytic hemolytic anemias and it is negative in hereditroy spherocytosis. "The diagnosis of immune spherocytosis is readily established by a positive coomb's test. - Harrison "Coomb's test is negative in hereditary spherocytosis." CMDT 06 Osmotic fratgliti, test will be positive in both hereditary spherocytosis and immune spherocytic hemolytic anemias. "Increased osmotic fragility merely reflects the presence of spherocytes and does not distinguish hereditary spherocytosis, from other spherocytic hemolytic disorders such as autoimmune hemolytic anemia." - CMDT 06 / 491 Coomb's test is the single best next investigation here as it will establish the above distinction. Causes of spherocytes in peripheral smear / Spherocytic hemolytic anemia Hereditary spherocytosis. Immunohemolytic anemias (Autoimmune hemolytic anemias). In association with hemolysis induced by splenomegaly in patients with cirrhosis. Clostridial infections. Ceain snake envenomations. G6PD deficiency (few spherocytes). | train | med_mcqa | null |
Obligate intracellular parasite among the following is | [
"Naegleria fowleri",
"Acanthamoeba",
"Toxoplasma",
"Balamuthia"
] | C | Obligate intracellular parasites cannot reproduce outside their host cell, meaning that the parasite's reproduction is entirely reliant on intracellular resources. Toxoplasma,Cryptosporidium Bacteria-chlamydia ,Rickettsia | train | med_mcqa | null |
Which of the following may be classified as a hydrophobic amino acid at pH 7.0? | [
"Isoleucine",
"Aginine",
"Aspaic acid",
"Lysine"
] | A | Amino acids having nonpolar side chains: These include Alanine, Valine, Leucine, Isoleucine, Methionine, Proline, Phenylalanine, and Tryptophan. These groups are hydrophobic (water repellant) and lipophilic. Therefore, the pas of proteins made up of these amino acids will be hydrophobic in nature.Ref: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 20-21 | train | med_mcqa | null |
Which of the following aery provides blood supply to lateral geniculate body? | [
"Anterior cerebral aery",
"Middle cerebral aery",
"Posterior cerebral aery",
"Posterior communicating aery"
] | C | Posterior cerebral aery supplies the posteromedial aspect of the lateral geniculate body and thus nourishes the fibers coming from the superior homonymous quadrants of the retina. Anterolateral aspect of the LGB is supplied by the anterior choroidal aery, and thus it supplies the fibers coming from the inferior homonymous quadrants of the retina. The region of the hilum which contains the macular fibers is supplied by a rich anastomoses from both the posterior cerebral aeries and anterior choroidal aeries. Venous drainage of LGB is through basal vein. Ref: Textbook of Ophthalmology edited by Sunita Agarwa page 317. | train | med_mcqa | null |
Post Superior Alveolar Nerve is a branch of: | [
"Mandibular",
"Facial",
"Lingual",
"Maxillary"
] | D | Posterior superior alveolar nerve is a direct branch of Maxillary Nerve. It supplies mainly the molar teeth. It also supplies the maxillary sinus, gingiva and inner cheek region. | train | med_mcqa | null |
Trypsin cleaves which amino acid? | [
"Glycine",
"Glutamate",
"Arginine",
"Aspartate"
] | C | Trypsin cleaves carboxy terminal of basic amino acids. Eg: Arginine, Lysine | train | med_mcqa | null |
All of the following are radiological features of scleroderrna except: | [
"Diffuse periosteal reaction",
"Oesophageal dysmotility",
"Erosion of the tip of the phalanges",
"Lung nodules"
] | A | Ans. Diffuse periosteal reaction | train | med_mcqa | null |
True statement about latch bridge mechanism | [
"Binding of tropomyosin to actin",
"Sustained contraction of smooth muscle with low consumption of energy",
"Variability of tension at particular length",
"None of the above"
] | B | Latch bridge mechanism is seen in smooth muscle. In smooth muscle, even after depolarisation of muscle cross bridge continue to cling for sometime leading to sustained contraction of smooth muscle. | train | med_mcqa | null |
Which presbyopic lens is used for 45 year old emmetropic individual? | [
"+0.5D",
"+1.0D",
"+1.5D",
"+2.0D"
] | B | Rough estimate for presbyopic add
45 yrs : +1.00 to +1.35 D
50 yrs : +1.50 to +1.75 D
55 yrs : +2.00 to +2.25 D | train | med_mcqa | null |
Most common cause of mitral stenosis is | [
"Rheumatic hea disease",
