Preconception Counseling
Contents1 Uncontrolled diabetes in mother is associated with following defects in neonate except2 To avoid...
Stove-in Chest
stove-in chest is a subtype of flail chest in which there is a depression or...
Nephrology MCQs-3
Contents1 Most common primary inherited aminoaciduria-2 Most common cause of autosomal recessive proximal renal tubular...
ECG Question-2
Contents1 What is the diagnosis of ECG?2 What is the diagnosis of ECG?3 Paroxysmal AF...
Fetal Skull and Maternal Pelvis
Contents1 Asynclitism during labor can be assessed by palpating2 Which of the following represents a...
LeCompte maneuver
Contents1 LeCompte maneuver is done in2 LeCompte maneuver is done in3 If LeCompte maneuver is...
Arterial switch operation
Contents1 Which of the following is the Arterial switch operation?2 Jatene procedure is ideally performed...
Image Question-25
Contents1 What is the most probable diagnosis?2 Egg-on-a-string sign3 What is the management line for...
Marcus Gunn pupil
Contents1 In Marcus Gunn pupil there is relative weakness of which of the following pathway...
Anticoagulation for Mechanical valves
Anticoagulation for Surgical Procedures in patients with Mechanical valves For high risk non-cardiac surgeries in...
Hyponatremia
What is the sodium level below which symptomatic hyponatremia occurs? MCQSymptomatic hyponatremia usually does not…
Spasticity and Rigidity
What is Spasticity? Increased tone of muscles called as spasticitySpasticity – Resistance determined by the…
Hürthle Cells
What is a Hürthle Cell? Hürthle cell is used to describe follicular-derived epithelial cells with oncocytic cytology. Oncocytes…
Medicine MCQs-8 : Frostbite
Most imminent threat to life in cold injuries is -
Systemic hypothermia - When hypothermia is identified, treatment should be instituted immediately with both passive and active rewarming measures
“chunk of wood” sensation in the extremity is seen in -
Frost bite - “chunk of wood” sensation in the extremity
Snow blindness is produced by -
Snow blindness is produced by ultraviolet (UV) solar radiation reflected from snow, ice, or water. It tends to be more common at high altitudes, where the air filtration of UV radiation is diminished.
Mildest form of peripheral cold injury is -
The mildest form of peripheral cold injury is frostnip, which tends to occur in apical structures (nose, ears, hands, feet), where blood flow is most variable because of the richly innervated arteriovenous anastomoses.
All of the following is non-freezing cold injury EXCEPT ?
Local cold injuries may be divided into freezing (frostbite) and nonfreezing (chilblains and immersion [trench] foot) injuries.
Mildest form of peripheral cold injury is frostnip
Hospital-acquired AKI
Most common clinical settings for hospital-acquired AKI- sepsis- major surgical procedures- critical illness involving heart…
Medicine MCQs – 7
What is the composition of Jackstone calculus?
Jackstone calculi - almost always composed of calcium oxalate dihydrate and consist of a dense central core and radiating spicules.
Randall's plaque is microscopically a plaque of -
Randall's plaque is microscopically a plaque of calcium deposited in the interstitial tissue of the renal papilla. These plaques are thought to serve as a nidus for urinary stone formation. Large amounts of Randall's plaque are unique to idiopathic calcium oxalate stone formers.
Which of the following is the diagnostic method to detect kidney stones?
helical CT scan with 5 millimeters (0.2 in) sections is the diagnostic method to use to detect kidney stones and confirm the diagnosis of kidney stone disease
Adding contrast to the CT scan study may sometimes help clarify a difficult or confusing case but in general, contrast obscures calcific densities and as such, contrast scans are usually only indicated during subsequent evaluation of patients with stones.
The noncontrast CT is the cornerstone of initial radiographic assessment.
Which of the following microorganism is not associated with struvite stone formation in urinary tract.
Struvite stones are formed by urinary tract infection with urease producing bacteria that splits urea to ammonium, and increases urine pH to neutral or alkaline values.
Organisms splitting urea are Proteus, Pseudomonas, Klebsiella, Staphylococcus, and Mycoplasma.
E coli is not associated with struvite stones
Urease-positive bacteria increase chances of which of the following stone formation?
Urease-positive bacteria, such as Proteus mirabilis can produce the enzyme urease, which converts urea to ammonia and carbon dioxide.
This increases the urinary pH and promotes struvite stone formation.
All of the following true for Struvite stone EXCEPT ?
Struvite readily forms in alkaline conditions.
Potentiated by alkaline urine and high magnesium excretion
Which of the following is most common type of kidney stone?
Calcium oxalate: The most common type of kidney stone
High dietary intake of potassium appears to reduce the risk of stone formation because potassium promotes the urinary excretion of citrate, an inhibitor of calcium crystal formation.
