Datasets:

multi-train

/

emb-medmcqa-train

like 0

Postponing paying attention of conscious impulse or conflict is a mature defence mechanism known as -

Suppression is pushing of unwanted feelings into unconscious which has reached conscious awareness.

medmcqa_train

The commonest site of perforation during colonoscopy is -

• Risks of colonoscopy: Perforation and hemorrhage • MC site of bleeding after colonoscopy: Stalk after polypectomy. • MC site of perforation during colonoscopy: Sigmoid colon • Perforation can be caused by excessive air pressure, tearing of the antimesenteric border of the colon from excessive pressure on colonic loops, and at the sites of electrosurgical applications

medmcqa_train

A 74-year-old woman develops occipital headache, vomiting, and dizziness. She looks unwell, her blood pressure is 180/100 mm Hg, pulse is 70/min, and respirations are 30/min. She is unable to sit or walk because of unsteadiness. Over the next few hours, she develops a decline in her level of consciousness.For the above patient with altered level of consciousness, select the most likely diagnosis.

Cerebellar hemorrhage, when mild, may present with only headache, vomiting, and ataxia of gait. Patients may complain of dizziness or vertigo. The eyes may be deviated to the side opposite the hemorrhage. Nystagmus is not common, but an ipsilateral sixth nerve palsy can occur. This is the only type of intracerebral hemorrhage that commonly benefits from surgical intervention.

medmcqa_train

Which is an uricosuric drug-

Ans. is 'b' i.e., Probenecid Uricosuric drugs are probenacid, sulfinpyrazone and benzbromarone.

medmcqa_train

After an incised wound ,new collagen fibrils are seen along with a thick layer of growing epithelium.The approximate age of the wound is

Ref Robbins 9/e p106 Incised wound for the formation of collagen and new tissue, thick layer of epithelial ,and granulation tissue formation along with new blood vessels requires atleast 4_5 days

medmcqa_train

After delivery, a 28 year old pre ecclamptic primigra has a soft uterus with moderate-to-heavy bleeding. There is no laceration and there is PPH diagnosed due to uterine atony. Which of the following is the best management option?

Ergot derivatives should not be given in patients with hypeension since this is classically known to increase blood pressure. A high BP may provoke a post paum ecclampsia Oxytocin is not orally effective . Prostaglandin F2-alpha is given IM.

medmcqa_train

Trendlenburg's test done for varicose veins is for detection of:

Ans: C (Saphenofemoral incompetency) Ref : 74 A Manual on Clinical Surgery S. DasExplanation:Clinical Examination of Varicose VeinsBrodie-Trendelenherg TestDone to determine the incompetency of Saphenofemoral valve.Patient is placed in recumbent position.Limbs are raised to empty the veins. Veins are milked proximally for further emptying.Saphenofemoral junction is compressed either with the thumb of the examiner/toumiquet and the patient is asked to stand up quickly.There are two variants of this test.The first method is to assess saphenofemoral incompetency. The pressure is released and if the column of blood fills up quickly from above downwards it indicates saphenofemoral incompetency.The second method is to assess the perforators. Here, the pressure is maintained for one minute. Gradual filling of the veins during this period indicates incompetent perforators allowing reflux of blood from deep veins to superficial veins.Positive Brodie--Trendelenberg test i~ an indication for surgery.Tests to Assess Saphenofemoral IncompetencyBrodie -Trendelenberg testMorrisey's cough impulse testTests to Assess Deep VeinsPerthe's testModified Perthe's testTests to Assess PerforatorsMultiple tourniquet testPratt's testFegan's testBrodie-Trendelenberg testTest to Assess V alves in Superficial VeinSchwartz testNote:Even though Brodie-Trendelenberg test is used to assess both saphenofemoral incompetency and incompetent perforators its primary purpose is to assess saphenofemoral incompetency.

medmcqa_train

Specific poison for succinate dehydrogenase is ?

B i.e. Malonate

medmcqa_train

Most common widespread zoonotic disease in the world is -

<p> Leptospirosis is the most wide zoonotic disease in the world. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:291. <\p>

medmcqa_train

Blood stained sputum may be the only symptom in?

Ans. is 'c' i.e., Adenoma bronchus

medmcqa_train

Inherited hyperammonemia is a result of deficiency of which enzyme of Krebs-Henseleit urea cycle?

Inherited hyperammonemias are a group of six diseases caused by inborn deficiencies of the enzymes of the Krebs-Henseleit urea cycle. The enzymes involved are: 1. N-acetyl glutamate synthetase 2. Arbamyl phosphate synthetase (CPS) 3. Ornithine transcarbamylase (OTC) 4. Argininosuccinic acid synthetase (citrullinemia) 5. Argininosuccinase deficiency 6. Arginase deficiency Most Severe Cases: In the most severe forms of the hyperammonemic disorders, the infants are asymptomatic at bih and during the first day or two of life, after which they refuse their feedings, vomit, and rapidly become inactive and lethargic, soon lapsing into an irreversible coma. Profuse sweating, focal or generalized seizures, rigidity with opisthotonos, hypothermia, and hyperventilation have been observed in the course of the illness. These symptoms constitute a medical emergency, but even with measures to reduce serum ammonia, the disease is usually fatal. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 37. Inherited Metabolic Diseases of the Nervous System. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

medmcqa_train

Punishment for infanticide comes under -

Ref:Textbook of forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.377 Infanticide refers to the deliberate killings of chlid below the age of one year.In England, Germany, UK, there is a clear-cut distinction between homicide and infanticides. In India, no such distinction exists, and accuse is punished under sec.302IPC,the same manner as in murder.

medmcqa_train

Carotid artery stenosis screening invivo choice is -

Ans. is 'd' i.e., Doppler o Color doppler ultrasonography is the screening method of choice (not simple USG : option a is incorrect),o Carotid angiography is the investigation of choice for diagnosis,o MRI is the investigation of choice for demyelinating disorder, e.g. multiple sclerosis.Investigations in nervous systemo Investigation of choice for white matter disease - MRI (CT is second choice),o Investigation of choice of acoustic neuroma - GD enhanced MRIo Best investigation for all brain tumors - Contrast enhanced MRIo Investigation of choice for meningeal carcinomatosis - Contrast (gadolinium) enhanced MRI.o Investigation of choice for posterior fossa tumor - MRIo Investigation of choice for para meningeal rhabdomyosarcoma - MRIo Investigation of choice for nasopharyngeal angiofibroma - Contrast enhanced CT.o Investigation of choice for hydrocephalus in older patients and for low pressure hydrocephalus - MRI.o Investigation of choice for acute (<48hrs) subarachnoid hemorrhage (SAH) - Non-Contrast CT scan,o Investivation of choice to know the etiology of SAH - Four vessels digital substruction angiography.o Hallmark of SAH - Blood in CSF on lumbar puncture,o Investigation of choice for chronic SAH - MRI.o Primary procedure of choice for evaluating intracranial complications of acute head injury - CT scan,o Best modality for assessing fractures of the skull base, calvarium and facial bone - CT scan,o Investigation of choice for demyelinating disorders MRI.o Investigation of choice for AV malformation and aneurysm - Angiography (MRI angiography or CT angiography),o Investigation of choice for Craniospinal infection - MRIo Investigation of choice for all intrinsic spinal cord lesions; all causes of cord compression - MRI.o Procedure of choice for emergent evaluation of acute intracerebral hemorrhage - CT scan,o Investigation of choice for myelopathy - MRI.o Shape of epidural hematomas on imaging - Biconvex, hyperdense or mixed density.o Shape of acute subdural hematoma on imaging - Crescent-shaped, hyperdense or mixed density ,o Chronic subdural hematoma on imaging - Hypodense.o Most sensitive test for ischaemic stroke - Diffusion weighted (DW) MRI.

medmcqa_train

Proposed guideline value for Radioactivity in drinking water is:

Key guidelines aspects of WHO recommended drinking water quality: Colour <15 true colour units (TCU) Turbidity <1 nephlometric turbidity units (NTU) pH: 6.5-8.5 Total dissolved solids (TDS) <500 mg/Litre Zero pathogenic microorganisms Zero infectious viruses Absence of pathogenic protozoa and infective stages of helminthes Fluoride <1.0 ppm (0.5-0.8 ppm: Optimum level) Nitrates <45 mg/Litre Nitrites <3 mg/Litre Gross alpha radiological activity <0.5 Bq/Litre (new guidelines -WHO) Gross Beta radiological activity <1.0 Bq/Litre (new guidelines-WHO) Ref: Park 25th edition Pgno: 762

medmcqa_train

Lens develops from?