"Infective endocarditis",
"Diabetes mellitus",
"Congenital"
] | A | Refer robbins 9/e 554 Rheumatic hea disease (RHD) is damage to one or more hea valves that remains after an episode of acute rheumatic fever (ARF) is resolved. It is caused by an episode or recurrent episodes of ARF, where the hea has become inflamed. The hea valves can remain stretched and/or scarred, and normal blood flow through damaged valves is interrupted. Blood may flow backward through stretched valves that do not close properly, or may be blocked due to scarred valves not opening properly. When the hea is damaged in this way, the hea valves are unable to function adequately, and hea surgery may be required. Untreated, RHD causes hea failure and those affected are at risk of arrhythmias, stroke, endocarditis and complications of pregnancy. These conditions cause progressive disability, reduce quality of life and can cause premature death in young adults. Hea surgery can manage some of these problems and prolong life but does not cure RHD. | train | med_mcqa | null |
A 14-year-old presents to the OPD since she has not yet menstruated.On examination there is breast development and normal pubic hair growth. Which of the following best describes the normal sequence of pubeal changes in the female? | [
"Veical growth, menarche, thelarche, Pubarche",
"Pubarche,Veical growth,thelarche, menarche",
"Thelarche, Veical growth, Pubarche, menarche",
"Thelarche, Pubarche, Veical growth, menarche"
] | D | In girls, pubeal development typically takes place over 4.5 years .Sex steroid production during pubey stimulates development of secondary sex characteristics,growth of long bones which is the reason for veical growth spu. * The first sign of pubey is accelerated growth, and breast budding is usually the first recognized pubeal change, followed by the appearance of pubic hair, peak growth velocity, and menarche. Delayed or interrupted pubey No Periods or any secondary sex characteristics by age 13, Have secondary sexual characteristics but not had menarche by age 15 or have not attained menarche 5 or more years since the onset of pubeal development. *Please note: the question can confuse us sometimes. If asked about the overall first event in pubey, then its Accelerated general growth. But if asked the first specific sign of pubey, then breast budding is the answer. | train | med_mcqa | null |
What is safe maximum time for storage of kidney? | [
"24 hours",
"48 hours",
"36 hours",
"80 hours"
] | C | Optimal time for kidney transplant is within 18 hours. Max peroid is 36 hours. | train | med_mcqa | null |
The active site of an enzyme will bind to which of the following set of molecules indicated? | [
"Substrate of the Reaction - Yes; Allosteric Inhibitors - Yes; Competitive Inhibitors - Yes; Non-competitive Inhibitors - Yes",
"Substrate of the Reaction - Yes; Allosteric Inhibitors - No; Competitive Inhibitors - Yes; Non-competitive Inhibitors - Yes",
"Substrate of the Reaction - No; Allosteric Inhibitors - ... | C | The active site is formed when the enzyme folds into its three-dimensional configuration and may involve amino acid residues that are far apart in the primary sequence. Substrate molecules bind at the active site, as will competitive inhibitors (because the inhibitor reduces enzyme activity by competing with substrate for binding at the active site). Allosteric inhibitors bind at a site other than the active site, as do noncompetitive inhibitors (which reduce the Vmax without affecting the Km ). | train | med_mcqa | null |
A 38 year old woman with peptic ulcer disease of the duodenum experiences severe abdominal pain. Which of the following nervous structures is most likely involved? | [
"Greater splanchnic nerve",
"Ventral roots of the spinal nerve",
"Lower intercostal nerve",
"Lesser splanchnic nerve"
] | A | Foregut: (Duodenum) sympathetic supply - greater splanchnic nerve which carries pain sensation as well parasympathetic - vagus. Midgut: sympathetic supply - lesser splanchnic nerve, parasympathetic - vagus. Hind gut: sympathetic- least splanchnic nerve, parasympathetic - pelvic splanchnic nerve. | train | med_mcqa | null |
All are seen in hypothyroidism except - | [
"Weight gain",
"Cold intolerance",
"Diarrhoea",
"Menorrhagia"
] | C | Diarrhea is a feature of hyperthyroidism.