Which of the following is used to differentiate between phleboliths and ureteric stone ?
"rim sign " - rim, ring, or halo of soft tissue visible on CT scans that completely surrounds ureteral stones.
The effect is enhanced by the local inflammation a stone produces in the ureteral wall, with subsequent edema at the site of the calculus.
The rim sign is generally missing or incomplete with phleboliths.
If a stone grows to more than ----- millimeters, it can cause blockage of the ureter
5 mm
Which of the following stone formation is promoted by the alkaline urine (pH >7.2) and the presence of ammonia in the urine?
Two conditions must coexist for the formation of struvite calculi. These are (1) alkaline urine (pH >7.2) and (2) the presence of ammonia in the urine.
Struvite stones are also known as triple-phosphate (3 cations associated with 1 anion), infection (or infection-induced), phosphatic, and urease stones.
Medicine MCQs -6 : Folates
Which vitamin deficiency causes 'methylfolate trap' ?
Vitamin -B12 -
THF starvation or the methylfolate trap:
MTHF accumulates in plasma
Intracellular folate concentrations fall due to failure of formation of THF
Elevated Methyl malonic acid levels indicate ---------- deficiency
Please select 2 correct answers
vitamin B12
Folate is also known as -
Folate- vitamin B9 https://medicalwikipedia.org/
Vitamin B1
Thiamine
Required as coenzyme in the catabolism of sugars and amino acids.
Vitamin B2
Riboflavin
A precursor of coenzymes called FAD and FMN, which are required for flavoprotein enzyme reactions. Vitamin B3
Niacin (nicotinic acid)
A precursor of coenzymes called NAD and NADP required for metabolic processes.
Nicotinamide
Nicotinamide riboside
Vitamin B5
Pantothenic acid
A precursor of coenzyme A
metabolize many molecules.
Vitamin B6
Pyridoxine
Required as coenzyme in metabolism.
Pyridoxal
Pyridoxamine
Vitamin B7
Biotin
Coenzyme for carboxylase enzymes
Required for of fatty acids and in gluconeogenesis.
Vitamin B9
Folate
Required for repair, and methylate DNA;
Cofactor in various reactions involving rapid cell division and growth, such as in infancy and pregnancy.
Vitamin B12
Cobalamins
Coenzyme involved DNA synthesis and regulation,fatty acid metabolism and amino acid metabolism.
Which of the following mediates uptake of methotrexate by cells?
Reduced folate transporter -mediates uptake of methotrexate by cells.
Large amounts of supplemental folic acid can hide ------------- deficiency
Large amounts of supplemental folic acid can hide vitamin B12 deficiency
All of the following enzyme deficiency cause homocystinuria EXCEPT ?
Deficiency of enzymes that cause homocystinuria -
- Methionine synthase
- MTHFR
- Cystathionine synthase
Deficiency of iron may be masked by which vitamin deficiency?
Deficiency of folic acid or vitamin B12 may mask the deficiency of iron
Which is the most frequently affected tissues in folate and vitamin - B12 deficiency?
Marrow - most commonly affected tissue in folate and vitamin - B12 deficiency
Next most frequently affected tissues are -
Mouth,
Stomach,
Small intestine
Respiratory,
Urinary,
Female genital tracts.
Risk of neural tube defects is associated with deficiency of -
Folic acid is- supplement by women during pregnancy to reduce the risk of neural tube defects
Folates are best absorbed from -
Folates are best absorbed from the upper small intestine
Gastric cells
Gastric cells Cells found in the gastric glands include CellsAlso calledSecret1Foveolar cellsMucous neck cells Mucus2Chief…
Megaloblastic Anemia MCQs
Bioactive forms of vitamin B12 in mitochondria?
Bioactive forms of vitamin B12 -
• Methylcobalamin in cytosol
• Adenosylcobalamin in mitochondria
Cobalamin requires Intrinsic Factor for absorption in ------------ cases
Cobalamin requires IF for absorption - 99%. Free cobalamin is absorbed passively in the terminal ileum -1%. This why oral replacement with large vitamin is required in pernicious anemia
Which of the following helps in protection of the acid-sensitive vitamin B12 while it moves through the stomach?
Essential function of haptocorrin is protection of the acid-sensitive vitamin B12 while it moves through the stomach
Transcobalamin-1 [Haptocorrin] is derived primarily from -
Transcobalamin-1 [Haptocorrin] is derived primarily from the specific granules in neutrophils.
Which of the following is major natural cobalamin?
Forms of cobalamin -
• Adenosylcobalamin • Cyanocobalamin • Hydroxocobalamin • Methylcobalamin
Cobalamin is synthesized by -
Cobalamin is synthesized solely by microorganisms.