Ans. c (Surface ectoderm). (Ref. Human Embryology by IB Singh, 6th/352)LENS# LENS develops from surface ectoderm.# Compared to the cornea, it has a much lower converging power of 17 diopters because of the relatively similar refractive indices of aqueous humor, lens, and vitreous body (cornea 42 D).# However, the lens is the only part of the refractive apparatus that is adjustable.# Adjustment to near vision (accommodation) therefore involves only the lens.# In addition, the lens functions as a UV filter for wavelengths between 300 and 400 nm and thus has a protective function for the macula.# Notching of the lens = "pseudocoloboma".# Wilson's disease can induce a yellow-green lens discoloration (chalcosis/ sunflower cataract).# Granular gold deposits located under the lens (chrysiasis lends) can occasionally occur after prolonged treatment with gold preparations (e. g. in primary chronic polyarthritis ).# Other medications, e.g., amiodarone or chlorpromazine, are sometimes deposited in the lens.# In patients with cataract, glittering cholesterol crystals are not infrequently found in the lens (so-called Christmas tree/ decoration cataract).

medmcqa_train

Palm of one hand is placed horizontally across the mouth and nostrils in

palmar strangulation Here the palm of one hand is placed horizontally across the mouth and nostrils, it's pressure being reinforced by placing the other palm on the top of it at right angles, the heel of the palm above pressing upon the front of the neck. Ref: TEXTBOOK OF FORENSIC MEDICINE AND TOXICOLOGY KRISHNAN VIJ FIFTH EDITION PAGE 134

medmcqa_train

In RDS all of the following statements are true except

Administration of 100% oxygen may increase the O2 load on fetal lung tissue. Hence, it is not given . Reference: GHAI Essential pediatrics, 8th edition

medmcqa_train

National program for prevention and control of Cancer, Diabetes, Cardiovascular disease and stroke (NPCDCS), true is -

Ans. is 'c' i.e., District hospital has specialised facilities Sational program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS1 Introduction Single centre fi- cancer, diabetes, cardiovascular disease, stroke. 100 districts in 21 states being covered in 1 1 th live year plan. 20,000 subcentres and 700 community health centres (CHCs) covered. o Activities as sub-centres Health promotion for behaviour and lifestyle change. Oppounistic screening of BP. blood glucose (strip method) in age > 30 years. Referral to CHC of cases of DM, HT. o Activities at CHCs : Diagnosis and management at NCD clinic. Home visits by nurse for bedridden cases. Referral to district hospital for complicated cases. o Activities as District hospital : Health promotion Screening of population > 30 years. Diagnosis and management of cardiovascular disease. Home-based palliative care for chronic, debilitating progressive patients. Specialized facilities. Urban health check-up shceme JOr diabetes and high BP : Screen urban slum population. Screen population > 30 years and pregnant females. Cancer control in NPCDCS : Regional cancer control scheme : Regional cancer centres to act as referral centres for complicated cases. Oncology wing development scheme. Decentralized NGO scheme : IEC activities and early cancer detection. lEC at central level. Research and mining.

medmcqa_train

All of the following are ACTH independent Cushing syndrome except :

ACTH dependent Cushing syndrome is caused by : ACTH producing pituitary adenoma Ectopic ACTH Bronchial or pancreatic carcinoid Small cell cancer of lung Medullary carcinoma of thyroids Pheochromocytoma ACTH Independent Cushing syndrome is caused by : Adrenocoical adenoma/ carcinoma Primary pigmented nodular adrenal disease Adrenal hyperplasia McCune Albright Syndrome Petrosal/Peripheral ACTH ratio > 2 indicates the presence of a pituitary adenoma-secreting ACTH. NOTE: Overall the most common cause of Cushing's syndrome is Iatrogenic steroids but if asked regarding ACTH dependent cause then answer should be given as Pituitary adenoma.

medmcqa_train

Hereditary spherocytosis is characterized by: March 2004

Ans. D i.e. All of the above

medmcqa_train

Ketamine can be given by all of following routes except-

Ketamine has been administered intravenously, orally , rectally, intramuscularly and epidural route and very rare intranasal but not subcutaneous

medmcqa_train

All of the following are features of Devic's syndrome (neuromyelitis optica), except?

Devic's disease is a variant of multiple sclerosis. Fulminant demyelinating process is seen with another variant called Marburg's variant.

medmcqa_train

A 7 years old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hairs and lymph nodes enlarged in occipital region. Which one of the following would be most helpful for diagnostic evaluation?

Ans. c. KOH mount

medmcqa_train

All the following are seen in Hyperparathyroidism except

Calvarial thickening is a feature of Hypoparathyroidism.

medmcqa_train

Spore forming anaerobic gram positive bacilli ?

Ans. is 'b' i.e., Clostridia There are two medically impoant spore forming bacteria. Both of them are 'gram positive' `bacilli' :-Aerobic : BacillusAnaerobic (obligate anaerobes) : Clostridia.

medmcqa_train

Drug of choice for Falciparum Malaria is:-

DOC for Falciparum Malaria - ACT.( Aemisinin based Combination therapy ) In Noh Eastern states:- ACT-AL co-formulated tablet of Aemether-20 mg / Lumefantrine - 120 mg. Primaquine 0.75 mg/ kg Body weight on day 2. 2. In Other States:- ACT-SP -Aesunate 50 mg tablet for 3 days and Sulphadoxine (500mg) - Pyremethamine (25mg) tablets for 1 Day. Primaquine tablets should be given on Day 2.

medmcqa_train

All are causes of white-dot syndrome except:

Ans. Sympathetic ophthalmitis

medmcqa_train

Platypnea is seen with?

Platypnea: Increase dyspnea on sitting position Seen in 1. Atrial myxoma 2. Hepatopulmonary syndrome

medmcqa_train

Factor V Leiden is caused due to a mutation that results in a substitution at position 506 glutamine to which of the following:

Mutation in factor V (called the Leiden mutation, after the city in the Netherlands where it was discovered) causes recurrent DVTs. The mutation results in a glutamine to arginine substitution at position 506 that renders factor V resistant to cleavage by protein C. As a result, an impoant antithrombotic counter-regulatory pathway is lost Ref: Robbins 8th edition Chapter 4.

medmcqa_train

Kunkel's test is done to demonstrate presence of ................. in blood.

