0 Prolactinoma in pregnancy

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True about prolactinoma in pregnancy all except ?

a. Most common pituitary tumors,but rarely symptomatic

b. Increasing level of prolactin show bad prognosis

c. regular visual checkup

d. Macro adenoma >1 cm ass with bad prog.





ANSWER:
Answer is B .... NOT D

2 Multiple Myeloma

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Q1. Most common clinical feature of multiple myeloma :
1. bone pain
2. anemia
3. hyperviscosity
4. hypercalcemia

Q2. Least common clinical feature of multiple myeloma :
1. bone pain
2. anemia
3. hyperviscosity
4. infection



ANSWER:
Ans of Q1: 2 (Anemia)

Ans of Q2: 3 (hyperviscosity)


0 Infarct Types

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White/Pale/Anaemic Infarct

Solid organs with one blood supply
eg: Heart , Spleen , Kidney

Red/Haemorhagic infarct

Spongy organs (Lungs)
Dual Blood Supply (Liver)
Organs with Collaterals (Intestine)
Torsion of Testis & Ovary

0 BLAST INJURY

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BLAST INJURY :  (In Air and Underwater )

Most Severe (Air)-- Lungs.
Most Severe(underwater): GIT 
Most common Air : T.M (tympanic membrane)
Most Common Underwater fully submerged : TM 
Most Common Underwater partially submerged (head is out): GIT

0 Hodgkin Disease of the chest

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Regarding Hodgkin Disease of the chest:
1. parenchymal disease can be seen in the absence of hilar adenopathy
2. hilar adenopathy can be seen in the absence of mediastinal adenopathy
3. pleural involvement is rare
4. posterior mediastinal adenopathy is common


ANSWER:
answer is 3) Hodgkin Disease - Freundlich and Bragg p 352, and Dahnert.
Parenchymal disease is "invariably" subsequent to hilar adenopathy, in fact, if a patient with known Hodgkin has no mediastinal-hilar disease and a new pulmonary nodule appears, it should be presumed to be unrelated and another source should be sought. Hilar adenopathy in the absence of mediastinal adenopathy is rare. Pleural involvement is rare even in the presence of a lymphomatous effusion. Most patients with pleural disease will have contiguous pulmonary or chest wall disease. Lymphadenopathy is nearly always anterior, not posterior, particularly in Hodgkin.

0 Transient synovitis

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AIIMS may 2009
Q. A 7yr old boy with abrupt onset of pain in hip with hip held in abduction. Hemogram is normal. ESR is raised. What is the next line of management?
a. Hospitalize and observe
b. Ambulatory observation
c. Intravenous Antibiotics
d. USG guided aspiration of Hip


ANSWER:
Ans is D
Reason: If septic arthritis needs to be ruled out, needle aspiration of the fluid can be performed under ultrasound guidance. In transient synovitis, the joint fluid will be clear. In septic arthritis, there will be pus in the joint, which can be sent for bacterial culture and antibiotic sensitivity testing.

0 2bp insertion in middle of intron

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What is the most likely effect of a 2bp insertion in the middle of the intron?
1. Normal transcription, altered translation.
2. Defective termination of transcription, normal translation.
3. Normal transcription, defective mRNA splicing.
4. Normal transcription, normal translation.
ANSWER:
Answer is A>D.
If the 2 bp insertion affects the translational regulatory elements , it will affect translation ; but if does not affect the translational regulatory elements , it will not affect translation. So ideally both ans a & d are right , but if to choose one - its better to go for A

0 Heat Rupture

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Q. Heat rupture is characterized by
a. irregular margin
b. regular margin
c. clotted blood
d. clotted blood vessel


ANSWER:
Ans is A and NOT D
Heat rupture is characterized by a) absence of blood clots b) Blood vessels stretched across fissures c) Irregular Edges
(ref: Forensic Medicine by Dr.Sumit Seth)

2 Non-Progressive dysphagia to both liquids and solids

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MCQ 144

Q. A 40 year-old female patient presented with dysphagia to both liquids and solids and regurgitation for 3 months. The dysphagia was non-progressive. What is the most likely diagnosis?

a) Caricnoma of the esophagus

b) Lower oesophageal mucosal ring

c) Achalasia cardia

d) Reflux esophagitis with esophageal stricture




ANSWER:
Answer here is B.... Not C...
In Achlasia, dysphagia is Progressive (read One Liner - 52)

