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A 20 year old girl presented with Raynaud's phenomenon, ahralgia, acrosclerosis, and mild myositis. She is positive for a distinctive antibody against U1-ribonucleoprotein (RNP). This antibody is a common finding in which of the following conditions?
|
[
"SLE",
"Scleroderma",
"MCTD",
"Dermatomyositis"
] |
Explanation:
Mixed connective-tissue disease (MCTD) is an overlapping of clinical features of systemic lupus erythematosus (SLE), scleroderma, and myositis.MCTD is associated with the presence of high titers of anti-U1RNP antibodies specifically directed against the proteins A, C, or 70K complexed with U1RNA. Anti-RNP bodies are, however, are not specific for MCTD as they are also seen in other connective tissue disorders. Absence of U1 RNP antibodies essentially rules out mixed connective tissue disorder. Ref: Diagnostic Criteria in Autoimmune Diseases edited by Yehuda Shoenfeld, Ricard Cervera, M. Eric Gershwin, 2008, Page 45 ; Harrison 17thedition, Table 325-4
|
c
| 2 |
medmcqa
|
Which of the following will be the most impoant adjuvant therapy in a case of fungal corneal ulcer :
|
[
"Atropine sulphate eye ointment",
"Dexamethasone eye drops",
"Pilocarpine eye drops",
"Lignocaine eye drops"
] |
Explanation:
A i.e. Atropine sulphate ointment
|
a
| 0 |
medmcqa
|
A pregnant woman with fibroid uterus develops acute pain in abdomen with low grade fever and mild leucocytosis at 28 weeks ,the most likely diagnosis is
|
[
"Preterm labour",
"Torsion of fibroid",
"Red degeneration of fibroid",
"Infection in fibroid"
] |
Explanation:
Red degeneration of fibroid: It results from softening of surrounding connective tissue The capillaries tend to rupture and blood effused out into the myoma causing a diffuse reddish discoloration The tumor it self assumes a peculiar purple red colour and develops a fishy odour,if the tumor is carefully examined We may find some vessels and large veins in the capsule thrombosed This is the most common complication with fibroid during pregnancy . And the patient is usually febrile and with moderate leucocytosis and raised ESR, the condition is aseptic one. And ultrasound is useful for diagnosis Ref Shaw 16/e pg 395
|
c
| 2 |
medmcqa
|
GIST associated marker is?
|
[
"CD 117",
"CD 34",
"CD 23",
"S-100"
] |
Explanation:
Ans. is 'a' i.e., CD 117 * The most useful marker of GIST is C-kit (CD-I 17). Other markers are CD 34, smooth muscle actin and vimentin.* Although CD 117 (c kit) is considered the most specific marker for GIST, it is not pathognomonic of GIST as other tumors may also express CD 117. These tumors include mast cell tumor, germ cell tumors (seminomas), leukemias, malignant melanoma, angiolipomas, and some sarcomas.
|
a
| 0 |
medmcqa
|
Tachypnoea is associated with the following agent:
|
[
"Ether",
"Halothane",
"Trilene",
"Cyclopropane"
] |
Explanation:
Trilene or trichloroethylene is a good analgesic, less depressant, and non-flammable. Cardiac dysrhythmia, or tachypnoea may occur during administration. It should not be used in the closed circuit as it reacts with soda-lime to produce a toxic gas (phosgene). Recovery is slow and nausea as well as vomiting may be present. It should not be used with adrenaline infiltration lest dysrhythmia be conveed to ventricular fibrillation. Ref: Anaesthesia and Resuscitation By Divekar, 2nd edition, Page 26.
|
c
| 2 |
medmcqa
|
All of the following act through GABA except -
|
[
"Phenobarbitone",
"Carbamazepene",
"Zopiclone",
"Muscimol"
] |
Explanation:
Ans. is 'b' i.e., Carbamazepene Gaba receptorso There are two types of GABA receptorsGABAa receptor - Intrinsic ion channel -increases Cl' conduction.GABAb receptor - G protein coupled receptor - hyperpolarizes neurones by increasing K+ conductance and altering Ca+2 flux.
|
b
| 1 |
medmcqa
|
In ophthalmology, muscle resection leads to
|
[
"Weakening of muscle",
"Strengthening of muscle",
"Muscle paralysis",
"No effect"
] |
Explanation:
Ans. (b) Strengthening of muscleRef Kanski 8/e, p. 769Weakening procedures on recti muscleStrengthening proceduresRecessionResection[?]Retro equatorial myopexy (FADEN)AdvancementMarginal myotomyDouble breasting or tuckingMyectomyCinchingFree tenotomy or disinsertionTransposition
|
b
| 1 |
medmcqa
|
Enzyme specific for gluconeogenesis -
|
[
"Glucose-6-phosphatase",
"Aldolase",
"Phosphoglycerate kinase",
"Phosphoglycerate mutase"
] |
Explanation:
Ans. is 'a' i.e., Glucose-6-phosphatase Enzyme in gluconeogenesiso Seven of the reactions of glycolysis are reversible and are used in the synthesis of glucose by gluconeogenesis. Thus, seven enzymes are common to both glycolysis and gluconeogenesis: (i) Phosphohexose isomerase; (ii) Aldolase; (iii) Phosphotriose isomerase; (iv) Glyceraldehyde 3-phosphate dehydrogenase; (v) Phosphoglycerate kinase; (vi) Phosphoglycerate mutase; (vii) Enolase.o Three of the reactions of glycolysis are irreversible and must be circumvented by four special reactions which are unique to gluconeogenesis and catalyzed by : (i) Pyruvate carboxylase, (ii) PEP carboxykinase, (iii) Fructose-1,6- bisphosphatase, (iv) Glucose-6-phosphatase.
|
a
| 0 |
medmcqa
|
Trendelenburg's sign is negative in an Inter-Trochanteric fracture because of:
|
[
"Gluteus medius",
"Gluteus maximus",
"Gluteus minimus",
"Tensor fascia lata"
] |
Explanation:
(d) Tensor fascia lata- In cases of fracture intertrochanteric femur both gluteus muscles become ineffective as these are inserted in greater trochanter. Tensor fascia lata (TFL) which is inserted through the iliotibial tract on to the lateral condyle of tibia will still be in a position to affect some abduction thereby causing a negative trendelenburg test.
|
d
| 3 |
medmcqa
|
Which of the following concerned with pain and temperature -
|
[
"Pyramidal tract",
"Anterior spinothalamic tract",
"Lateral spinothalamic tract",
"Dorsal column"
] |
Explanation:
Lateral spinothalamic tract - carry pain and temperature sensation of body. Pyramidal tract(coicospinal tract) - carry motor sensation of body from brain to muscles of limbs. Anterior spinothalamic tract - carry crude touch and pressure sensation. Dorsal column is for conscious proprioception, fine touch and vibaration.
|
c
| 2 |
medmcqa
|
Which villi is seen between 15th to 20th day after fertilization?
|
[
"Primitive",
"Primary",
"Secondary",
"Tertiary"
] |
Explanation:
Ans. is 'c' i.e., Secondary * Chorionic villi sprout from the chorion after their rapid proliferation in order to give a maximum area of contact with the maternal blood. These villi invade and destroy the uterine decidua while at the same time they absorb nutritive materials from it to support the growth of the embryo.* During the primary stage (primay villi formed on the 13th day following fertilization), the chorionic villi are small, nonvascular, and contain only the trophoblast. During the secondary stage (secondary villi formed on 16th day following fertilization) the villi increase in size and ramify, while the mesoderm grows into them; at this point the villi contain trophoblast and mesoderm.* During the tertiary stage (tertiary villi completed on 21st day) the branches of the umbilical vessels grow into the mesoderm; in this way, the chorionic villi are vascularized. At this point, the villi contain trophoblast, mesoderm, and blood vessels.
|
c
| 2 |
medmcqa
|
Although more than 400 blood groups have been identified, the ABO blood group system remains the most important in clinical medicine because :
|
[
"It was the first blood group system to be discovered.",
"It has four different blood groups A, B, AB, O (H).",
"ABO(H) antigens are present in most body tissues and fluids.",
"ABO(H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen."