Carbon monoxide (CO)

medmcqa_train

In which case cystometric study is indicated -

Cystometric studies are urodynamic studies in which the pressure changes in the bladder is simultaneously measured with bladder filling and during micturition. It helps in accurate assessment of detrusor and sphincter activity especially if a neurogenic abnormality is suspected. Though it is also used in stress incontinence but the aim here is to rule out any neurogenic cause.

medmcqa_train

Fish tank granuloma is seen in -

Ans. is 'c' i.e., M. Marinum o Fish tank granulomaalso called ' swimming pool granuiomaf is caused by M. marinum.Principal types of opportunist mycobacterial disease in man and the usual causative agents.DiseasesUsual causative agentLymphadenopathyM. avium complexM. scrofulaceumSkin lesionPost-trauma abscessSwimming pool granulomaBuruli ulcerM. chelonaeM.fortuitumM. terraeM.marinumM. ulceransPulmonary' diseaseM. avium complexM. kansasiiM.xenopiM.malmoenseDisseminated diseaseAIDS-relatedM, avium complexM.genevenseM.avium complexM. chelonae

medmcqa_train

A 49-year-old female taking ibuprofen for increasing joint pain in her hands presents with increasing pain in her midsternal area. Gastroscopy reveals multiple, scattered, punctate hemorrhagic areas in her gastric mucosa. Biopsies from one of these hemorrhagic lesions reveal mucosal erosions with edema and hemorrhage. No mucosal ulceration is seen.

Gastritis is a nonspecific term that describes any inflammation of the gastric mucosa. Acute gastritis refers to the clinical situation of gastric mucosal erosions (not mucosal ulcers). Acute gastritis is also known as hemorrhagic gastritis or acute erosive gastritis. Acute gastritis is associated with the use of nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and coicosteroids, and also with alcohol, chemotherapy, ischemia, shock, and even severe stress. Two types of stress ulcers are Curling's ulcers, seen in patients with severe burns, and Cushing's ulcers, seen in patients with intracranial lesions. Grossly acute gastritis appears as multiple, scattered, punctate (less than 1 cm) hemorrhagic areas in the gastric mucosa. This is helpful in differentiating acute gastritis from peptic ulcers, which tend to be solitary and larger. Microscopically the gastric mucosa from a patient with acute gastritis is likely to reveal mucosal erosions, scattered neutrophils, edema, and possibly hemorrhage. Acute gastritis. Erosion and complete effacement of the epithelium is observed. The residual glands, on the left, display regenerative changes with basophilic epithelium. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition

medmcqa_train

Sedimentation coefficient of Ig E is:

Ans : b 8S Ref: Ananthanarayanan 8th editionSvedberg unit - a sedimentation constant of 1 x 1013sec. Sedimentation unit is studied by ultracentrifugation - for diversity of antibody moleculeIgG -7IgA -7IgM -19Ig D -7IgE -8

medmcqa_train

DNA dependent RNA synthesis is inhibited by:

Rifampicin

medmcqa_train

Iliac crest involvement is common in which condition: March 2007

Ans. A: Ankylosing Spondylitis The basic pathologic lesion of ankylosing spondylitis occurs at the entheses, which are sites of attachment to bone of ligaments, tendons, and joint capsules. Enthesopathy results from inflammation, with subsequent calcification and ossification at and around the entheses. Inflammation with cellular infiltration by lymphocytes, plasma cells, and polymorphonuclear leukocytes is associated with erosion and eburnation of the subligamentous bone. The process usually stas at the sacroiliac joints. Other enthesopathic sites include the iliac crest, ischial tuberosity, greater trochanter, patella, and calcaneum. Ankylosing spondylitis/ AS/ Bechterew's disease/ Bechterew syndrome/ Marie Strumpell disease/Spondyloahritis is a chronic, painful, degenerative inflammatory ahritis primarily affecting spine and sacroiliac joints, causing eventual fusion of the spine. AS is a systemic rheumatic disease and one of the seronegative spondyloahropathies. About 90% of the patients express the HLA-B27 genotype. Men are affected more than women by a ratio in excess of 10:1. Typical signs of progressed AS are the visible formation of syndesmophytes on X-rays and abnormal bone outgrowths similar to osteophytes affecting the spine. Complete fusion results in a complete rigidity of the spine, a condition known as bamboo spine. In 40% of cases, ankylosing spondylitis is associated with iridocyclitis causing eye pain and photophobia. 4.1 AS is also associated with ulcerative colitis, Crohn's disease, psoriasis, and Reiter's disease Other complications are aoic regurgitation, Achilles tendinitis, AV node block and amyloidosis & restrictive lung disease. A clinical examination and X-ray studies of the spine, which show characteristic spinal changes and sacroiliitis, are the major diagnostic tools. The Schober's test is a useful clinical measure of flexion of the lumbar spine performed during examination.

medmcqa_train

A 40-year-old man presents with a 2-week history of recur- rent oral ulcers, genital ulcers, intermittent arthritic pain of the knees, and abdominal pain. Physical examination reveals shallow ulcerations of the mucosa of the glans penis, as well as oral aphthous ulcers and conjunctivitis. Which of the following is the most likely diagnosis?

Behget disease is a systemic vasculitis characterized by oral aphthous ulcers, genital ulceration, and ocular inflammation, with occasional involvement of the nervous, gastrointestinal, and cardiovascular systems. The mucocutaneous lesions show a non-specific vasculitis of arterioles, capillaries, and venules. The cause of the necrotizing inflammation of small blood vessels is not known, but an association with specific HLA subtypes suggests an immune basis. Herpes (choice B) does not present with arthritis.Diagnosis: Behqet disease

medmcqa_train

About biotransformation not true ?

Ans. is 'b' i.e., Polar to less polar

medmcqa_train

In which phase of cell cycle, proof reading occurs?

EVENTS PHASE of cell cycle Proofreading S phase Most repairs G1 phase Mismatch repair G2 phase

medmcqa_train

The number of ATPs generated in krebs cycleare ?

Ans. is 'b' > b' i.e., 24 One turn of the TCA cycle, staing with acetyl CoA produces 10 ATPs. When the staing molecule is pyruvate, the oxidative decarboxylation of pyruvate, the oxidative decarboxylation of pyruvate yields 2.5 ATPs and therefore, 12.5 ATPs are produced when staing compound is pyruvate. Since, two molecules of pyruvate enter the TCA cycle when glucose is metabolized (glycolysis produces 2 molecules of pyruvate), the number of ATPs is doubled. Therefore, 25 ATP molecules, per glucose molecule, are produced when pyruvate enters the TCA cycle.Note : Previously calculations were made assuming that NADH produces 3 ATPs and FADH generates 2 ATPs. This will amount a net generation of 30 ATP molecules in TCA per molecule glucose and total 38 molecules from staing. Recent experiments show that these values are overestimates and NADH produces 2.5 ATPs and FADH produces 1.5 ATPs. Therefore, net generation during TCA is 25 ATPs and complete oxidation of glucose through glycolysis plus citric acid cycle yield a net 32 ATPs.Energy yield (number of ATP generated) per molecule of glucose when it is completely oxidized through glycolysis plus citric acid cycle, under aerobic conditions, is as follows :- Method ofNo of ATPsNo of ATPsPathwayStepEnzymeSource ATP formationgained perglucose(new calculation)As per oldcalculationGlycolysis1Hexokinase MinusMinus 1Do3Phosphofructokinase MinusMinus 1Do5Glyceraldehyde-3-p DHNADH Respiratory chain2.5 x 2 = 53 x 2 = 6Do61,3-BPGkinase ATPSubstrate level1 x 2 -- 21 x 2 = 2Do9Pyruvate kinaseATP Substrate level1 x 2 = 21 x 2 = 2Pyruvate to?PyruvateNADH Respiratory chain2.5x2= 53x2= 6Acetyl CoA Dehydrogenase TCA cycle3Isocitrate DHNADH Respiratory chain2.5x2= 53 x 2= 6Do4Alpha keto glutarate DHNADH Respiratory chain2.5x2= 53x2= 6Do5Succinate thiokinaseGTP Substrate level1 x 2 = 21 x 2 = 2Do6Succicinate DHFADH2Respiratory chain1.5x2= 32 x 2= 4Do8Malate DHNADH Respiratory chain2.5x2= 53 x 2= 6Net generation in glycolytic pathway 9 minus 2= 7 10 minus 2= 8Generation in pyruvate dehydrogenase reaction 5 * 6Generation in citric acid cycle 20 * 24Net generation of ATP from one glucose mole 32 * 38

medmcqa_train

Child with mild squint. Intrauterine, bih history, developmental history till date all normal. Corneal reflex normal. All other eye parameters normal except exaggerated epicanthal fold. Diagnosis ?