Cubilin receptors are present in -
Cubilin receptors are present in -
- Ileum - helps to absorb Vitamin B12 - IF Complex
- Yolk sac
- Renal proximal tubular epithelium
Which of the following has a cobalt atom at the center of a corrin ring?
Vitamin B12 - has a cobalt atom at the center of a corrin ring.
Intrinsic Factor for Vitamin -B12 is produced by which cells?
IF is produced in the gastric parietal cells of the fundus and body of the stomach, and its secretion parallels that of hydrochloric acid.
Gastric cells -
Cells found in the gastric glands include -
-Foveolar cells - also called mucous neck cells - produce mucus
-Chief cells - Zymogen cells/ peptic cells - zymogens – pepsinogen (precursor to pepsin) and prorennin [in childhood only ]
-Parietal cells - oxyntic cells -secrets : HCl , castle's intrinsic factor
-G cells - secret : gastrin hormone
-D-cells - secret : somatostatin
-Enterochromaffin- like cells (ECLs) - release serotonin and histamine
Methylmalonyl coenzyme A mutase uses -------------- to convert L-methylmalonyl-CoA to succinyl-CoA, an important step in the catabolic breakdown of some amino acids into succinyl-CoA.
Methylmalonyl coenzyme A mutase (MUT) is an isomerase enzyme which uses the Adenosylcobalamin form to convert L-methylmalonyl-CoA to succinyl-CoA, an important step in the catabolic breakdown of some amino acids into succinyl-CoA, which then enters energy production via the citric acid cycle.
Methylmalonyl-CoA mutase (MCM) [mitochondrial] also known as methylmalonyl-CoA isomerase
Methylmalonyl-CoA mutase is a vitamin B12-dependent enzyme that catalyzes the isomerization of methylmalonyl-CoA to succinyl-CoA in humans. This functionality is lost in vitamin B12 deficiency, and can be measured clinically as an increased serum methylmalonic acid (MMA) concentration.
Haptocorrin
Follow the link to Get Answers Contents What are the other names of Haptocorrin?What is…
What are the types of homocystinuria?
What are the types of homocystinuria? Homocystinuria type-I- Due to the deficiency of cystathionine ß…
Medicine MCQs-4
Philadelphia Chromosome is seen in -
Chronic myeloid leukemia (CML) has a presence of the hallmark Philadelphia Chromosome (BCR-ABL1) mutation.
Signs of hypovolemic shock appears when acute blood loss is -
Volume of acute blood lost is >40% [ i.e.,>2L in the average-sized adult ] signs of hypo-volemic shock appears
All of the following are classified as myloproliferative neoplasms EXCEPT -
World Health Organization lists the following subcategories of MPNs:
• Chronic myeloid leukemia
• Chronic neutrophilic leukemia
• Polycythemia vera
• Primary myelofibrosis
• PMF, Prefibrotic Stage
• PMF, Overt Fibrotic Stage
• Essential thrombocythemia
• Chronic eosinophilic leukemia
Previously, myloproliferative neoplasms were known as myeloproliferative diseases
Presence of splenomegaly in a patient with polycythemia supports a diagnosis of -
Presence of splenomegaly supports a diagnosis of polycythemia vera rather than secondary polycythemia.
Presence of a palpable spleen in a patient with sickle cell disease after age 5 suggests -
Presence of a palpable spleen in a patient with sickle cell disease after age 5 suggests a coexisting hemoglobinopathy, e.g., thalassemia or hemoglobin C
All of the following are associated with massive splenomegaly EXCEPT -
DISEASES ASSOCIATED WITH MASSIVE SPLENOMEGALY -
- Chronic myeloid leukemia
- Gaucher’s disease
- Lymphomas
- Chronic lymphocytic leukemia
- Hairy cell leukemia
- Sarcoidosis
- Polycythemia vera
Sickle cell anemia - autosplenectomy
Pneumococcal sepsis- has been reported to cause autosplenectomy but is a very rare
All of the following are adaptive functions of normal human Spleen EXCEPT -
Adaptive unctions of Spleen :
(1) Clearance of bacteria and particulates from the blood,
(2) Immune responses to pathogens,
(3) Extramedullary hematopoiesis
Normal human spleen does not sequester or store red blood cells and does not contract in response to sympathetic stimuli.
Microcytosis is reflected by MCV -
Microcytosis - MCV < 80
Macrocytosis. - MCV >100
Castell's sign is a medical sign assessed to evaluate -
Castell's sign is a medical sign assessed to evaluate splenomegaly
Gaisbock’s syndrome is best categorized under the heading of -
Gaisbock’s syndrome is best categorized under the heading of a relative polycythemia
Medicine MCQs – 3
How addition of hydroxychloroquine to doxycycline for treatment against C. burnetii helps?