] |
Explanation:
Ans. is 'd' i.e. ABO (H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen The basic difference between ABO blood group system and other blood group systems (such as Rh, Kell, Duffy, MNSs blood groups), which makes the ABO group so important is that -preformed ABO antibodies (agglutinins) are present in person serum when his RBCs lack the corresponding antigen (ie. anti B antibody would be present in a person of type A and type O blood groups. These two blood groups do not have the 'B' antigen on the RBCs)This is not the case with other blood groups. Preformed antibodies are not present. They are formed only after an exposure to the antigen, for example, an Rh-negative person do not have anti- Rh antibodies, these antibodies are formed only after an exposure to Rh-positive blood (by a blood transfusion, i.e. this makes the first blood transfusion safe even if mismatched)These preformed antibodies, rapidly destroy the RBCs of any mismatched blood transfusion.Read the following lines from the Journal of Hematology- "In clinical transfusion practice, the ABO blood groups are the most important and can never be ignored in red cell transfusion, because individuals who genetically lack any antigen, have antibodies against the red cell types that they have not inherited. These antibodies can destroy red cells rapidly in circulation"
|
d
| 3 |
medmcqa
|
The forcible separation of the head of the radius from the capitulum of the humerus is mainly prevented by the?
|
[
"Aicular capsule",
"Annular ligament",
"Quadrate ligament",
"Radial collateral ligament"
] |
Explanation:
The radial notch of the ulna and the annular ligament form a ring in which the head of the radius rotates at its aiculation with the capitulum of the humerus. The annular ligament narrows over the neck, cupping the head of the radius and preventing downward dislocation.
|
b
| 1 |
medmcqa
|
Which of the following is false about diaphragmatic injury
|
[
"Left side is common",
"Delayed presentation",
"Mesh repair is done",
"No resp distress"
] |
Explanation:
Its treated with mesh repair.
Respiratory distress occur as bowel enters chest cavity.
|
d
| 3 |
medmcqa
|
Fluconazole is used for the treatment of
|
[
"Pemphigus",
"Herpes simplex",
"Candidiasis",
"Syphilis"
] |
c
| 2 |
medmcqa
|
|
The best time to do chorionic villous sampling is
|
[
"Between 6-8 weeks",
"Between 7-9 weeks",
"Between 9-11 weeks",
"Between 11-13 weeks"
] |
Explanation:
Ans. is d i.e. Between 11 - 13 weeks Chorionic villi sampling "CVS is the second most common procedure for genetic prenatal diagnosis. Because this procedure is routinely performed at about 10 to 12 weeks of gestation, it allows for an earlier detection of abnormalities and a safer pregnancy termination, if desired."
|
d
| 3 |
medmcqa
|
Most valuable diagnostic test in a case of suspected ectopic pregnancy:
|
[
"Serial (3-hCG levels",
"Transvaginal USG",
"Progesterone measurement",
"Culdocentesis"
] |
Explanation:
Transvaginal ultrasound Repeat from Nov 09 Q no.161
|
b
| 1 |
medmcqa
|
A 28-year-old male complains of glare in both eyes. The cornea shows whorl-like opacities of the epithelium. He also gave a history of long-term treatment with amiodarone. The most likely diagnosis is –
|
[
"Terrain's marginal degeneration",
"Cornea verticillata",
"Band shaped keratophathy",
"Arcus juvenalis"
] |
Explanation:
Whorl like corneal opacities in corneal epithelium, in a patient on amiodarone, suggests the diagnosis of corneal verticillata.
|
b
| 1 |
medmcqa
|
The treatment of choice in recurrent venous thrombosis leading to pulmonary embolism despite intensive anticoagulation is:
|
[
"Fibrinolysis treatment with tissue plasminogen activator",
"Pulmonary embolectomy",
"Pulmonary thromboendaerectomy",
"Inferior vena caval filters"
] |
Explanation:
The two indications for inseion of an IVC filter are (1) active bleeding that precludes anticoagulation and (2) recurrent venous thrombosis despite intensive anticoagulation. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2176.
|
d
| 3 |
medmcqa
|
Least malignant thyroid cancer is:
|
[
"Papillary carcinoma",
"Follicular carcinoma",
"Medullary carcinoma",
"Anaplastic carcinoma"
] |
Explanation:
Ans is 'a' i.e. Papillary Cancer Important points about thyroid malignancy :Least MalignantPapillary CaMost MalignantAnaplastic CaMC type of thyroid cancer after radiationPapillary Ca*Latent period for radiation induced thyroid CaAbout 30 yrs*Type of thyroid cancer assoc with MEN syndromeMedullary Ca*Thyroid Ca assoc with amyloidosisMedullary Ca*Thyroid Ca assoc with dystrophic calcificationPapillary*Psammoma bodies are seen inPapillary Ca*Orphan Annie-eyed nuclei are seen inPapillary Ca*Thyroid cancer occurring in longstanding multinodular goitreFollicular Ca*Carcinoma derived from the C cells of thyroidMedullary*
|
a
| 0 |
medmcqa
|
True about heterochromic uveitis –
|
[
"Involves posterior surface of iris",
"Involves anterior part of iris",
"Involves posterior chamber",
"Posterior synechiae"
] |
Explanation:
In Fush's heterochromic iridocyclitis, anterior surface is involved more commonly.
"Inflammatory membranes are common over the anterior surface of the iris and anterior face of the ciliary body"...... Yanoff
|
b
| 1 |
medmcqa
|
A 53-year-old male smoker, unemployed with no occupational exposure, is admitted with progressive shoness of breath. He has been unwell for some time and has received multiple courses of antibiotics for "bronchitis." During the prior 4 mo, he has not had any medical follow-up. On exam, he is afebrile but looks ill. Lung exams reveal diffuse rhonchi and crackles with no localizing signs. ABGs on room air show PaO2 of 68 mm Hg with mild compensated respiratory alkalosis. Sputum for AFB is negative. CXR is shown.Associated with this diagnosis is
|
[
"Clubbing",
"Increased IgE",
"Hypocalcemia",
"Eosinophilia"
] |
Explanation:
This x-ray shows a bilateral generalized nodular pattern in all lung fields. There is an area of a masslike confluence in the left upper zone. The superior mediastinum appears widened primarily on the left side with a prominent right paratracheal node. Cardiophrenic and costophrenic angles are clear. This x-ray is consistent with left upper lobe mass with metastatic disease. This clinical scenario is consistent with metastatic carcinoma. The presence of a confluent density in the left upper lobe suggests the metastases probably arose from a lung primary malignancy. Diffuse pulmonary nodular metastases usually arise from a nonlung primary (70%). Clubbing is the most likely associated finding. Hypocalcemia is unlikely. Hypercalcemia is most commonly caused by bony metastases, especially with small cell carcinoma and adenocarcinoma. It is seen in squamous cell carcinoma as a result of humoral mediators with PTH-like activity. However, squamous cell carcinoma of the lung is a very infrequent cause of widespread pulmonary metastasis. Sputum for AFB would most likely be positive in this radiographic setting. Eosinophilia and increased IgE levels may be seen in the pulmonary infiltrates with eosinophilia syndrome, but there is no indication or history of fleeting infiltrates to suppo that diagnosis here.
|
a
| 0 |
medmcqa
|
Which of the following tracts is concerned with pain and temperature?
|
[
"Pyramidal tract",
"Anterior spinothalamic tract",
"Lateral spinothalamic tract",
"Dorsal spinocerebellar tract"
] |
Explanation:
Sensation carried
Posterior column (Dorsal column)
Proprioception (Position of body or limb, the position of joint)
Fine touch (two point discrimination, topognosis, stereognosis)
Vibration
Kinesthesia
Anterolateral system
Anterior spinothalamic tract → Crude touch
Lateral spinothalamic tract → Pain, Temperature
|
c
| 2 |
medmcqa
|
The anterior triangle occupy the side of the neck in front of sternomastoid muscle. Each triangle presents boundaries in front
|
[
"Anterior median line of the neck extending from symphysis menti to supra sternal notch",
"The midline of the neck",
"Midline of the neck upto the sternoclavicular joint",
"Posterior border of thyroid gland"
] |
a
| 0 |
medmcqa
|
|
A 9-month-old girl is brought with PR bleed, vomiting, mass in right lumbar region with masked liver dullness. She is in shock like condition. Management should include all of the following EXCEPT?
|
[
"Barium enema",
"IV fluid",
"Give O2",
"Nasogastric tube"
] |
Explanation:
* In patients with prolonged intussusception with signs of shock, peritoneal irritation, intestinal perforation, reduction (with barium, saline or air) should not be attempted * Urgent laprotomy should be planned * But the first priority is urgent resuscitation ie A, B, C (airway, breathing, circulation). Hence in case of shock, and as the child in question is also vomiting, she should be made NPO and Nasogastric tube inseion should be done.
|
a
| 0 |
medmcqa
|
Which of the following is NOT consistent with antemoem burns?
|
[
"Presence of marked cellular exudates",
"Presence of line of redness",
"Blisters containing air and thin clear fluid with yellow base",
"Presence of increased enzymatic reaction at peripheral zone of burns"
] |
Explanation:
In case of antemoem burns the blisters are filled with serous fluid and the base is red in colour. All the other options given are consistent with ante moem burns. Note that no inflammatory changes are seen in post-moem burns. Ref: Essentials of Forensic Medicine and Toxicology By Dr.K S Narayan Reddy, 21st Edition, Page 277
|
c
| 2 |
medmcqa
|
Wheal and flare reaction is what type of hyperstensitivity reaction?
|
[
"Type I",
"Type II",
"Type III",
"Type IV"
] |
Explanation:
Ans. a. Type I
|
a
| 0 |
medmcqa
|
Which of the following are responsible for conduction of pain impulse?