In few cases of Shatzki ring- it has been seen to have dysphagia for both solids and liquids (though majority cases have dysphagia for solids only) ref: http://www.ajronline.org/content/171/5/1361.full.pdf

Also this could be a wrong recall and the option might be Lower oesophageal MUSCULAR ring -- if so then this can be the clear answer to the question -- ref : http://rajgoyal.com/Publications/2000-03.pdf

A Schatzki’s ring can be differentiated from the muscular ring based on several findings.
Firstly , Although both types of rings present with intermittent chronic dysphagia, the history of liquid dysphagia seen in our three patients is distinctly unusual with a Schatzki’s ring.
Secondly, the radiological picture in both disorders is of a concentric narrowing in the distal esophagus. However, the muscular ring has a greater, donut-like rather than washer-like thickness, and is characteristically situated a few centimeters proximal to the location of the Schatzki’s ring at the squamocolumnar junction.
Thirdly, the manometric findings of high-amplitude contractions of the esophageal body distinguish the muscular ring from the Schatzki’s ring, in which motility studies are typically normal (10, 11).
And fourth, the majority of patients with Schatzki’s rings derive immediate and long-lasting relief from esophageal dilation (12), whereas the patients with symptomatic muscular rings had incomplete, short-lasting symptom relief after dilation.


Schatzki and Muscular ring :
ref of image above : Click Here



MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 Pneumocystis jiroveci

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  1. May be associated with CMV
  2. May be ass. with Pneumatocele
  3. Infect both - Immuno-compromised and immuno-competent person
  4. Disease ONLY in Immuno-COMROMISED
  5. Diagnosis Usually by SPUTUM

0 Optic radiation

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The optic radiation (also known as the geniculo-calcarine tract or as the geniculostriate pathway) is a collection of axons from relay neurons in the lateral geniculate nucleus of the thalamus carrying visual information to the visual cortex (also called striate cortex) along the calcarine fissure.


A distinctive feature of the optic radiations is that they split into two parts on each side:


1. Fibers from the inferiorretina (also called "Meyer's loop" or "Archambault's loop") -- Pass through temporal lobe by looping around the inferior horn of the lateral ventricle.----- when damaged : superior quadrant (quadrantanopia or "pie in the sky" defect.)


2. Fibers from the superior retina (also called "Baum's loop") --- travel straight back through the parietal lobe to the occipital lobe ----- when damaged : Inferior Quadrantopis or "pie in the floor" defect.




Source : http://en.wikipedia.org/wiki/Optic_radiation



0 Capnography

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Capnography is the monitoring of the concentration or partial pressure of carbon dioxide (CO2) in the respiratory gases. Its main development has been as a monitoring tool for use during anaesthesia and intensive care. It is usually presented as a graph of expiratoryCO2 plotted against time, or, less commonly, but more usefully, expired volume. The plot may also show the inspired CO2, which is of interest when rebreathing systems are being used.


Capnogram: a typical capnogram is shown above. During inspiration the CO2 tension should be neligible unless there is rebreathing. Dead space gas is exhaled first, it contains no CO2, and is followed by alveolar gas and a rapid rise in CO2 which reaches a clear plateau in normal lungs and is termed the end-tidal CO2 tension. 

Image source: http://www.frca.co.uk/article.aspx?articleid=100389



0 TAR , Fanconi Anemia

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Absent thumb, radial deviation of wrist, bowing of forearm wid thrombocytopenia, which invg. need NOT to be done?
A. Echochardiography
b. Bone marrow examination
c. Platelet count
d. Karyotyping


ANSWER:
Ans is D....
D/D to this ques are :
1. TAR syndrome
2. Fanconi Anemia
Associations of absent radius-
1.TAR - thrombocytopenia and absent radius ass. with holt oram - ASD
2.Fanconi anemia has congenital aplastic anemia - therefore do bone marrow examination
3.Karyotyping will not be helpful(but very rarely Edwards can have absent radius )

0 Switch over from fetal to adult Hb

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At what gestational age switch over from fetal to adult hb synthesis begins? 
a.30 weeks 
b.36 weeks 
c.7 days post natal 
d.3 weeks post natal