Hypothyroidism
Iodine deficiency is the most common cause of hypothyroidism
In area of iodine sufficiency, autoimmune thyroiditis (Hashimoto's disease) is the most common cause.
Clinical features of hypothyroidism
Weight gain, poor appetite
Cold intolerance, cool peripheral extremities.
Bradycardia, ↑ Diastolic BP
increased cholesterol, phospholips, triglyceride → Arteriosclerosis. | train | med_mcqa | null |
Effect of efferent aeriole constriction and afferent aeriole dilatation on GFR is? | [
"Increases",
"Decreases",
"No change",
"First increase then decrease"
] | A | Increases REF: Ganong's 22" chapter 38 Increase in renal blood flow increases GFR. Afferent aeriole brings blood to the nephron hence its dilation will increase renal blood flow, and efferent aeriole takes blood away from the nephrons, hence its constriction will cause increase filtration, hence increase in GFR. | train | med_mcqa | null |
Quarter staggered arrangement is seen in: | [
"Immunoglobulin",
"Hemoglobin",
"Collagen",
"Keratin"
] | C | Ans. C. CollagenTriple Helix in CollagenQuarter Staggered arrangement in CollagenCovalent cross links in collagenDesmosine cross links in elastin | train | med_mcqa | null |
Peussis vaccine side effect | [
"Local pain",
"Excessive cry",
"Fever",
"All of above"
] | D | Ans. is 'd' i.e., All of the above Peussis vaccine Available as whole cell and acellular as DTPw and DTPa Primary immunisation at 6, 10, 14 weeks followed by booster dose 1'/2 year and 5 year. Whole cell causes more side effect than acellular Side effect-local pain, redness, fever, irritability, excessive cry because of coical irritation. Contraindication Progressive neurological disease (Relative) Immediate anaphylasix Encephalopathy Persistent Inconsable cry Hypotensive - hyporesponsive episode | train | med_mcqa | null |
Thiamine deficiency is known to occur in all of the following except | [
"Food faddist",
"Homocystinemia",
"Chronic alcoholic",
"Chronic hea failure"
] | B | beriberi, may or may not be associated with hea failure and edema acute pernicious (fulminating) beriberi, in which hea failure and metabolic abnormalities predominate Wernicke encephalopathy is associated especially with alcohol and narcotic abuse ref harper 13th ed page 556 | train | med_mcqa | null |
Jiffy denture is a type of | [
"Interim immediate denture",
"Conventional complete denture",
"Fixed partial denture",
"Cast partial denture"
] | A | null | train | med_mcqa | null |
Protein A of Staphylococcus aureus is a pa of | [
"Cell wall",
"Genome",
"Limiting membrane",
"Plasmid"
] | A | Protien A, is the cell surface protien, present in most S.aureus strains, has many biological propeies, including chemotactic, antiphagocytic and anti-complementary effects. IT also induces platelet damage and hypersensitivity. Ref: Textbook of Ananthanarayan and paniker's; 10th Edition; Pg:203 | train | med_mcqa | null |
Lifespan of fetal RBC is- | [
"Same as adult RBC",
"1/4 of adult RBC",
"1/2 of adult RBC",
"2/3 of adult RBC"
] | D | Ans. (d) 2/3 of adult RBCRef: Ganong, 25th ed/p.555Life span of fetal RBCs is 60 to 90 days. It is about 2/3rd of adult RBCs life span | train | med_mcqa | null |
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