|
[
"Alpha",
"beta",
"delta",
"gamma"
] |
c
| 2 |
medmcqa
|
|
Methods to measure error of refraction are all except?
|
[
"Retinoscopy",
"Refractometry",
"Keratometry",
"Binocular balancing"
] |
Explanation:
Ans. is 'd' i.e., Binocular balancing Refraction The procedure of determining and correcting refractive errors is termed as refraction. The refraction comprises two complementary methods : ? Objective methods These are used to measure the error of refraction. These tests are :- Retinoscopy Keratometry Refractometry Subjective refraction Subjective refraction is meant for finding out the most suitable lenses to be prescribed. The proper subjective refraction includes three steps. Subjective verification of refraction Subjective refining of refraction Subjective binocular balancing
|
d
| 3 |
medmcqa
|
Rat bite fever may be caused by -
|
[
"Leptospira canicola",
"Streptobacillus moniliformis",
"Borrelia recurrentis",
"Yersinia"
] |
Explanation:
Ans.is 'b' i.e., Streptobacillus moniliformis Rat bite fever* Rat bite fever (RBF) is characterized by relapsing fever, rash, and arthralgia occuring after a rat bite.* Two different bacteria can cause the condition1. Streptobacillus moniliforms2. Spirillum minus
|
b
| 1 |
medmcqa
|
Anabolic steroids may produce the following side effects except ?
|
[
"Precocious pubey in children",
"Cholestatic jaundice",
"Delayed closure of epiphysis in children",
"Acne in males and females"
] |
Explanation:
Ans. is 'c' i.e., Delayed clossure of epiphysis in children
|
c
| 2 |
medmcqa
|
Following an overdose of an over-the-counter (OTC) drug, a young college student has marked GI distress and is lethargic and confused, with elevated body temperature. Lab analysis of blood reveals |pCO2--|HCO3---|K+and an anion gap acidosis. The most likely cause of these signs and symptoms is a toxic dose of
|
[
"acetaminophen",
"acetylsalicylic acid",
"diphenhydramine",
"pseudoephedrine"
] |
Explanation:
If the patient had been able to mention tinnitus, this would be a classic case of aspirin poisoning. At high salicylate blood levels, the combination of effects leading to respiratory depression (respiratory acidosis) and metabolic acidosis results in the observed pH and electrolyte changes, the anion gap (a marker for acidosis), and hyperthermia.
|
b
| 1 |
medmcqa
|
Dementia of Alzheimer&;s type is not associated with one of the following
|
[
"Depressive symptoms",
"Delusions",
"Apraxia and Aphasia",
"Cerebral infarcts"
] |
Explanation:
Dementia is a chronic organic mental disorder, characterized by the following main clinical features: 1. Impairment of intellectual functions, 2. Impairment of memory (predominantly of recent memory, especially in early stages), 3. Deterioration of personality with lack of personal care. Reference: A sho textbook of Psychiatry by Niraj Ahuja, page no.22.
|
d
| 3 |
medmcqa
|
The commonest cause of primary Amenorrhoea is:
|
[
"Genital tuberculosis",
"Ovarian dysgenesis",
"Mullerian duct anomalies",
"Hypothyroidism"
] |
Explanation:
Most common cause of Primary Amenorrhea = Gonadal dysgenesis/ovarian dysgenesis
2nd most common cause of Primary Amenorrhea = Mullerian agenesis (Mayer Rokitansky Kuster Hauser Syndrome)
“Mullerian agenesis is a relatively common cause of primary amenorrhea, more frequent than congenital androgen insensitivity and second only to gonadal dysgenesis”
3rd most common cause is testicular feminizing syndrome.
|
b
| 1 |
medmcqa
|
Which of the following factors are activated by vitamin K
|
[
"Factor II",
"Protein C",
"Protein S",
"All of the above"
] |
Explanation:
Vitamin K activates clotting factors like factor II, VII, IX and X. It also activates anti - clotting proteins like Protein C & Protein S.
|
d
| 3 |
medmcqa
|
A 58-year-old female employee of a housecleaning business visits the outpatient clinic with a complaint of constant, burning pain in her knees. Clinical examinations reveal a "housemaid's knee" condition. Which of the following structures is most likely affected?
|
[
"Prepatellar bursa",
"Infrapatellar bursa",
"Posterior cruciate ligament",
"Patellar retinacula"
] |
Explanation:
(a) Source: GAS 577, 578; GA 306 Excessive compression of the prepatellar bursa, as in working on bended knees, can result in pain and swelling of the prepatellar bursa, the socalled housemaid's knee. Prepatellar bursitis affects plumbers, carpet layers, and other people who spend a lot of time on their knees. The bursa normally enables the patella to move smoothly under the skin. The constant friction of these occupations irritates this small lubricating sac (bursa) located just in front of the patella, resulting in a deformable tense cushion of fluid. Treatment usually requires simple drainage, but this may need to be repeated and occasionally steroids introduced. Excessive irritation of the infrapatellar bursa in kneeling for frequent and long periods of time (as in prayer) can result in "parson's knee." The posterior cruciate ligament of the knee can be injured in sudden, strong flexion of the knee, with posterior displacement of the tibia upon the femur. The patellar retinacula are strong, tendinous bands of tissue that join the quadriceps tendon to the vastus lateralis and medialis muscles. The lateral meniscus is a cartilaginous structure between the lateral condyles of the femur and tibia.
|
a
| 0 |
medmcqa
|
All are true about Coho studies EXCEPT: September 2012
|
[
"Prospective",
"Useful for rare diseases",
"Necessary for incidence",
"Costly as compared to case control studies"
] |
Explanation:
Ans: B i.e. Useful for rare diseases Case control studies Advantages Good for studying rare conditions or diseases Less time needed to conduct the study because the condition or disease has already occurred Lets you simultaneously look at multiple risk factors Useful as initial studies to establish an association Can answer questions that could not be answered through other study design Disadvantage Retrospective studies have more problems with data quality because they rely on memory and people with a condition will be more motivated to recall risk factors (also called recall bias). Not good for evaluating diagnostic tests because it's already clear that the cases have the condition and the controls do not It can be difficult to find a suitable control group Coho studies Advantages Subjects in cohos can be matched, which limits the influence of confounding variables Standardization of criteria/outcome is possible Easier and cheaper than a randomized controlled trial (RCT) Disadvantages Cohos can be difficult to identify due to confounding variables No randomization, which means that imbalances in patient characteristics could exist Blinding/masking is difficult Outcome of interest could take time to occur
|
b
| 1 |
medmcqa
|
Muscles paralysed in Erb's paralys are all except?
|
[
"Biceps",
"Triceps",
"Brachioradialis",
"Brachiali"
] |
Explanation:
Ans. is 'b' i.e., Triceps Erb's paralysis One region of upper trunk (C5, C6) of the brachial plexus is called Erb's point where six nerves meet. o Injury at this point results in Erb's paralysis The injury is due to undue separation of the head from the shoulder, which may be seen in : ? Bih injury Fall on the shoulder During Anesthesia Clinical features of Erb's palsy Muscles paralysed : Mainly biceps brachii, deltoid, branchialis and brachioradialis. Paly supraspinatus, infraspinatus and supinator. Deformity (position of the limb) Arm : Hanges by the side; it is adducted and medially rotated Forearm : Extended and pronated The deformity is known as 'policeman's tip hand' or 'poer's tip hand'. Disability : The following movements are lost. Abduction and lateral rotation of the arm (shoulder). Flexion and supination of the forearm. Biceps and supinator jerks are lost. Sensations are lost over a small area over the lower pa of the deltoid
|
b
| 1 |
medmcqa
|
True about calcium reabsorption in kidney ?
|
[
"Most of the calcium reabsorption occurs in DCT",
"Major regulating factor is parathormone",
"Parathormone decreases calcium reabsorption",
"Increased plasma phosphate decreases calcium reabsorption"
] |
Explanation:
Ans. is 'b i.e., Major regulating factor is parathormone Calcium excretion by kidney Calcium is both filtered and reabsorbed in kidneys but not secreted. Thus renal excretion of kidney is - Renal calcium excretion = Filtered calcium - Calcium reabsorbed Normally, 99% of filtered calcium is reabsorbed in kidney. 1) PCT : Maximum calcium is reabsorbed in PCT. About 65% of filtered calcium is absorbed here. 2) Loop of Henle : About 25-30% of calcium is reabsorbed in loop of Henle (only from thick ascending limb). 3) DCT and collecting tubules : About 4-9% of calcium is reabsorbed in DCT and collecting tubules. Primary controller of renal tubular reabsroption is parathormone. It increases calcium reabsorption in Loop of Henle (thick ascending limb) and distal tubules. Vitamin D (calcitriol) and calcitonin also stimulate calcium absorption in thick ascending limb of loop of Henle and distal tubule, although these hormones are not as impoant quantitatively as PTH in reducing renal excretion.