Ans. is 'a' i.e., Pseudostrabismus Epicantnic fold causes Pseudoesotropia (Pseudostrabismus).

medmcqa_train

Pain-sensitive intracranial structure is:

C i.e.Duramater

medmcqa_train

Not used for iron poison in: FMGE 09; NEET 13

Ans. Penicillamine

medmcqa_train

Posterior relations of the head of the pancreas include all of the following, except:

The posterior relations of the head of the pancreas include the common bile duct, inferior vena cava and the right and left renal veins terminating into it. The first pa of the duodenum is an anterior relation of the head of the pancreas.Ref: Clinical Anatomy, By Richard S. Snell, 6th edition, Page 230; Clinical Anatomy (A Problem Solving Approach), By Neeta V Kulkarni, 2nd edition, Page 689.

medmcqa_train

Which of the following events is involved in cleavage of the zygote during week 1 of development?

Cleavage is a series of mitotic divisions by which the large amount of zygote cytoplasm is successively paitioned among the newly formed blastomeres. Although the number of blastomeres increases during cleavage, the size of individual blastomeres decreases until they resemble adult cells in size.

medmcqa_train

A female child with virilization, hypertension with low plasma renin diagnosis is :

9] Congenital adrenal hyperplasia represents a group of autosomal recessive inherited, metabolic errors, each characterized by decency or total lack of a particular enzyme involved in the biosynthesis of cortical steroids, Steroidogenesis is then channelled into other pathways leading to increased production of androgens, which accounts for virilization. Simultaneously, the decency of cortisol results in increased secretion of ACTH resulting in adrenal hyperplasia. Following enzymes are implicated in the congenital adrenal hyperplasia 21 α hydroxylase decency (partial or complete) 17 α hydroxylase deficiency 11β hydroxylase deficiency 21 α hydroxylase deficiency • Two forms of this deficiency include - A. Salt-wasting adrenogenital ism B. Simple Virilizing adrenogenital ism A) Salt-wasting syndrome (complete lack) The salt wasting syndrome results from complete lack of 21 hydroxylases. There is no synthesis of mineralocorticoids and glucocorticoids in the adrenal cortex. Decreased mineralocorticoids causes marked sodium loss in the urine, resulting in hyponatremia, hyperkalemia, acidosis and hypotension. Because of the enzyme block, there is increased formation of 17 - hydroxyprogesterone, which is then shunted into the production of testosterone. This may cause virilism (pseudo-hermaphroditism) in female infants. That is (XX) Female with 21 hydroxylase deficiency develops ovaries, female ductal structures and external male genitalia. But in the male child, the effect of increased testosterone will not be manifested at the time of birth. The complete21 hydroxylase deficiency or salt wasting syndrome usually comes to light only after the birth because in utero the electrolytes and uids can be maintained by maternal kidneys. Males with this disorder comes to clinical attention 5 to 15 days later because of salt losing crisis while females come to attention soon after the birth because of the virilization. B) Simple Virilizing adrenogenital syndrome (Partial deficiency) Occurs in individuals with partial deficiency of 21 hydroxylases Less severe deficiency of mineralocorticoid, is sufficient for salt reabsorption, but the lowered glucocorticoid fails to cause feedback inhibition of ACTH secretion. Thus level of aldosterone is mildly reduced, testosterone is increased and ACTH elevated with resultant adrenal hyperplasia. 11B hydroxylase deficiency-. Rare Leads to decreased cortisol and increased ACTH. This, in turn, leads to the accumulation of DOC (deoxycorticosterone) and 11 deoxycortisol both of which are strong mineralocorticoids. This results in increased sodium retention by the kidneys and hypertension, hypokalemia. Patients also develop virilization due to androgen excess. 17 α hydroxylase deficiency - Patients with deficiency of 17 hydroxylases also have impaired cortisol production, increased ACTH and secondary increased DOC. These patients, however, cannot synthesize normal amount of androgens and estrogens. This is because the gene that codes for 17 α hydroxylase is the same for the enzyme in the adrenal cortex and the gonads and the decency is same in both organs. Because of decreased sex hormones, genotypic females develop primary amenorrhoea and fail to develop secondary sex characteristics while genotypic males will present as pseudohermaphrodite. 3 β hydroxylase deficiency 3-β hydroxylase deficiency is a rare genetic disorder of steroid biosynthesis that results in decreased production of all three groups of adrenal steroids which include mineralocorticoid, glucocorticoid and sex steroids. Decreased mineralocorticoid secretion results in varying degrees of salt wasting in both males and females. Decent androgen production results in ambiguous genitalia in males The usual presentation is a male child with ambiguous genitalia and severe salt wasting. Sometimes it may also occur in females

medmcqa_train

'Patterned' abrasion is variety of:

Ans. is 'b' ie pressure abrasion (Ref: Parikh; 6/e, p4.3).An abrasion is a superficial injury involving only the superficial layers of the skin (epidermis only), caused by friction and / or pressure between the skin and some rough object or surface. It bleeds very slightly, heals rapidly in a few days and leaves no scar.They can be classified into 3 types, depending on the manner they are created.ScratchIs a linear injury produced by a sharp object, such as pin, thorn or finger nail.Graze (Sliding, scraping or grinding abrasion).Is produced when a broad surface of skin slides against a rough surface.It is also known as brush or friction burn because it is caused by the frictional force and resembles a burn after dryingIt is commonly found in road traffic accidents.Imprint, Pressure or contact abrasion.Is produced as a result of direct impact or pressure of or contact with some object at right angles to the skin surface.The cuticle is crushed, and the object marks a reproduction of its shape and pattern on the to the skin, therefore it is known as patterned abrasion.Example are ligature marks in hanging and strangulation, nail and thumbs marks in throttling, teeth marks in biting, radiator, grill or tyre mask in vehicular accidents.

medmcqa_train

Pimozide belongs to class of:

Thioxanthenes are flupenthioxol. Butyrophenones are haloperidol, trifluperidol , penfluridol. Phenothiazines are Chlorpromazine, triflupromazine , thioridazine, flufenazine. Promazine belongs to the group of other of other hetero cyclics that is diphenyl butyl piperidine. Ref: KD Tripathi 8th ed.

medmcqa_train

Following poisoning retards putrefaction: NEET 13

Ans. Arsenic

medmcqa_train

True statements about parotid gland

The duct runs forwards for a sho distance between the buccinator and the oral mucosa. Finally, the duct turns medically and opens into the vestibule of the mouth(gingivobuccal vestibule)opposite the crown of the upper second molar tooth. Notes: Parotid abscess may be caused by spread of infection from the opening of parotid duct in the mouth cavity. <img src=" /> REF.BDC VOL.3,Sixth edition pg 110

medmcqa_train

Which of the following statement is false about hydrocele?