ANSWER:
Ans here is 30 wks and NOT 36wks... If 20 wks was in options then the ans would be 20 wks.... many MCQ books give the wrong answer to it....
CORRECT POINTS ARE ---
1.After the first 8 weeks of development, the fetus' primary form of hemoglobin switches from embryonic hemoglobin to fetal hemoglobin....
2.Fetal Hb to Adult Hb SWITCHOVER BEGINS at 20 wks Intrauterine...
3.Significant switch over to adult Hb at 30 wks Intrauterine...
4.Adult Hb levels attained at 7 months of LIFE...
CLICK IMAGE TO ENLARGE --> Wintrobe's Clinical Hematology, Volume 1 By John P. Greer, Maxwell Myer Wintrobe

0 Stain to visualise reticulocyte

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Best stain to visualise reticulocyte?
1)giemsa
2)methylene blue
3)cresyl blue
4)leishman stain 


ANSWER:
Ans is 3
Both 2nd and 3rd can stain. But best is 3rd

0 Rtpa for Acute Ischemic Stroke

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From Harrison's Principles of Internal Medicine, 18th Edition

Table 370-1 Administration of Intravenous Recombinant Tissue Plasminogen Activator (Rtpa) for Acute Ischemic Stroke (Ais)a
Indication Contraindication

Clinical diagnosis of stroke

Onset of symptoms to time of drug administration 3 h

CT scan showing no hemorrhage or edema of >1/3 of the MCA territory

Age 18 years

Consent by patient or surrogate

Sustained BP >185/110 mm Hg despite treatment

Platelets <100,000; HCT <25%; glucose <50 or >400 mg/dL

Use of heparin within 48 h and prolonged PTT, or elevated INR

Rapidly improving symptoms

Prior stroke or head injury within 3 months; prior intracranial hemorrhage

Major surgery in preceding 14 days

Minor stroke symptoms

Gastrointestinal bleeding in preceding 21 days

Recent myocardial infarction

Coma or stupor
Administration of rtPA 

Intravenous access with two peripheral IV lines (avoid arterial or central line placement)

Review eligibility for rtPA

Administer 0.9 mg/kg IV (maximum 90 mg) IV as 10% of total dose by bolus, followed by remainder of total dose over 1 h

Frequent cuff blood pressure monitoring

No other antithrombotic treatment for 24 h

For decline in neurologic status or uncontrolled blood pressure, stop infusion, give cryoprecipitate, and reimage brain emergently

Avoid urethral catheterization for 2 h


aSee Activase (tissue plasminogen activator) package insert for complete list of contraindications and dosing. Abbreviations: BP, blood pressure; HCT, hematocrit; INR, international normalized ratio; MCA, middle cerebral artery; PTT, partial thromboplastin time.

0 HBV - Mother to child

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HBV is a large virus and does not cross the placenta, hence it cannot infect the fetus unless there have been breaks in the maternal-fetal barrier, e.g. via amniocentesis. Still, pregnant women who are infected with HBV can transmit their disease to their babies at birth. If not vaccinated at birth, many of these babies develop lifelong HBV infections, and many develop liver failure or liver cancer later in life.

0 NMS

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AIIMS nov 2008

Q . All of the following drugs can cause Neuroleptic Malignant syndrome (NMS) except :

a. Amantadine
b. Domperidone
c. Haloperidol
d. Metoclopramide


ANSWER:
Ans is A (amantadine) not B...
Domperidone may cause NMS though rarely... BUT AMANTADINE NEVER CAUSES NMS (its withdrawal can cause)..
This question is given wrongly in many MCQ books.

0 Gunpowder and / or Soot on blood stained garments

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Gunpowder and / or Soot on blood stained garments can be visualized by :
a. Magnifying Lens
b. UV rays
c. Infrared Rays
d. X-Rays





ANSWER:
C. Infrared Rays

0 Empty sella syndrome

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Empty sella syndrome (abbreviated ESS) is a disorder that involves the sella turcica, a bony structure at the base of the brain that surrounds and protects the pituitary gland. ESS is a condition that is often discovered during tests for pituitary disorders, when radiological imaging of the pituitary gland reveals a sella turcica that appears to be empty ("partially empty sella").