|
b
| 1 |
medmcqa
|
An X-linked recessive disease is characterized by the following inheritance :
|
[
"Veical transmission",
"50% female carriers if male is affected and female is normal",
"50% male affected if female is carrier and male is normal",
"50% male carriers if female is affected and male is normal"
] |
Explanation:
Answer is C (50% male affected if female is carrier)
|
c
| 2 |
medmcqa
|
A 54-year-old diabetic patient repos to his physician's office complaining of an unresolved skin lesion on his foot. The lesion began several weeks ago as a blister and has since become a painful, erosive, expanding sore. On examination, the affected site is now 5 cm in diameter, with a black necrotic center and raised red edges. Which of the following toxins has a mechanism of action most similar to the toxin responsible for tissue damage in this patient?
|
[
"Anthrax toxin",
"Botulinum toxin",
"Cholera toxin",
"Diphtheria toxin"
] |
Explanation:
This patient's wound is infected with Pseudomonas aeruginosa, and the characteristic lesion described is called ecthyma gangrenosum. The Pseudomonas alpha toxin, which is responsible for the tissue damage, inhibits protein synthesis by acting on EF-2 with a primary target cell in the liver. The diphtheria toxin has a similar action, although its target cells are hea and nerve. Anthrax toxin is an adenylate cyclase that causes fluid loss from cells. Botulinum toxin is a neurotoxin that decreases acetylcholine synthesis. Cholera toxin acts to increase adenylate cyclase activity by ribosylation of GTP-binding protein. Ref: Brooks G.F. (2013). Chapter 16. Pseudomonads, Acinetobacters, and Uncommon Gram-Negative Bacteria. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
|
d
| 3 |
medmcqa
|
False about celiac disease
|
[
"Villous atrophy",
"Crypt hyperplasia",
"Infiltration of lymphocytes",
"Villous hyperplasia"
] |
Explanation:
It is a malabsorption syndrome characterised by significant loss of villi in the small intestine and thence diminished absorptive surface area. The condition occurs in 2 forms- childhood and adult type. Childhood form referred to as coeliac disease. Adult form called idiopathic steatorrhea. Both forms are histologically similar. In Paial villus atrophy, There is shoening and blunting of the villi with reduction in their height. There is crypt hyperplasia. In Subtotal villous atrophy, There is near total flattening of the villi and crypt hyperplasia. Lamina propria shows increased number of plasma cells and lymphocytes. REF: TEXTBOOK OF PATHOLOGY 6TH EDITION HARSH MOHAN PAGE NO:575 IMAGE REF:
|
d
| 3 |
medmcqa
|
Biological value is maximum of:
|
[
"Egg",
"Milk",
"Soyabean",
"Pulses"
] |
Explanation:
Egg
|
a
| 0 |
medmcqa
|
Extensive pleural thickening and especially involving the diaphragmatic pleura are classical feature of
|
[
"Coal worker's pneumoconiosis",
"Asbestosis",
"Silicosis",
"Siderosis"
] |
Explanation:
(Asbestosis) (263-CMDT- 08) (1612-14-H17th)ASBESTOSIS - is a nodular interstitial fibrosis occuring in asbestos workers and miners is characterized by a in exorably progressive dyspnea, inspiratory crackers and in some cases clubbing and cyanosis* Radiographic features - include interstitial fibrosis, thickened pleura and calcified plaque (pleural) on the diaphragm or lateral chest wall*** HRCT is the best imaging method*** Cigarette smoking in asbestos workers increases the incidence of lung carcinoma* PFT shows - restrictive dysfunction and diffusing capacity
|
b
| 1 |
medmcqa
|
A newborn baby presents with shock, hyperkalemia and hypoglycemia. What is the most likely diagnosis –
|
[
"Septicemia",
"Inborn error of metabolism",
"Diabetes mellitus",
"Congenital adrenal hyperplasia"
] |
d
| 3 |
medmcqa
|
|
A 40-year-old lady intraoperatively develops HR = 220 bpm and Blood pressure of 70/40, ECG shows qRS complex =120 milliseconds. What is the best management?
|
[
"Adenosine 6 mg/12 mg",
"Amiodarone",
"DC cardioversion",
"Esmolol"
] |
Explanation:
Here in the question vital are unstable. so best therapy will be DC cardioversion Normal qRS complex = 0.08-0.1 sec. Prolonged QRS suggestive of: 1. Atrial fibrillation with ventricular pre-excitation (AVN) 2. Ventricular tachycardia Diagnostic criteria for ventricular tachycardia are: Presence of qRS duration >140 ms in the absence of drug therapy. Superior and rightward qRS frontal plane axis, Bizarre qRS complex that does not mimic the characteristic qRS pattern associated with left or right bundle branch block Slurring of the initial poion of the qRS Hence the pt. is not having Ventricular Tachycardia. In patients who manifest pre-excitation and AF--> therapy should be aimed at preventing a rapid ventricular response. In life-threatening situations, DC cardioversion should be used to terminate the AF. Vagal stimulation with the Valsalva maneuver and carotid sinus pressure may create sufficient AV nodal slowing to terminate the AV. Intravenous administration of adenosine, 6-12 mg, is first-line pharmacologic therapy; the calcium channel blockers verapamil and diltiazem or beta blockers may also be effective.
|
c
| 2 |
medmcqa
|
Imatinib mesylate used in the treatment of GIST is a inhibitor of
|
[
"IL-12",
"TNF-x",
"Tyrosine kinase",
"VEGE"
] |
Explanation:
Imatinib mesylate used in the treatment of GIST ( GastroIntestinal Stromal Tumours) is a c-kit(transmembrane receptor tyrosine kinase) tyrosine kinase inhibitor. GIST is rare but most common nonepithelial small bowel tumours. More than 95% show c-kit mutation. Reference : page 877 SRB's manual of surgery 5th edition
|
c
| 2 |
medmcqa
|
Salt losing nephritis is a feature of:
|
[
"Interstitial nephritis",
"Polycystic kidney",
"Lupus nephritis",
"Renal amyloidosis"
] |
Explanation:
Ans. is 'a' interstitial nephritis One of the important functional consequence of interstitial nephritis is salt wasting.Interstitial nephritis is caused by drugs such as methicillin* or penicillin*It is a type of tubulointerstitial disease in which there is tubular degeneration and necrosis and marked inflammation of interstitium.
|
a
| 0 |
medmcqa
|
Cementum covers resected root end in:
|
[
"12 days",
"20 days",
"28 days",
"8 weeks"
] |
Explanation:
Proliferation of granulation tissue from the severed PDL was observed at 4 days, and the tissue had completely encapsulated the root end at 8 days. In the experimental groups, cementum deposition was observed at 12 days, and by 16 days, cementum covered more than 50% of the surface areas of the resected root ends.
The complete healing will take around 4 weeks.
|
c
| 2 |
medmcqa
|
False about paial mole
|
[
"Caused by triploidy",
"Can be diagnosed very early by USG",
"Can present as missed aboion",
"Rarely causes persistent GTD"
] |
Explanation:
Ans. is b i.e. can be diagnosed very early by USG Paial moles Paial moles or incomplete molar pregnancy means that along with the hydatidiform changes some element of fetal tissue is present They have a triploid karyotype (69 chromosomes)deg, the extra haploid set of chromosomes usually is derived from the fatherdeg. Characteristic pathological features of paial mole Chorionic villi of varying sizes with focal hydatiform swelling, cavitation and trophoblastic hyperplasia Marked villous scalloping Prominent stromal trophoblastic inclusions Identifiable embryonic or fetal tissue. Clinical features -- hey generally do not have the dramatic clinical features characteristic of complete pt general these patients have the signs and symptoms of incomplete or missed aboion, and paial mole can be diagnosed after histologic review of tissue obtained by curettage". Features like hyperemesis, hypehyroidism and Theca lutein cysts are rare in paial mole. Prognosis "The risk of persistent trophoblastic disease after a paial mole is substancially lower than following a complete molar pregnancy. Moreover, persistent disease is seldom a choriocarcinoma." The risk of persistent trophoblastic disease in a case of paial mole is 1-5% wherease with complete mole, it is 15-20% Hence option d i.e. it rarely causes persistent trophoblatic disease is paially correct Diagnosis -- of paial mole by USG is not that easy as is in the case of complete mole because it does not give the characteristic vesicular & ultrasonographic appearance like a complete mole. "Sonographic features of a paial mole include a thickened, hydropic placenta with fetal tissue. Impoantly, in early pregnancy, sonographv will demon t te the rho raeristic appearance in as few as third of women with a paial mole" ... Williams Obs 23/ed pg-260 Hence Option b i.e. it can be diagnosed very early by USG is incorrect Remember - - The USG criteria for diagnosis of paial mole is Presence of focal cystic areas in the placental tissues . Increase in transverse diameter of gestational sac. The combination of above two criterias have a positive predictive value of 90% for paial moles . (This means USG can diagnose paial mole but not in early pregnancy) The nonble fetus associated with a triploid paial mole typically has multiple malformations, like syndactyly and hydrocephaly and have symmetrical growth retardation. 13 hcg levels > 200 m IU/rni, after evacuation of paial mole in the third through the eighth week are associated with a 35% risk of persistent trophoblastic disease. Extra edge The most significant recent development in the pathological analysis of H. mole is the use of P57kip2 immunostaining to make a definitive diagnosis of androgenetic complete H. Mole as opposed to an hydropic aboion or a paial mole. P57kip2 is a paternally imprinted gene. which is maternally expressed. The absence of maternal genes in androgenetic complete mole means that the gene cannot be expressed in a complete mole cytotrophoblast Hence V kip2 staining is negative in complete mole in contrast to paial moles, hydropic aboion & normal placenta. This technique is well validated, easy and inexpensive to perform.