Treatment of Hydrocele Congenital Hydrocele: Usually spontaneous obliteration by 2 years age. If persists then Herniotomy. Treatment of Vaginal Hydrocele 1. Small hydrocele: Lord's procedure (Plication of sac)Q 2. Medium hydrocele: Jaboulay's procedure (Eversion of sac)Q 3. Large hydrocele: Excision of sacQ

medmcqa_train

A normally developing 10 months old child should be able to do all of the following except –

A child starts trying to build a tower of cubes (2 cubes) by the age of 1 year. About other options Child can stand with support by 9 months. Child can play peak-a-boo game by 10 months. Child can pick up a pellet with thumb and index finger (pincer grasp) by 9 months.

medmcqa_train

Lines of Blaschko&;s are along

Blaschko&;s lines, are lines of normal cell development in the skin. These lines are invisible under normal conditions.

medmcqa_train

All the teeth in patient’s mouth are similarly affected as shown in the radiograph. What is the most likely anomaly?

Dentinal dysplasia Dentinal dysplasia is an inherited condition affecting both dentitions. It is divided into two types: Type I (radicular dentinal dysplasia) and Type II (coronal dentinal dysplasia). It occurs less frequently than dentinogenesis imperfecta. Clinical features Type I is the more frequent type. Teeth erupt normally with no obvious abnormality but rapidly develop mobility resulting from limited root support. In type II, the deciduous teeth are similar to those in dentinogenesis imperfecta, whereas the permanent teeth appear normal. Radiological signs In Type I, all the teeth, except the canines, have extremely short roots. The roots are conical or blunted. There is pulpal obliteration and the inferior aspects of the crown exhibit linear crescent-shaped radiolucent lines. Periapical radiolucencies are commonly seen associated with non-carious teeth in Type I dentinal dysplasia. In Type II dentinal dysplasia, obliteration of the pulp occurs post eruption in the deciduous dentition. In the permanent dentition, there is alteration in the configuration of the pulp resulting in enlarged pulp chambers extending well down into the root. The pulp contains multiple calcifications. Ref: Interpreting Dental Radiographs by Keith Horner, Jon Rout and Vivian E Rushton

medmcqa_train

Middle aged female with mass in sella turcica hormone increased is -

The sella turcica is a saddle shaped depression of the sphenoid bone. It forms the caudal border of the pituitary gland. Sella turcica is an anatomically complex area with a number of different potential pathologies especially neoplastic process. Pathologies of sella turcica can lead to important clinical presentations such as hormonal imbalances from pathologies affecting the pituitary gland and neurological symptoms from the mass effect. Sella turcica is critically located as several structures pass close to it due to compression of the adjacent structures. Important anatomical structures related to sella Optic chiasm Pituiatry gland Internal carotids​ Gavernous sinus and cranial nerves Sphenoid sinuses

medmcqa_train

Hyoid bone fracture most common occurs in ?

Ans. is 'a' i.e., Manual strangulation As manual strangulation (throttling) is among the most violent form of asphyxia, hyoid fracture and other injury to neck structures is more common.

medmcqa_train

"Acute Meningoencephalitis" is caused by:

Nageleria

medmcqa_train

All are major symptoms of sinusitis except

According to Rhinosinusitis task force definition of sinusitis,Major criteria-Facial pain, pressure, congestion, nasal obstruction, nasal/postnasal discharge, hyposmia and feverMinor criteria- Headache, halitosis, and dental painRef: Hazarika; 3rd ed; Pg 328

medmcqa_train

Most sensitive nerve fiber to hypoxia

Question repeated

medmcqa_train

Nasal septum is formed except by

The bony pa is formed by: 1.Vomer 2.Perpendicular plate of ethmoid 3.Nasal spine of frontal bone 4.Rostrum of sphenoid 5.Nasal crest of nasal, palatine and maxillary bones. NOTES: The cailaginous pa is formed by; 1.Septal cailage 2.Septal process of inferior nasal cailages The cuticular pa is formed by; 1.Fibrofatty tissue Ref.BDC volume3,Sixth edition pg 240

medmcqa_train

Metoprolol is preferred over Propranolol as it: September 2010

Ans. A: Is more potent in blocking beta-1 receptors Metoprolol is cardioselective beta blocker, more potent in blocking beta-1 than beta-2 adrenergic receptors.

medmcqa_train

All will predispose to atherosclerosis, except

Elevated plasma levels of  homocysteine are associated with increased risk of atherosclerosis, thrombosis and hypertension. Lipoprotein A inhibits fibrinolysis, therefore predisposes to atherosclerosis. Atherosclerosis (Greek  athere-mush)  is a complex disease characterized by thickening or hardening of arteries due to the accumulation of lipids (particularly cholesterol, free, and esterified), collagen, fibrous tissue, proteoglycans, calcium deposits, etc. in the inner arterial wall.  Satyanarayana, Ed 3, Pg No 152

medmcqa_train

Most serious complication seen in other eye after traumatic injury to one eye: March 2005, September 2008

Ans. C: Sympathetic ophthalmia Sympathetic ophthalmia (SO) is a condition in which serious inflammation attacks the sound eye after injury (including intraocular surgeries) to the other. It is the most dreaded complication of unilateral severe eye injury, as it can leave the patient completely blind. Symptoms may develop from days to several years after a penetrating eye injury. Sympathetic ophthalmia is thought to be an autoimmune inflammatory response toward ocular antigens, specifically a delayed hypersensitivity to melanin-containing structures from the outer segments of the photoreceptor layer of the retina. It is thought that Louis Braille, who injured his left eye as a child, lost vision in his right eye due to SO Floating spots and loss of accommodation are among the earliest symptoms. The disease may progress to severe iridocyclitis with pain and photophobia. Commonly the eye remains relatively painless while the inflammatory disease spreads through the uvea. The retina, however, usually remains uninvolved. Papilledema, secondary glaucoma, vitiligo and poliosis of the eyelashes may accompany SO. Diagnosis is clinical, seeking a history of eye injury. An impoant differential diagnosis is Vogt-Koyanagi-Harada syndrome (VKH), which is thought to have the same pathogenesis, without a history of surgery or penetrating eye injury. Definitive prevention of SO requires prompt (within the first 7 to 10 days following injury) enucleation of the injured eye. Evisceration--the removal of the contents of the globe while leaving the sclera and extraocular muscles intact--is easier to perform, offers long-term orbital stability, and is more aesthetically pleasing. But evisceration may lead to a higher incidence of SO compared to enucleation. Immunosuppressive therapy is the mainstay of treatment for SO. When initiated promptly following injury, it is effective in controlling the inflammation and improving the prognosis.

medmcqa_train

Least commonly seen in conduct disorder seen in girls:-

Conduct disorder - Persistent pattern of antisocial behavior in which the individual repeatedly breaks social rules and carries out aggressive acts.in conduct disorder they do it deliberately usually characterized by aggression and violation of the rights of others boys with conduct disorder show physical & relationship aggression but In girls relationship aggression is more predominant than physical aggression children with conduct disorder usually have behaviors characterized by aggression to persons or animals, destruction of propey, deceitfulness or theft, and multiple violations of rules, such as truancy from school.