Addition of hydroxychloroquine to doxycycline against C. burnetii helps to - alkalinize the phagolysosome
Hydroxychloroquine increases lysosomal pH in antigen-presenting cells by two mechanisms: As a weak base, it is a proton acceptor and via this chemical interaction, its accumulation in lysozymes raises the intralysosomal pH
All of the following are characteristic lab finding of rickettsioses EXCEPT -
Characteristic laboratory findings -
- Thrombocytopenia
- Normal or low white blood cell [WBC] counts, elevated hepatic enzyme levels
- Hyponatremia
Which of the following is the most frequently reported travel-associated rickettsial infections?
Tickborne spotted fever rickettsioses are the most frequently reported travel-associated rickettsial infections.
What is the drug of choice of rocky mountain spotted fever in pregnant patients
Drug of choice for the treatment of both children and adults with rocky mountain spotted fever is doxycycline, except when the patient is pregnant
Pregnancy - Treatment with chloramphenicol, a less effective drug, is advised only for patients who are pregnant
What is the causative agent of rickettsialpox?
causative agent of rickettsialpox - R. akari
Which is called as 'walking pneumonia' ?
Walking pneumonia
"Primary atypical pneumonia" is called primary because it develops independently of other diseases.
Known as "walking pneumonia" because its symptoms are often mild enough that one can still work and walk.
Brill-Zinsser disease is a type of -
Brill–Zinsser disease :
- relapse of epidemic typhus, caused by Rickettsia prowazekii.
- Brill-Zinsser disease is an exacerbation of epidemic louse-borne typhus fever.
- Caused by Rickettsia prowazekii.
- Rather than being eradicated, the microorganisms become latent and reappear after several years as a milder form of the disease.
Which is the most frequently detected “atypical” organism in community-acquired pneumonia in adults?
Community-acquired pneumonia in adults - M. pneumoniae is the most frequently detected “atypical” organism.
C. burnetii escapes intracellular killing in macrophages by inhibition of -
C. burnetii
- gram-negative cell wall,
- survives in harsh environments
- escapes intracellular killing in macrophages by inhibiting the final step in phagosome maturation (cathepsin fusion)
- has adapted to the acidic phagolysosome by producing superoxide dismutase
Which is the most common bacterial cause of pneumonia?
Streptococcus pneumoniae is the most common bacterial cause of pneumonia
Medicine MCQs – 2
Low-FODMAP diet is used for -
Dietary modification to reduce the volume of flatus produced is - reducing the amount of fermentable carbohydrates.
Low-FODMAP diet- low fermentable oligosaccharide, disacharide, monosaccharide and polyols
Early-morning nausea and vomiting is seen in all of the following cases EXCEPT -
Early-morning nausea and vomiting is seen in -
- Pregnancy
- Alcohol dependence
- Uraemia.
Large volumes of vomit - suggest gastric outlet or upper intestinal obstruction.
Bilateral renal cell carcinomas is seen in -
von Hippel–Lindau disease -
- autosomal dominant disorder We can find - - bilateral renal cell carcinomas - haemangioblastomas - phaeochromocytomas - renal cysts
VHL syndrome is found in 4.3% of bilateral RCCs
Café au lait spots with rough borders seen in -
Café au lait spots are often harmless but may be associated with syndromes such as neurofibromatosis type 1 and McCune–Albright syndrome
Neurofibromatosis Type 1 -
- Café au lait lesions tend to resemble the "coast of California," rather than the "coast of Maine," - Meaning the edges are smoother and more linear.
McCune-Albright syndrome.- Café au lait lesions with rough borders (“coast of Maine”)
Check shoulder shrug or trapezius muscle action is the testing of which nerve -
CN XI (Spinal Accessory) Check shoulder shrug (trapezius muscle) and head rotation to each side (sternocleidomastoid) against resistance.
Most common form of electrolyte disorder in the emergency room
Hyponatremia is the most common form of electrolyte disorder in the emergency room
Horizontal nystagmus is best assessed at -
Horizontal nystagmus is best assessed at 45° and not at extreme lateral gaze
All of the following are usually CORRECT about Isolated proteinuria without hematuria EXCEPT -
Isolated proteinuria without hematuria
is usually in the sub-nephrotic range without an active urine sediment and there is normal renal function. Over 50% of these patients have postural proteinuria.
Most common form of glomerulonephritis in adults worldwide -
IgA nephropathy is also known as Berger's disease. It is the most common form of glomerulonephritis in adults worldwide
IgA nephropathy, also known as Berger's disease, is the most common type of glomerulonephritis, and generally presents with isolated visible or occult hematuria, occasionally combined with low grade proteinuria
Patients with aerophagia have excessive intestinal gas that is mostly composed of -
Patients who have excessive intestinal gas that is mostly composed of nitrogen have aerophagia
Café au lait spots
Café au lait spots are often harmless but may be associated with syndromes such as…