|
b
| 1 |
medmcqa
|
Corpus luteum is maintained by :
|
[
"Progesterone",
"LH",
"FSH",
"Estrogen"
] |
Explanation:
B i.e. LHAction of LH areStimulates ovulation12.Formation & maintenance of corpur luteumQFormation of progesterone in the corpus leutieum from the lutein cellsQ.
|
b
| 1 |
medmcqa
|
RHD diagnostic criteria include
|
[
"Oral ulcer",
"Malar rash",
"Erythema marginatum",
"Nail telengectasia"
] |
Explanation:
Erythema marginatum is a cutaneous finding associated with acute rheumatic fever. The lesions typically develop 7 days to months after the onset of the streptococcal pharyngitis or, rarely, streptococcal skin infections. Erythema marginatum occurs in about 10% cases of acute rheumatic fever. Jones criteria is used for diagnosis of rheumatic fever . Its shown in the following picture Ref Davidson edition23rd pg 532
|
c
| 2 |
medmcqa
|
Neurological manifestations of Wilson's disease include all except?
|
[
"Cerebellar ataxia",
"Peripheral neuropathy",
"Chorea",
"Dysphagia"
] |
Explanation:
The neurologic manifestations of Wilson's disease typically occur in patients in their early twenties. MRI and CT scans reveal damage in the basal ganglia and occasionally in the pons, medulla, thalamus, cerebellum, and subcoical areas. The three main movement disorders include dystonia, incoordination and tremor. Dysahria and dysphagia are common. In some patients, the clinical picture closely resembles that of Parkinson's disease. Dystonia can involve any pa of the body and eventually leads to grotesque positions of the limbs, neck, and trunk. Autonomic disturbances may include ohostatic hypotension and sweating abnormalities as well as bowel, bladder, and sexual dysfunction. Memory loss, migraine-type headaches, and seizures may occur. Patients have difficulties focusing on tasks, but cognition is not usually grossly impaired. Sensory abnormalities and muscular weakness are not features of the disease. Ref: Harrison's Internal Medicine, 18th Edition, Pages 3188-3190
|
b
| 1 |
medmcqa
|
Most common psychiatric illness -
|
[
"Depression",
"Bipolar",
"Mania",
"Cyclothymia"
] |
Explanation:
Ans. is 'a' i.e., Depressiono Depresson is the most common psychiatric disorder that affect 15% of the population at some time in their lives (Mates - 8-12%; Females -20-25%). Middle aged (25-45 years) females are most commonly affected.o Note : Among the given options, depression is most common. Overall, anxiety disorder is the most common psychiatric illness.
|
a
| 0 |
medmcqa
|
All the following muscles have dual nerve supply except
|
[
"Subscapularis",
"Pectoralis major",
"Pronator teres",
"Flexor digitorum profundus"
] |
Explanation:
1) Flexor digitorum profundus is supplied by - (i) Medial half by ulnar nerve and Lateral half by anterior interosseous nerve(C8 , T1) ( branch of median nerve ). 2)Subscapularis is supplied by - Upper and lower subscapular nerves ( C5 , C6 ). 3) pectoralis major is supplied by - Medial and lateral pectoral nerves. 4)pronator teres is supplied by - median nerve only. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 1 , pg. no., 44, 70, 110, 108.
|
c
| 2 |
medmcqa
|
Tachycardia due to nitrates in a patient with angina pectoris is blocked by-
|
[
"Digoxin",
"Dobutamine",
"Beta blocker",
"Calcium channel blocker"
] |
Explanation:
Ans. is 'c' i.e., Beta blocker o Use of beta blocker and long acting nitrate combination is rational in classical angina because:Tachycardia due to nitrate is blocked by beta blockerThe tendency of beta blocker to cause ventricular dilatation is countered by nitrateThe tendency of beta blocker to reduce the total coronary flow is opposed by nitrate
|
c
| 2 |
medmcqa
|
In tandem bullet, number of bullet/bullets comingout of the gun is/are
|
[
"1",
"2",
"3",
"4"
] |
Explanation:
2 [Ref: Parikh 6/e, p 4.26; Reddy, 25/e, p 1961 Tandem bullets: also k/a piggiback bullets are 2 bullets ejected one after the other, when the first bullet, having been stuck in the barrel, fails to leave the barrel, and is ejected by the subsequently fired bullet. The bullets may separate within the body, or before they hit the target. Also know Tandem or Duplex caridge: here the gun fires two bullets simultaneously which have different projectiles by design and enter the target at different points. Frangible bullets: there bullets are designed to fragment upon impact. often to the point of disintegration. Recovery and matching with a test bullet is difficult. Souvenir bullets: a bullet present for a long time in the body leading to dense fibrous tissue formation around it. Dum-dum bullet: is a jacketed bullet with its nose cut-off to expose the core. Ricochet bullet: its a single bullet which strikes some intervening object first and then after ricocheting and rebounding strikes the target. Yawning bullet: bullet travelling in an irregular fashion instead of travelling nose on.
|
b
| 1 |
medmcqa
|
Most common cause of neuropathic joint ?
|
[
"Leprosy",
") Tabes dorsalis",
"Diabetes",
"Nerve injury"
] |
Explanation:
Ans. is `c' i.e., Diabetes Neuropathic joint (Charcot's joint) o It is a progressive destructive ahritis associated with loss of pain sensationx, proprioception or both, in addition normal muscular reflexes that modulate joint movements are decreased. Without these protective mechanisms, joints are subjected to repeated trauma, resulting in progressive cailage and bone damage. o It is most commonly caused by diabetes mellitus. Causes of Neuropathic joint disease (Charcoat's joint) Causes of Neuropathic joint disease (Charcoat's joint) Diabetes mellitus (most common) Amyloidosis Tabes Dorsalis Leprosy Meningomyelocele Congenital indifference to pain Syringomyelia Peroneal muscular atrophy
|
c
| 2 |
medmcqa
|
The vitamin synthesized by bacteria in the intestine is:
|
[
"Vitamin K",
"Vitamin B1",
"Vitamin D",
"Vitamin B3"
] |
Explanation:
Vitamins that are synthesized by intestinal flora are Vitamin B2, B5, B7 & Vitamin K. ADDITIONAL EDGE: Vitamin B3 and Vitamin D are two vitamins that are synthesized by human body. So these are called Atypical Vitamins. These vitamins are synthesized by human enzymes during metabolism, not by intestinal bacterial enzymes. Vitamin B3 is synthesized from Tryptophan Vitamin D is synthesized from 7-Dehydro Cholesterol by UV light in skin.
|
a
| 0 |
medmcqa
|
Carey coombs murmur, which is false -
|
[
"Delayed diastolic murmur",
"Seen in rheumatic fever",
"Can be associated with A.R.",
"Low pitched murmur"
] |
Explanation:
A sho, mid-diastolic murmur is rarely heard during an episode of acute rheumatic fever (Carey-Coombs murmur) and probably is due to flow through an edematous mitral valve. An opening snap is not present in the acute phase, and the murmur dissipates with resolution of the acute attack. Complete hea block with dyssynchronous atrial and ventricular activation may be associated with intermittent mid- to late diastolic murmurs if atrial contraction occurs when the mitral valve is paially closed. Mid-diastolic murmurs indicative of increased tricuspid valve flow can occur with severe, isolated TR and with large ASDs and significant left-to-right shunting. Other signs of an ASD are present ( Chap. 236 ), including fixed splitting of S 2 and a mid-systolic murmur at the mid- to upper left sternal border. TTE is indicated for evaluation of a patient with a mid- to late diastolic murmur. Harrison principal of internal medicine,20edition,pg no.1432
|
a
| 0 |
medmcqa
|
Most common dislocation of shoulder causing axillary nerve injury is -
|
[
"Anterior dislocation",
"Posterior dislocation",
"Recurrent instability",
"Inferior dislocation"
] |
Explanation:
Ans. is 'a' i.e., Anterior dislocation Complications of anterior dislocationi) Injury to the axillary (circumflex) nerve is the most common complication (5- 30%)ii) Occasionally other branches of brachial plexus are damaged especially the posterior cord.iii) Occasionally axillary artery may be damaged especially if the vessel is atheromatous or it may damage during attempted late reduction.iv) Associated fractures like greater tuberosity.v) Recurrent dislocation.