medmcqa_train

Familial adenomatous polyposis is characterized by all except

Familial adenomatous polyposis (FAP) Is a rare, inherited condition caused by a defect in the adenomatous polyposis coli (APC) gene - located in 5q 21 chromosome. FAP is autosomal dominant- >50% chance of inheritance in family members Has > 100 adenomatous polyps 100% RISK of malignancy Polyp formation - by 15 yrs. 100% develop malignancy - by 40 yrs. TOC: Total proctocolectomy + ileal pouch-anal anastomosis (TPC + IPAA) M/C/C of death after TPC = Peri-ampullary Ca (polyps in duodenum - periampullary region) Two variants of FAP Gardner's syndrome Osteoma (mandible) Congenital hyperophy of the retinal pigmented epithelium (CHRPE) lesions Sebaceous cysts Benign lymphoid polyposis of ileum Desmoid tumors Supernumerary teeth Turcot's syndrome: Brain tumors Medulloblastoma - m/c associated with FAP Glioblastoma multiforme - m/c associated with HNPCC

medmcqa_train

In Steiner's analysis, SNA demonstrates:

Relating the Maxilla to the Skull: The angle SNA is formed by joining the lines S-N and N-A . The mean reading for this angle is 82°. Steiners analysis demonstrates the position of maxilla and mandible in relation to the cranial base.  If the angular reading is more than 82°, it would indicate a relative forward positioning or protrusion of the maxilla. Conversely, should the reading be less than 82°, it would indicate a relative backward or recessive location of the maxilla.

medmcqa_train

. Sulphasalazine is NOT used for the treatment of-

Sulhasalazine is not used for treatment of sarcoidosis As a treatment for sarcoidosis, these drugs are most likely to be effective in people who have skin symptoms or a high level of calcium in their blood. Hydroxychloroquine (Plaquenil) and chloroquine (Aralen) are antimalarial drugs that are used to treat sarcoidosis Ref Davidson 23rd edtion pg 981

medmcqa_train

Post traumatic stress disorder is differentiated from other anxiety disorders by which of the following symptoms?

This question is not about the diagnostic features of PTSD. This is about the differential diagnosis. PTSD is an anxiety disorder and it shares symptoms with other disorders. Impoant features in distinguishing the condition are given below. Differential diagnosis: Point 1: Etiologically significant trauma should be present for a diagnosis of PTSD. E.g. A traumatic event in the past. Point 2: 'Intentionality' or 'aboutness' is an impoant factor for PTSD. Nightmares, flashbacks or reliving experiences should be related to the past event. PTSD concerns memory - Intrusion of past stressors into the present. Point 3: Avoid a 'stimulus' or 'activity' that provokes the memory of the past event. In the above question, only reliving experience is mentioned as connected to the past experiences. Hence, that is the answer for this question. All other symptoms can be see in other anxiety disorders. Ref: Kaplan & Sadock's, Comprehensive Textbook of Psychiatry, 9th Edition, Page 2659

medmcqa_train

Which muscle is responsible for unlocking of knee?

Ans. A PopliteusRef: BDC, vol II pg. 155* Quadriceps femoris is the main and only extensor of knee.* It produces locking action as a result of medial rotation of the femur during the last stage of extension.* To reverse this lock popliteus muscle comes into action and does so by the lateral rotation of femurRemember: Lock is: Quadriceps femoris muscle and, Key is popliteus muscle.Muscles producing movements at the knee jointMovementPrincipal musclesA. Flexion * Biceps femoris* Semitendinosus* SemimembranosusB. ExtensionQuadriceps femorisC. Medial rotation of flexed leg* Popliteus* Semimembranosus* SemitendinosusD. Lateral rotation of flexed leg * Biceps femorisExtra Mile* Quadriceps femoris incudes: Rectus femoris, Vastus Lateralis, Vastis Medialis, Vastus Intermedius.* Rectus femoris is also known as "kicking muscle"

medmcqa_train

Polymorphic ventricular tachycardia can occur when terfenadine(antihistaminic):

Torsades de pointes (polymorphic ventricular tachycardia) occurs when terfenadine is taken in higher doses or when hepatic metabolism is impaired by disease or by drugs which inhibit the cytochrome P450 responsible for metabolism of terfenadine. Drugs include erythromycin, clarithromycin, ketoconazole and itraconazole. Azithromycin and fluconazole that are excreted unchanged in the urine have not been associated with impaired metabolism of terfenadine. Terfenadine blocks the delayed rectifier potassium channels and prolongs cardiac repolarization and the QT interval.

medmcqa_train

Which component transfers four protons:

A i.e. NADH-Q Oxidoreductase; C i.e. Cytochrome C-Q oxidoreductase

medmcqa_train

All of the following are true about Asthma, Except:

Answer is D (Small airways are not involved): Asthma involves both large and small airways but alveoli are not involved Charcot Leyden crystals may be seen in sputum: Pathology by woolf lsr (1998)/434 Sputum from Asthmatics show ceain characteristic features, including charcot leydencrystas The microscopically identifiable features described in sputum are three 'C's Charcot Leyden crystals - Derived from granules of eosnophils andfbund only in Asthma Curshmann spirals - Curiously twisted casts of airways : Whorls of shed epethelium Creola bodies - Clumps of cells or isolated metaplastic cells Reversible Airflow obstruction is a charachteristic feature (Davidsons 18th/55, 326) Reversible Bronchoconstriction is the hallmark of Asthma The charachteristic feature of Asthma is Intermittent and Reversible airflow obstruction. Narrowing of airways is usually reversible, but in some patients with chronic asthma there may be an element of irreversible airflow obstruction Asthma involves both large and small airways Asthma involves Large and small airways hut not alveoli - 'Allergic Diseases: Diagnosis Treatment' 3rd/ 120 The large and small airways are both involved in Asthma -'Childhood Asthma: Diagnosis, Treatment & Management' r/15 Intermittent Asthma responds better to bronchodilator therapy than persistant Asthma Bronchodilators are effective drugs for the treatment of acute exacerbations or intermittent episodes of Asthma but they are not sufficient to control asthma in patients with persistant symptoms (persistant asthma) Bronchodilators are not sufficient to control Asthma in patients with persistant symptoms'

medmcqa_train

In emergency, which aery can be safely ligated ?

Ans. is 'a' i.e. Internal iliac

medmcqa_train

Late metabolic acidosis is seen in-

Ans. is 'b' i.e., Preterm baby getting cow milk Late metabolic acidosis (LMA) o Late metabolic acidosis is a special type of acidosis in apparently healthy premature infant. o This hyperchloremic acidosis appeares during second and third week of life, and resolves spontaneously within a couple of weeks. Definition "An acidosis occuring after second day of life, in which base excess values are lower than -5meq/L on two consecutive estimations done at least 24 hours apa". Etiology o Prematurity is the most impoant single predisposing factor in the development of LMA. o The incidence varies considerably depending upon the gestational maturity and protein content of feeding formula. o In preterm neonates fed on a modified cow's milk the risk of developing LMA is very high.

medmcqa_train

Chemotherapeutic drugs can cause?

Ans. is 'c' i.e., Both necrosis and apoptosis o Injurious stimuli, e.g., radiation, cytotoxic anticancer durgs, heat and hypoxia, can induce apoptosis if the insult is mild, but large doses of same stimuli result in necrotic cell death.

medmcqa_train

Which of the following nerve is involved in Frey's syndrome?