There are two types of ESS: primary and secondary.
  • Primary ESS happens when a small anatomical defect above the pituitary gland increases pressure in the sella turcica and causes the gland to flatten out along the interior walls of the sella turcica cavity. Primary ESS is associated with obesity and high blood pressure in women. The disorder can be a sign of idiopathic intracranial hypertension.
  • Secondary ESS is the result of the pituitary gland regressing within the cavity after an injury, surgery, or radiation therapy. Individuals with secondary ESS due to destruction of the pituitary gland have symptoms that reflect the loss of pituitary functions, such as the ceasing of menstrual periods, infertility, fatigue, and intolerance to stress and infection.


0 Adrenal histoplasmosis

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Q. Which of the following statements is correct regarding adrenal histoplasmosis:

a) In active disease, calcification is commonly seen

b) Lymphadenopathy is not seen

c) The adrenal glands are usually symmetrically enlarged

d) Adrenal insufficiency is uncommon


ANSWER:
Answer : C - The adrenal glands are usually symmetrically enlarged
Points to remember :
Patient is usually asymptomatic
Bilateral symmetrical enlargement of the adrenals
Calcification is rare
Shape of the gland is preserved
Cases may present with adrenal insufficiency
Diagnosis is by CT scan and CT directed biopsy




0 Tuberculosis Bone

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Tuberculosis Bone Is due to?  (AIPGMEE 2012) 
a. paucibacilllary and hematogenous
b. multibacillary and hematogenous
c. paucibacillary and lymphatic
d. multibacillary and lymphatic 





ANSWER:
A

0 Digoxin induced arrythmias

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True for Digoxin induced arrythmias are All except
a. Biventricular Tachycardia
b. Paroxysmal Atrial Tachycardia with variable AV block
c. Ventricular Bigeminy
d. May be used to regularize atrial fibrillation.



ANSWER:
d. May be used to regularize atrial fibrillation.

0 FLAIR

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Fluid attenuated inversion recovery (FLAIR) is a pulse sequence used in magnetic resonance imaging which was invented by Dr. Graeme Bydder. FLAIR can be used with both three dimensional imaging (3D FLAIR) or two dimensional imaging (2D FLAIR).
The pulse sequence is an inversion recovery technique that nulls fluids. For example, it can be used in brain imaging to suppress cerebrospinal fluid (CSF) effects on the image, so as to bring out the periventricular hyperintense lesions, such as multiple sclerosis (MS) plaques.
By carefully choosing the inversion time (TI), the signal from any particular tissue can be nulled. The appropriate TI depends on the tissue via the formula:
\textrm{TI} = \ln(2) \cdot T_1,\,
in other words, one should typically use a TI of around 70% of the T1 value. In the case of CSF suppression, one aims for T2 weighted images.


0 Epiphyseal injuries

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Source of image : http://www.primary-surgery.org/ps/vol2/html/sect0324.html


Examples
Type I - Slip capital femoral epiphysis
        II - Lower end of Radius
       III - Medial Malleolus
       IV - Lateral Condyle Of Humerous
        V - Lower tibial epiphysis.
  • Type II is Most common
  • Type II - The triangular fragment = Thurston Holland Sign
  • Type IV is 2nd MC and also known as Fracture of Necessity.
  • Type V - difficult to diagnose on X-Ray , Has Compulsory Growth Arrest.


0 Poison MCQ

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A patient presents to the emergency department with bluish discolouration of conjunctiva , mucous membranes and nails one hour after ingestion of a poison. Examination reveals tachycardia and hypotension. Which of the following is most likely ingested poison:

a. Mercury
b. Arsenic
c. Lead
d. Silver





ANSWER:
D. Silver... ref: CLICK HERE

0 Autism Awareness Day

Reactions: 
The fifth annual World Autism Awareness Day is April 2, 2012. Every year, autism organizations around the world celebrate the day with unique fundraising and
awareness-raising events.


http://www.autismspeaks.org/what-autism/waad



Autism is a brain disorder that limits a person's ability to communicate and relate to other people. It first appears in young children, who fall along a spectrum from mild to severe. Some people can navigate their world, some have exceptional abilities, while others struggle to speak. Autism spectrum disorders (ASDs) affect about one child in 110, striking four times as many boys as girls.


http://www.webmd.com/brain/autism/ss/slideshow-autism-overview
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