|
a
| 0 |
medmcqa
|
A 45-year-old crane operator at a construction site with pre-existing seropositive rheumatoid ahritis complains of progressive difficulty in breathing. On examination - Rheumatoid nodules are also present. Chest X-ray was performed. What is the diagnosis?
|
[
"Caplan syndrome",
"Felty syndrome",
"Bronchiolitis obliterans organizing pneumonia",
"Lung cancer"
] |
Explanation:
CXR of this patient is suggestive of - Pneumoconiosis On examination - Rheumatoid nodules are also present. This points to diagnosis of Caplan syndrome. CAPLAN Syndrome: Coal worker pneumoconiosis + Rheumatoid nodules Felty's syndrome- Rheumatoid ahritis with splenomegaly and neutropenia
|
a
| 0 |
medmcqa
|
Dead space is increased by all except
|
[
"Anticholinergic drugs",
"Standing",
"Hyperextention of Neck",
"Endotracheal intubation"
] |
Explanation:
Dead space is actually composed of gases in nonrespiratory airways (anatomic dead space) and alveoli that are not perfused (alveolar dead space). The sum of the two components is referred to as physiological dead space. In the upright position, dead space is normally about 150 mL for most adults (approximately 2 mL/kg) and is nearly all anatomic. The weight of an individual in pounds is roughly equivalent to dead space in milliliters. Dead space can be affected by a variety of factors. Endotracheal intubation decreases the dead space. Ref: Miller&;s anesthesia 8th edition Ref: Morgan & Mikhail&;s clinical anesthesiology 6e
|
d
| 3 |
medmcqa
|
During population-based screening programs, a 40 years old lady found to have cervical intraepithelial neoplasia. Which of the following is the treatment modality for this patient?
|
[
"Cryotherapy",
"LEEP",
"Cold knife conization",
"All of the above"
] |
Explanation:
The 5 most common techniques for the treatment of CIN include 2 ablative techniques--cryotherapy and laser ablation--and 3 excisional procedures--cold knife conization, laser cone excision, and LEEP. That these techniques are of equal efficacy, averaging 80-90% success rates in the treatment of CIN. Cure depends on the size of the lesion, endocervical gland involvement, margin status of any excisional specimen, and endocervical curettage results. Ref: Holschneider C.H. (2013). Chapter 48. Premalignant & Malignant Disorders of the Uterine Cervix. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
|
d
| 3 |
medmcqa
|
Ligation of cord in orchidectomy for treatment of testicular tumor is done at -
|
[
"External ring",
"Internal ring",
"Base of scrotum",
"Just above epididiymis"
] |
Explanation:
• The cord must be ligated as close as possible to the internal ring to facilitate complete removal of cord tissue in case a later retroperitoneal lymph node dissection is required.
|
b
| 1 |
medmcqa
|
Termination of Descemet's membrane is:
|
[
"Trabecular mesh work",
"Schlemm canal",
"Scieral spur",
"Ring of Schwalbe"
] |
Explanation:
Descemet's membrane is a strong homonymous structure less layer of cornea. It ends abruptly at the limbus as the ring of Schwalbe. Unlike Bowman's membrane it can regenerate and is very resistant to the inflammatory process of cornea
|
d
| 3 |
medmcqa
|
After evacuation of a hydatidiform mole the risk for choriocarcinoma is considered when:
|
[
"Beta-hCG value plateaus for 2 weeks",
"Beta-hCG value plateaus for 3 weeks",
"Beta-hCG value plateaus for 4 weeks",
"Beta-hCG value plateaus for 6 weeks"
] |
Explanation:
Following evacuation of the uterus, weekly serum Beta -hCG levels should be monitored until normalized for 3 weeks, followed by monthly testing for 6-12 months depending on assessment of pretreatment risk factors. If the Beta -hCG value plateaus for 3 weeks or rises for 2 weeks, invasive gestational trophoblastic disease, including either invasive mole or choriocarcinoma, should be suspected. Effective contraception during the surveillance phase is impoant in order not to complicate interpretation of the Beta-hCG. Ref: Reynolds R. Loar P.V. (2010), Chapter 39, Gynecology ; G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13th Edition
|
b
| 1 |
medmcqa
|
"Split" laceration is seen in:
|
[
"Blunt tangential impact",
"Blunt perpendicular impact",
"Horizontal crushing",
"Impact by sharp objects"
] |
Explanation:
Blunt perpendicular impact
|
b
| 1 |
medmcqa
|
Cu T 200 is so called -
|
[
"200 sqmm of Cu2+ over loop",
"200 mm of Cu over loop",
"For 200 days, Cu concentration does not changes",
"200 sqcm of Cu over loop"
] |
Explanation:
Ans. is 'a' i.e., 200 sq. mm of Cu+ over loop o The numbers included in the names of the intrauterine devices refer to the surface area (in sq. mm) of cooper on the device.
|
a
| 0 |
medmcqa
|
Which of the following organisms would typically be found in a patient with atypical community-acquired pneumonia?
|
[
"Staphylococcus aureus",
"Pseudomonas spp.",
"Streptococcus pneumonia",
"Legionella pneumophilia"
] |
Explanation:
H. influenza and S. pneumonia are organisms which are usually responsible for community-acquired pneumoniA. S. aureus and Pseudomonas spp. are usually found in patients with hospital-acquired pneumoniA. L. pneumophilia, along with Chlamydia spp. and Mycoplasma pneumonia, are the atypical pneumonia-causing organisms. A urinary antigen test is routinely used for the detection of Legionella spp. Serological tests can be used for the detection of Mycoplasma and Chlamydia spp. and also Legionella spp.
|
d
| 3 |
medmcqa
|
The recommended level of anti-coagulation for most patients is an INR of
|
[
"1.0-2.0",
"2.5-3.5",
"2.0-3.0",
"3.0-4.56"
] |
c
| 2 |
medmcqa
|
|
Second stage of labour is from:
|
[
"Onset of contraction to rupture of membranes",
"Onset of contractions to full dilation",
"Rupture of membranes to delivery of fetus",
"Full dilatation to delivery of fetus"
] |
Explanation:
Full dilatation to delivery of fetus
|
d
| 3 |
medmcqa
|
For post-exposure prophylaxis of HIV is:-
|
[
"Tenoir + Lamivudine for 4 weeks",
"Lamivudine + Ritonavir for 4 weeks",
"Zidovudine + Lamivudine + Indinavir for 4 weeks",
"Single dose Zidovudine + Lamivudine + Indinavir"
] |
Explanation:
New post-exposure guidelines for HIV for adolescents and adults: Preferred backbone regimen: Tenofovir + Lamivudine for 4 weeks. Preferred third drug: Lopinavir / Ritonavir or Atazanavir / Ritonavir.
|
a
| 0 |
medmcqa
|
Main enzyme for glycogen metabolism
|
[
"Glucose-6-phosphatase",
"Glycogen synthase",
"PFK-1",
"None of the above"
] |
Explanation:
The key enzyme for glycogenolysis is phosphorylase, which is activated by glucagon and adrenaline, under the stimulus of hypoglycemia. ii. The key enzyme for glycogen synthesis is glycogen synthase, the activity of which is decreased by adrenaline but is enhanced by insulin, under the stimulus of hyperglycemia (Fig. 9.40). Glycogen metabolism is regulated by coordinated regulation of glycogen synthase and glycogen phosphorylase. The regulatory mechanisms include allosteric control as well as hormonal control by covalent modification of enzymes. The allosteric effectors are ATP, Glucose-6-phosphate, and AMP.Ref: DM Vasudevan, 7th edition
|
b
| 1 |
medmcqa
|
Neurological defect seen in fetus of diabetic mother is?
|
[
"Caudal regression",
"Neural tube defect",
"Anencephaly",
"All of the above"
] |
Explanation:
ANSWER: (D) All of the aboveREF: Dutta 6th ed p. 287, Current Diagnosis 8; Treatment Obstetrics & Gynecology, 10th edition chapter 18, Willians 22nd edition Table 52-8, http://en.wikipedia.org/wiki/Gestational_ diabetesCONGENITAL MALFORMATIONS IN INFANTS OF WOMEN WITH DIABETESAnomalyRatios of InddenceaCaudal regressionSitus inversusSpina bifida, hydrocephaly, or other central nervous system defectAnencephaly2528423Heart anomaliesAtrial septal defectsVentricular septal defectsTransposition of the great vesselsCoarctation of the aortaTetralogy of FallotTruncus arteriosusDextrocardiaCardiomegaly4Anal/rectal atresiaRenal anomaliesAgenesisCystic kidneyDuplex ureter354423Ratio of incidence is in comparision with the general population.
|
d
| 3 |
medmcqa
|
A primigravida with full term pregnancy in labor for 1 day is brought to casualty after dia handing. On examination she is dehydrated, slightly pale, bulse 100/min, BP120 / 80 mm Hg. abdominal examination reveals a fundal height of 36 weeks, cephalic presentation, foetal hea absent, mild uterine contractions present. On PN examination, cervix is fully dialted, head is at +1 station, caput with moulding present, pelvis adequate. Diy, infected discharge is present. What would be the best management option after initial work-up ?