Syndrome (Gustatory Sweating) aka auriculotemporal syndrome: Frey's syndrome arises as a complication of parotid surgery usually manifesting several months after the operation. lt is characterised by sweating and flushing of the preauricular skin during mastication causing nuisance to the person or social embarrassment. It is the result of damage to auriculotemporal nerve and aberrant innervation of sweat glands by parasympathetic secretomotor fibres which were destined for the parotid. Now instead of causing salivary secretion from the parotid, they cause secretion from the sweat glands. The condition can be treated by tympanic neurectomy which intercepts these parasympathetic fibres at the level of middle ear. Some people like to place a sheet of fascia lata between the skin and the underlying fat to prevent secretomotor fibres reaching the sweat glands. Generally, no treatment other than reassurance is required in most of these patients. Also known as Crocodile tears (gustatory lacrimation): There is unilateral lacrimation with mastication. This is due to faulty regeneration of parasympathetic fibres which now supply lacrimal gland instead of the salivary glands. It can be treated by section of greater superficial petrosal nerve or tympanic neurectomy.

medmcqa_train

Opening of mouth is caused by:

Ans. A Lateral pterygoidRef: Grays, 41st ed. pg. 507-508* The primary function of the lateral pterygoid muscle is to pull the head of the condyle out of the mandibular fossa along the articular eminence to protrude the mandible.* The effort of the lateral pterygoid muscles acts in helping lower the mandible and open the jaw whereas unilteral action of a lateral pterygoid produces contralateral excursion (a form of mastication), usually performed in concert with the medial pterygoids.* Unlike the other three muscles of mastication, the lateral pterygoid is the only muscle of mastication that assists in depressing the mandible i.e. opening the jaw. At the beginning of this action it is assisted by the digastric, mylohyoid and geniohyoid muscles.

medmcqa_train

All are true about streptococcus Except

Mucoid colonies are due to the production of the capsule of hyaluronic acid not due to M-protein. Growth characteristic of Strep. pyogenes: On blood agar, virulent stains form matt or mucoid colonies while avirulent from glossy colonies. M, T, R are proteins found on the outer pa of the cell wall and forms the basis of Griffith classification. M protein - acts as virulence factor and antibody against it is protective. T and R protein - No relation to virulence Ref : 208

medmcqa_train

What is monitored in a patient of Pre eclamsia ?

Ans. is 'd' i.e. All of the abov Investigations in a case of Pre eclampsia* URINE for proteins/albumin. 24 hours urine protein* CBC: There is hemoconcentration so HB values are false elevated. Low platlets indicate HELLP syndrome* Sr uric acid: It is a biochemical marker of preeclampsia. Raised levels (>4.5 mg/dl) indicate renal involvement and also correlate with severity of preeclampsia, volume contraction and fetal jeopardy.* LFT: SGOT, SGPT, Bilirubin* RFT: Sr creatinine* Coagulation profile may be required in severe cases:i) BTii) CTiii) PT, APTTiv) Fibrinogen levelsv) FDP

medmcqa_train

In a young female of reproductive age an absolute contraindication for prescribing oral contraceptive pills is:

Ans-D i.e., Impaired liver function Repeat Q No 173 (Nov. 2004)Absolute contraindications include:A personal h/O thromboembolic venous, arterial or cardiac disease or severe or multiple risk factor for these. Transient cerebral ischaemic attacks without a headache.Infective hepatitis, until 3 months after liver function tests has become normal, and another liver disease including disturbances of hepatic excretion e.g. cholestatic jaundice, Dubin Johnson and Rotor syndromes.A migraine, if there is a typical aura, focal features or if it is severe and lasts > 72 hours despite t/t or is treated with an ergot derivative.Carcinoma of the breast or the genital tractOther conditions including SLE, porphyria, following the evacuation of a hydatidiform mole (until urine and plasma gonadotropin concentrations are normal), undiagnosed vaginal bleeding.Relative contraindications of OCP'sThe family history of venous thromboembolism, arterial disease or a known prethrombotic condition e.g. Factor V Leiden (pretreatment coagulation investigation is advised).Diabetes mellitus which may be precipitated or become more difficult to control (avoid if there are diabetic complications).Hypertension (avoid if B.P. exceeds 160/100)Smoking > 40 Cigarettes per day (15 Cigarettes/day enhances the risk of circulatory disease and constitutes an absolute contraindication for women over 35 years.Long-term immobility (e.g. due to Leg plaster, confinement to bed.Breastfeeding (until weaning or for 6 months after birth).Obesity

medmcqa_train

A tracheostomised patient, with poex tracheostomy tube, in the ward, developed sudden complete blockage of the tube. Which of the following is best next step in the management?

Immediate removal of the tracheostomy tube is best next step in the management in the above case -Suction of tube with sodium bicarbonate is done to avoid the blockage. -Suction of the tube with saline can't be used when there's a complete obstruction. - Jet ventilation is done below the level of larynx, when we're operating on the larynx.

medmcqa_train

All of the following are well recognised predisposing factors for adult respiratory distress syndrome, except:

Status asthmaticus is an example of type 2 respiratory failure while ARDS is type 1 respiratory failure. All other choices lead to cytokines release and damage the alveoli leading to ARDS.

medmcqa_train

Gottron papules is seen in ?

Ans. is 'a' i.e., Dermatomyositis

medmcqa_train

Which among the following is the BEST irrigating fluid during ECCE?

BSS plus a balanced salt solution enhanced with bicarbonate, dextrose and glutathione. It is specially used for surgeries requiring prolonged irrigation such as phacoemulsification, pars plana vitrectomy and automated extracapsular cataract extraction. Balanced sterile solution is a sterile physiologically balanced irrigating fluid. It is the most frequently used solution during ophthalmic surgery to keep the cornea from drying out. BSS plus solution causes less corneal edema and endothelial cell damage following vitrectomy. The glutathione protects against depletion of endothelial ATP levels and maintains the integrity of the cell membrane by counteracting endogenous and exogenous oxidative agents. Ref: Surgical Technology for the Surgical Technologist: A Positive Care Approach By Association of Surgical Technologists page 223. Ocular Toxicity of Intraoperatively Used Drugs and Solutions By Rudolph Marie Matheus Antonius Nuijts page 16. Clinical Ophthalmology: Contemporary Perspectives, 9/e By Gupta page 43.

medmcqa_train

Acute Gouty ahritis is seen early in treatment following -

All of the above Rapid lowering of urate level in chronic gout, by any means, may precipitate an attack of acute gout, probably by causing the dissolution of tophi. o It is therefore usual to give prophylactic suppressive treatment with indomethacine, colchicine or steroid cover during first 2 months of allopurinol or uricosurics. o Amongs the given options, allopurinol, probenecid and Rasburicase are the drugs that lower serum urate level. So, all three can precipitate acute gout. However, among these three, allopurinol is used most commonly therefore is the best answer here.

medmcqa_train

Chandler's index is associated with: September 2006

Ans. B: Hook worm Morbidity and moality from hookworm infection depend much on the worm load. Chandler worked out an index on the basis of an average number of hookworm eggs per gram of feces for the entire community, Chandler's index is still used in epidemiological studies of hookworm disease. By this index, worm loads in different population groups can be compared and also the degree of reduction of egg output after mass treatment.

medmcqa_train

Heparin is the commonly used anticoagulant in cardiac surgery. All of the following are true about heparin except-

Ans. is 'a' Weakest acid found in living organism Heparin is a direct acting anticoagulant Chemical nature and preparationHeparin is a sulfated mucopolysaccharide which occurs in the secretory granules of mast cells.It is the strongest organic acid in the body and in the solution it carries an electronegative charge.It is prepared commercially from a variety of animal tissues (generally porcine intestinal mucosa or bovine lung).Mechanism of Action of HeparinHeparin acts by activating antithrombin which is a naturally occuring inhibitor of activated coagulation factors of intrinsic and common pathway. 'Adverse effects of HeparinBleedingHeparin induced thrombocytopeniaOccurs more commonly in heparin derived from bovine lung.Heparin induced thrombocytopenia should be suspected in whom the platelet count falls by 50% or more after starting heparin and usually occurs 5 or more days after starting therapy.In patients with heparin induced thrombocytopenia following drugs should be substituted.Danaparoid sodiumHirudinArgatrobanOsteoporosis - (most frequently seen in pregnancy)Hypersensitivity reactions & skin necrosis

medmcqa_train

One of the following is the first enzyme to be released at the site of wound?