|
[
"Cesarean section",
"Oxytocin drip",
"Ventouse delivery",
"Craniotomy and vaginal delivery"
] |
Explanation:
Ventouse delivery
|
c
| 2 |
medmcqa
|
A 45-year-old man is admitted to the hospital with breathing problems. During physical examination the patient shows signs of airway obstruction. A CT scan examination reveals a nasal polyp obstructing the airway. Drainage from which of the following structures is also obstructed?
|
[
"Sphenoid sinus",
"Maxillary sinus",
"Ethmoidal sinus",
"Frontal sinus"
] |
Explanation:
(b) Source: GAS 797, 879, 1018, 1020, 1022; GA 487, 518, 525 The nasal polyp also involved the maxillary sinus, located immediately laterally to the nasal cavity. The sphenoid sinus, located posterosuperiorly to the nasopharynx, is unlikely to be affected by a nasal polyp. The ethmoidal sinuses, located medially to the orbit and lateral to the nasal cavity, are also unlikely to be affected by a nasal polyp, although this possibility cannot be ruled out. The frontal sinuses located superomedially to the eyes are unlikely to be affected by the nasal polyp. The frontonasal ducts, the communication between the frontal sinus and the nasal cavity, are also unlikely to be affected.
|
b
| 1 |
medmcqa
|
Treatment of CMV retinitis in AIDS patient is -
|
[
"Amantadine",
"Fludrabine",
"Oseltamivir",
"Valganciclovir"
] |
Explanation:
Ans. is 'd' i.e. Valganciclovir o CMV retinitis is the most common ophthalmic manifestation of CMV, occuring as a congenital infection in infants or an opportunistic infection in the immunocompromised hosto Adults commonly affected include those individuals with acquired immunodeficiency syndrome (AIDS), oncology patients, and patients on immunosuppresive therapy. There is characteristic hemorrhagic, full thickness retinitis. In early stage there are yellow-white exudates (areas of retinal necrosis) associated with areas of vasculitis and retinal hemorrhage. There may be exudative retinal detachment and ultimately, there occurs total retinal atrophyo Treatment of CMV retinitis -# HAART.# Valganciclovir- pro-drug of ganciclovir that is taken orally and is as effective for both induction (900 mg twice daily for up to 3 weeks) and maintenance (900 mg daily). Neutropenia is a common side effect due to bone marrow suppression, but can be effectively treated with filgrastim (granulocyte colony-stimulating factor.# Ganciclovir, foscamet and cidofovir given intravenously were formerly key therapeutic agents.# Ganciclovir slow-release intravitreal implant.
|
d
| 3 |
medmcqa
|
A male with insulin-dependent diabetes and having macular edema develops glaucoma. Which drug should be used as the least resort to treat?
|
[
"Alpha agonist",
"Prostaglandin analogue",
"Pilocarpine",
"Beta blocker"
] |
Explanation:
Ans. B. Prostaglandin analoguesAlthough prostaglandin analogues are the first-line treatment for open angle glaucoma, these should not be given in case a patient with macular edema develops glaucoma. The reason for the same is maculopathy caused by prostaglandin analogues (can cause blurring of vision).Extra Edge: Other drugs causing maculopathy* Niacin* Griseofulvin* Thiazolidinediones* Tamoxifen* Clofazimine, chloroquine (Bulls' eye maculopathy)* PG analoguesDrugs used for treatment of macular degeneration* Monoclonal antibodies: Bevacizumab, Ranibizumab* Photodynamic therapy: Verteporfin* Steroids (Dexamethasone, Prednisolone)* I/V Methotrexate* Pegaptanib: PEGylated oligonucleotide that binds VEGF
|
b
| 1 |
medmcqa
|
Which of the following is first formed after tooth brushing
|
[
"Materia alba",
"Plaque",
"Pellicle",
"Calculus"
] |
c
| 2 |
medmcqa
|
|
Immediate treatment for hyperkalemia with significant ECG changes?
|
[
"Calcium chloride",
"Calcium hydroxide",
"K+ Binding Resin Enema",
"Calcium Carbonate"
] |
Explanation:
Calcium increases threshold potential- restoring normal gradient between threshold potential and resting membrane potential (elevated abnormally in hyperkalemia) Calcium chloride - onset of action is < 5min and lasts about 30-60 min. Doses should be titrated with constant monitoring of ECG changes during administration Potassium binding resin exchanges Na+ for K+ :onset of action after PO ranges from 2-12 h. Calcium hydroxide and calcium carbonate have no role in management of hyperkalemia.
|
a
| 0 |
medmcqa
|
Until the end of the 16th week, the placenta grows. At term, ratio of weight of fetus to weight of placenta is:
|
[
"3:01",
"4:01",
"6:01",
"8:01"
] |
Explanation:
Placenta at term is a circular disc with diameter 15-20 cm and thickness of 2.5 cm. Its weight is 500 gm. The propoion of weight of the fetus to the weight of the placenta is roughly 6:1 at term and occupies about 30% of the uterine wall. At term, about four-fifths of the placenta is of fetal origin. Ref: Textbook of Obstetrics by D C Dutta, 6th edition, Page 29.
|
c
| 2 |
medmcqa
|
Nerve of grass is related to?
|
[
"Facial nerve",
"Glossopharyngeal nerve",
"Vagus nerve",
"Hypoglossal nerve"
] |
Explanation:
In amphibians, the spinomedullary region of the central nervous system is compressed rostrocaudally because of the absence of a neck. In Ranid frogs, the hypoglossal nerve emerges as the ventral ramus of the second spinal nerve. The first spinal nerve, though present in tadpoles, is absent as a separate nerve in adults. To investigate the central nervous system components of the hypoglossal nerve in Rana pipiens, we soaked identified, transected branches of this nerve in horseradish peroxidase, a retrograde and anterograde tracer. We found that the hypoglossal nerve in these frogs originates from two efferent nuclei located in the caudal medulla, a medial and a lateral one. Afferent fibers, primarily from the tongue, are also found in the hypoglossal nerve and travel in the dorsolateral funiculus of the spinal cord, descending to thoracic levels of the cord. Efferents to intrinsic tongue muscles and the genioglossus muscle originate in the medial medullary nucleus. Efferents to the sternohyoid muscle, which travel through the hypoglossal nerve, originate in the lateral medullary nucleus. Since in mammals the sternohyoid muscle is innervated by the first spinal nerve, we have obtained experimental evidence that the hypoglossal nerve in Rana pipiens contains components of this spinal nerve.
|
b
| 1 |
medmcqa
|
NAD acts as a cofactor for all except
|
[
"Isocitrate dehydrogenase",
"Alpha ketoglutarate dehydrogenase",
"Malate dehydrogenase",
"Succinyl thiokinase"
] |
Explanation:
Niacin (Vitamin B3) in biologically active form of NAD+ (nicotinamide adenine dinucleotide) and NADP+ (nicotinamide, adenine dinucleotide phosphate) act as cofactor for various enzymes such as
NADP+ Cofactor
Glucose-6-phosphate dehydrogenase (G-6-PD (glucose-6-PO4 to 6-phosphogluconate)
Glutathione reductase
Either NADP+ or NAD+ Cofactor
Glutamate dehydrogenase (glutamate → α-ketoglutarate + NH3)
Isocitrate dehydrogenase (isocitrate → oxalosuccinate)
NAD+ Cofactor
Malate dehydrogenase (malate → oxaloacetate)
Alcohol dehydrogenase (ethanol → acetaldehyde
Lactate dehydrogenase (pyruvic acid → lactic acid)
Glyceraldehyde-3-phosphate dehydrogenase (glyceraldehyde 3P →1, 3 diphosphoglycerate)
α - Glycero-P-dehydrogenase
α -Ketoglutarate dehydrogenase (α – ketoglutarate → CoA)
Pyruvate dehydrogenase complex (PDC) (pyruvate → CoA)
|
d
| 3 |
medmcqa
|
Which of the following drugs should be removed by dialysis ?
|
[
"Digoxin",
"Salicylates",
"Benzodiazepines",
"Organophosphates"
] |
Explanation:
- All other given options except salicylates are widely distributed in the body whereas salicylates stay in the blood. So it needs to be removed by dialysis.
|
b
| 1 |
medmcqa
|
"Smack" is the "common" name for
|
[
"Heroin",
"Cocaine",
"Opium",
"None"
] |
Explanation:
Heroin or di-acetyl-morphine is about two times more potent than morphine in injectable form. Apa from the parenteral mode of administration, heroin can also be smoked or 'chased' ( chasing the dragon), often in an impure form (called ' smack' or ' brown sugar' in India). Heroin is more addicting than morphine and can cause dependence even after a sho period of exposure. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 43
|
a
| 0 |
medmcqa
|
Genital ridge derived from which mesoderm?
|
[
"Paraxial mesoderm",
"Lateral plate mesoderm",
"Intermediate mesoderm",
"None"
] |
Explanation:
Each testis develops from the coelomic epithelium, that covers the medial side of the mesonephros, of the corresponding side. In the region where testis is to develop, this germinal epithelium becomes thickened. This thickening is called the genital ridge. The gonadal ridge (or genital ridge) is the precursor to the gonads. The gonadal ridge initially consists mainly of mesenchyme and cells of underlying mesonephric origin. Once oogonia enter this area they attempt to associate with these somatic cells.The gonadal ridge appears at approximately five weeks, and gives rise to the sex cords. (Reference : I B Singh's Embryology, 10th edition , pg 307)
|
c
| 2 |
medmcqa
|
Double bubble sign seen in :a) Duodenal atresiab) Duodenal stenosisc) Volvulusd) Intestinal perforation
|
[
"abc",
"bc",
"acd",
"bcd"
] |
a
| 0 |
medmcqa
|
|
Chemical mumps' is synonymous with
|
[
"Epidemic parotitis",
"Iodine mumps",
"Nutritional mumps",
"Nonspecific mumps"
] |
b
| 1 |
medmcqa
|
|
A 50-year-old female presented with ulcerated firm to hard nodules over the covered pas of her body, along with generalized erythema, edema and extreme pruritis. Initially they were barely palpable erythematous, well defined patches, which later on conveed to plaques and became itchy and ultimately turned into the current lesions. Cervical lymphadenopathy was also noted. Skin biopsy from the lesion was taken. Peripheral blood smear also showed abnormal cells. Which is the most likely diagnosis: -
|
[
"Sezary disease",
"Tinea corporis",
"Psoriasis",
"Lichen planus"
] |
Explanation:
This is a case of sezary syndrome. 1st image shows the classical Sezary cell with cerebriform nucleus. 2nd image shows intraepidermal collection of atypical lymphocytes (Pautrier's microabscesses) a feature of epidermotropism and a band of lymphoid cells, some atypical, in the upper dermis. Diagnosis is based on: 1. Chronicity of lesions and poor response to conventional therapy. 2. Lesions predominantly on covered pas. 3. Characteristic stages: Well-defined patches of bizarre shapes with cigarette paper atrophy indurated itchy plaques Nodules which often ulcerate 4. Typical histology: Intraepidermal collection of atypical lymphocytes (Pautrier's microabscesses) a feature of epidermotropism 5. A band of lymphoid cells, some atypical, in the upper dermis.
|
a
| 0 |
medmcqa
|
The most probable diagnosis of the lesion depicted in the X-ray below is (GCT)
|
[
"Simple bone cyst",
"Osteoma",
"Ewings tumour",
"Osteoclastoma"
] |
Explanation:
Osteoclastoma 98% cases are benign with potential for metastasis with female predominance Sites - Distal femur/proximal tibia, lower end of radius, proximal humerus Occurrence - 20 - 40 years Arises from epiphysis Egg shell crackling on palpation X ray finding - Soap bubble appearance HPE - mesenchymal stromal cells Treatment Lower end of femur/Upper end of tibia - Excision with turn-o-plasty Veebra - Radiation Ref: Maheshwari 6e pg 237.
|
d
| 3 |
medmcqa
|
A 48-years-old male had a road traffic accident and was brought to emergency. All of the following are done as a part of primary survey except.
|
[
"CT abdomen for bleeder identification",
"Airway checking",
"BP recording",
"Cervical spine stabilization"
] |
Explanation:
Ans. A. CT abdomen for bleeder identificationExplanationThis initial assessment, also termed the primary survey, follows the mnemonic ABCDE:Airway and cervical spine protectionBreathingCirculationDisability or neurologic conditionExposure and environmental controlAlgorithm for management of a trauma victim:
|
a
| 0 |
medmcqa
|
Which of the following cells play a crucial role in the pathogenesis of alveolar-capillary damage in adult respiratory distress syndrome (ARDS)?
|
[
"CD4-positive lymphocytes",
"CD8-positive lymphocytes",
"Eosinophils",
"Neutrophils"
] |
Explanation:
ARDS, pathologically referred to as diffuse alveolar damage, is a clinical syndrome of acute respiratory failure resulting from diffuse injury to the alveolar/capillary barrier. Such injury may be caused by a great variety of initiating insults, the most frequent of which are shock, severe trauma, sepsis, and gastric aspiration. All these different forms of injury result in recruitment of neutrophils within the alveolar capillaries. Neutrophils release chemokines that attract histiocytes and produce oxygen radicals, prostaglandins, and proteases that damage alveolar epithelium. Formation of hyaline membranes is due to a combination of plasma fluid extravasation and alveolar cell necrosis.CD4+ (helper) lymphocytes, CD8+ (cytotoxic) lymphocytes, eosinophils, and mast cells have been implicated in a number of pulmonary diseases, but not in diffuse alveolar damage. Ref: Chandrasoma P., Taylor C.R. (1998). Chapter 35. The Lung: II. Toxic, Immunologic, & Vascular Diseases. In P. Chandrasoma, C.R. Taylor (Eds), Concise Pathology, 3e.
|
d
| 3 |
medmcqa
|
The following is the finding seen in DIVC -
|
[
"Increased fibrinogen, increased antithombin III, increased thrombin-antithrombin III complexes",
"Increased FDP, decreased PT, Increased antithrombin III",
"Increased FDP, prolonged PT, decreased thrombin-antithrombin complexes",
"Increased FDP, prolonged PT, reduced Platelets"
] |
d
| 3 |
medmcqa
|
|
Amongst the following, extrapyramidal side effect is commonest with which drug : September 2006
|
[
"Thioradizine",
"haloperidol",
"Clozapine",
"Ziprasidone"
] |
Explanation:
Ans. B: Haloperidol Extrapyramidal disturbances are the major dose limiting side effects of neuroleptics; more prominent with high potency drugs like fluphenazine, haloperidol, pimozide etc., least with thioridazine, clozapine, and all other atypical antipsychotics, except high doses of risperidone.
|
b
| 1 |
medmcqa
|
Malignant pustule is caused by:
|
[
"B. Anthracis",
"Leishmaniasia",
"Basal cell carcinoma",
"Pyoderma"
] |
Explanation:
Ans. (a) B. anthracis
|
a
| 0 |
medmcqa
|
Patient presents with neck swelling and respiratory distress few hours after a thyroidectomy surgery. Next management would be:
|
[
"Open immediately",
"Tracheostomy",
"Wait and watch",
"Oxygen by mask"
] |
Explanation:
In this case, the swelling is due to tension haematoma which is a complication of thyroidectomy. Hence the resulting complication will be respiratory obstruction secondary to laryngeal oedema. Ref: Harrison's Internal Medicine, 18th Edition, Page 362; bailey and Love's Sho Practice of Surgery, 25th Edition, Page 790, 794 and 23rd Edition, Page 727.
|
a
| 0 |
medmcqa
|
Study time, place, and person of a disease is__________study -
|
[
"Descriptive",
"Analytic",
"Association",
"Comparison"
] |
Explanation:
Ans. is 'a' i.e., Descriptive
|
a
| 0 |
medmcqa
|
A beta hemolytic bacteria is resistant to vancomycin shows growth in 6.5% NaCI, is non bile sensitive. It is likely to be -
|
[
"Strep agalactiae",
"Strep pneumoniae",
"Enterococcus",
"Strep bovis"
] |
Explanation:
Ans. is 'c' i.e., Enterococcus The bacteria in this question is showing growth in 6.5% NaC1, non bile senstive (ie growing in the presence of bile) and showing 3 hemolysis, Enterococci have all these features.
|
c
| 2 |
medmcqa
|
Most common presentation of carcinoma of the right colon:
|
[
"Anaemia",
"Mass",
"Obstruction",
"Diarrhoea"
] |
Explanation:
Ans: a (Anaemia) Ref: Bailey, 24th ed, p. 1178Carcinoma colon is usually asymptomatic and may present as anaemia in locally advanced cases.Macroscopic varieties:annular type : most common symptom is obstructivetubular : most common symptom is bleedingulcerative: most common symptom is bleedingcauliflower type: least malignantcarcinoma colon occurs more commonly on the left side and the rectum.Most common site-Rectosigmoid junction- 59%RectumSigmoid colonTNM staging Ca right colonCa left colonUsually presents lateUlcerate with chronic insidious blood loss- leading to anaemia anaemia> fatigue> mass RIFMore well formed stools than right -so obstructiveAlteration of bowel habits > palpable lump > abdominal distension with pain.Ca sigmoidPain usually colicky from onsetTenesmus Bladder symptoms- This is not uncommon and may sometimes lead to colovesical fistula- (Bailey, 24th ed, p. 1178)Risk factors for the development of colorectal cancerDiet: Animal fatHereditary syndromes (autosomal dominant inheritance)Polyposis coliNonpolyposis syndrome (Lynch syndrome)Inflammatory bowel diseaseUreterosigmoidostomyTobacco use
|
a
| 0 |
medmcqa
|
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