Ref - Krishan Vij textbook of forensic medicine and toxicology 5e pg - 202

medmcqa_train

Sign of diabetic ketoacidosis is-

Physical findings of diabetic ketoacidosis are tachycardia, dehydration/hypotension, hypothermia, tachypnea/Kussmaul respirations/ respiratory distress, abdominal tenderness (may resemble acute pancreatitis or surgical abdomen), lethargy/obtundation/cerebral edema/possibly coma. Reference : page 2418 Harrison's Principles of Internal Medicine 19th edition

medmcqa_train

Which of the following drug is used in scabies as single oral dose agent: March 2011

Ans. C: Ivermectin Ivermectin is used as single oral dose of 200 microgram/ kg body weight It can be repeated after 2 weeks It is indicated in epidemics of scabies in orphanages and Norwegian scabies Scabies: Incubation period: 4 weeks Pathognomic lesion: Burrow, which lies in stratum corneum MC site in infants: Scalp, face Most severe form: Norwegian scabies Drug used orally: Ivermectin

medmcqa_train

Most common complication after ERCP is

Complication perforation(1.3%)/hemorrhage (1.4%),pancreatitis (4.3%) and sepsis (3-30%). Bailey & Love 26th, 208

medmcqa_train

Which of the following clinical situations is associated with an increase in predominantly conjugated ("direct") bilirubin?

Of the conditions listed, only pancreatic head tumors are associated with an increase in conjugated ("direct") bilirubin (obstructive jaundice). Increased levels of unconjugated ("direct") bilirubin result from hemolysis over liver defects that impair uptake or conjugation mechanism in liver cells (Gilbe's syndrome, Crigler- Najjar syndrome) positive. Unconjugated bilirubin may cross the immature blood brain Barrier of the newborn and cause Kernicterus. The physiologic jaundice of the newborn observed during the first week of bih is usually mild and due to relatively immature liver conjugation. Ref: Cothren C., Biffl W.L., Moore E.E. (2010). Chapter 7. Trauma. 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.

medmcqa_train

Regarding carcinoma Gallbladder true statement

Clinical features Most commonly presents with right upper quadrant pain often mimicking cholecystitis and cholelithiasis Weight loss, jaundice and abdominal pain are less common presenting symptoms Chronic cholecystitis with a recent change in quality or frequency of the painful episodes in 40% patients Malignant biliary obstruction with jaundice, weight loss and RUQ pain Ref: Sabiston 20th edition Pgno : 1512-1514

medmcqa_train

Which anaesthetic agent increases intracranial tension among the following

All inhalational anaesthetics directly act on cerebral blood vessels→vasodilatation→increase cerebral blood flow→ increase intracranial tension

medmcqa_train

Granules of Eleidin are present in which of the following layer?

Stratum Lucidum - Also called clear cell layer. Present only in skin of palms and soles. Translucent due to presence of refractile Eleidin granules

medmcqa_train

Antidepressant drug used in nocturnal enuresis is:

Sleep related enuresis- Treatment Bed alarms (behavioral therapy)- TOC Desmopressin (DOC) Imipramine (TCA Antidepressant)

medmcqa_train

Five days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is found to have a serum sodium level of 125 mEq/L. Which of the following is the most appropriate management strategy for this patient?

The initial, and often definitive, management of hyponatremia is free-water restriction. Symptomatic hyponatremia, which occurs at serum sodium levels less than or equal to 120 mEq/L, can result in headache, seizures, coma, and signs of increased intracranial pressure and may require infusion of hypeonic saline. Rapid correction should be avoided so as not to cause central pontine myelinolysis, manifested by neurologic symptoms ranging from seizures to brain damage and death. Additionally, a search for the underlying etiology of the hyponatremia should be undeaken. Acute severe hyponatremia sometimes occurs following elective surgical procedures due to a combination of appropriate stimulation of antidiuretic hormone and injudicious administration of excess free water in the first few postoperative days. Other potential etiologies include hyperosmolarity with free-water shifts from the intra- to the extracellular compament (eg, hyperglycemia), sodium depletion (eg, gastrointestinal or renal losses, insufficient intake), dilution (eg, drug-induced), and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).

medmcqa_train

Reversible cause of dementia is -

Ans. is 'c' i.e., Hypothyroidism Causes of dementiaReversible causesSurgically treatableMedically treatableo Normal pressure hydrocephaluso Brain tumors (frontal lobe tumor)o Meningiomao Subdural hematoma (Head injury)o Hydrocephaluso Hypothyroidismo Depressiono HIV infectiono Alcohol abuseo Vitamin B12, Folate, Niacin deficiencyo Any metabolic or endocrine disturbanceo Neurosyphiliso Hashimoto's encephalopathy o Wilson's diseaseo Celiac disease or Whipple's diseaseo Chronic meningoencephalitiso Drugs and toxin (toxic dementia)Irreversible causeso Alzheimer's diseaseo Huntington's choreao Lewy body dementiao Vascular (Multi-infarct) dementiao Parkinson's diseaseo Creutzfeld Jakob diseaseo Pick's diseaseo Overall Alzheimer's disease is the most common cause. Vascular dementia is the 2nd most common cause.

medmcqa_train

A obese female having hirsutism on laboratory investigation has high level of LH and androgens. Likely cause is-

Ans. is 'a' i.e., PCOS o The clinical and laboratory features of the patient described in the question match with those of PCOS as depicted in the table. So the most appropriate answer is PCOS.Clinical features of polycystic ovarian diseaseClinical featureHannonalSequelaeo Young womano | E2. levelo Diabaetes (15%)o Central obesityo | FSH | LH > 10 IU/mlo CVS disorder# SMI > 30kg/cm2o | FSK/LH ratioo Lipidaemia# Waist line > 35o | Androgenso Hypertensiono Gligomenorrhoea, amenorrhoeao Testosterone,epiandrostenedione. |dehydropepiandrosterone |o Endometrial cancero Infertility (20%)o Breast cancero Hirsutismo Premature ovariano Acanthosis nigra due to insulin resistance, Thick pigmented skin over the nape of neck, inner thigh and axillao 17-alpha-hvdroxy progesterone> 800 ng.'dLfailure following surgeryo Testosterone > 2 ng/mlo Most androgens from ovaryo | fasting insulin > l0mlu/Lo Protactin |o Sex hormone binding globulin (SHBG)o | E2/oestrone (E1) ratioo F glucose,'insulin ratio <4-5 (normal 2-4-4-5)

medmcqa_train

All are used in the management of head injury patient except?

Glucocoicoids are useful for management of vasogenic edema from tumor or brain abscess. In contrast glucocoicoids are avoided in case of head trauma, ischemic and hemorrhagic stroke. Norepinephrine or pressor therapy is used to maintain a MAP to maintain CPP> 60 mm Hg. Sedation is done with propofol or midazolam. Neuromuscular paralysis will be necessary and the patient will need ventilator suppo. This will ensure securing the airway and keeping pCO2 between 30-35mmHg.

medmcqa_train