An 16-year-old man presents with polyuria and polydipsia. Which of the following may confirm the diagnosis of diabetes mellitus? 1) A random plasma glucose of >7.5 mmol/L 2) A finding of 3+ ketonuria 3) An HbA1c of 7.0% 4) A fasting plasma glucose of 7.5 mmol/L 5) An abnormal glucose tolerance test

An 16-year-old man presents with polyuria and polydipsia. Which of the following may confirm the diagnosis of diabetes mellitus? 1) A random plasma glucose of >7.5 mmol/L 2) A finding of 3+ ketonuria 3) An HbA1c of 7.0% 4) A fasting plasma glucose of 7.5 mmol/L 5) An abnormal glucose tolerance test
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Answers-4 The diagnosis is usually relatively easy to confirm in a symptomatic subject. A random glucose of >11.1 mmol/L or a fasting glucose of >7.0 mmol/L would be regarded as confirmatory. There is usually glycosuria in addition to ketonuria. Isolated ketonuria suggests fasting. A raised glycosolated haemoglobin (HbA1c) is also highly suggestive but not diagnostic. A glucose tolerance test is rarely needed.
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A 16 year old male with a day history of malaise, weakness and vomiting. He was diagnosed with Insulin dependent diabetes mellitus 3 years prviously. Which ONE of the following supports a diagnosis of diabetic ketoacidosis: 1) Abdominal pain at onset 2) A serum bicarbonate of 10 mmol/l 3) A serum glucose 14 mmol/l 4) Decreased appetite in the past few days 5) Shallow respirations

Description : A 16 year old male with a day history of malaise, weakness and vomiting. He was diagnosed with Insulin dependent diabetes mellitus 3 years prviously. Which ONE of the following supports a diagnosis of ... serum glucose 14 mmol/l 4) Decreased appetite in the past few days 5) Shallow respirations

Last Answer : Answers-2 a-An unusual but recognised feature particularly in children. However does not support a diagnosis of DKA. b-Suggests metabolic acidosis. c-'Normoglycaemic DKA' can occur and a glucose ... anorexia. e-Respiratory compensation leads to rapid deep (Kussmaul's) breathing. (Dr Mike Mulcahy)

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Description : A 55 year-old female complaining of vague tiredness is found to have a serum corrected calcium concentration of 2.9 mmol/l. Examination was unremarkable. Which of the following results ... 4) Low normal plasma phosphate concentration 5) Low normal serum 25-hydroxyvitamin D concentration

Last Answer : Answers-3 Bit too easy really. A high or even normal PTH concentration in the presence of hypercalcaemia would support the diagnosis of hyperparathyroidism. A high urinary Calcium concentration may ... but neither confirm the diagnosis. Elevated 1,25 VitD suggests a diagnosis of hypervitaminosis D.

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Last Answer : Answers-2 The hypokalaemic hypertension with hypomagnesaemia suggests primary hyperaldosteronism. The most reliable assessment for this would be renin to aldosterone ratio.

Glycocylated haemoglobin: a. is absent in the plasma of people without diabetes mellitus b. results from the combination of a HbA and a sugar c. when measured as HbA1c in plasma gives a more accurate retrospective estimates of blood sugar levels than other glycosylated products d. all above

Description : Glycocylated haemoglobin: a. is absent in the plasma of people without diabetes mellitus b. results from the combination of a HbA and a sugar c. when measured as HbA1c in plasma gives a more accurate retrospective estimates of blood sugar levels than other glycosylated products d. all above

Last Answer : all above

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Description : A 53-year-old man presented with hypertension of 150/110 mmHg. He is generally asymptomatic and has no previous medical history of note. He is a smoker of 5 cigarettes daily and drinks ... Adrenocortical adenoma 2) Bartter's syndrome 3) Liddle's syndrome 4) Liquorice ingestion 5) Pheochromocytoma

Last Answer : Answers-1 This patient is most likely to have Conn's syndrome as reflected by the hypokalaemic hypertension. Liquorice ingestion or Liddle's syndrome are again possible causes of ... hypertension (often diastolic hypertension), muscular weakness, paresthesias, headache, polyuria, and polydipsia."

The following occur in untreated insulin dependent diabetes mellitus: a. diuresis b. decreased plasma amino acid c. increased plasma fatty acid d. ketonuria

Description : The following occur in untreated insulin dependent diabetes mellitus: a. diuresis b. decreased plasma amino acid c. increased plasma fatty acid d. ketonuria

Last Answer : ketonuria

Polyuria can occur in (A) Diabetes mellitus (B) Diarrhoea (C) Acute glomerulonephritis (D) High fever

Description : Polyuria can occur in (A) Diabetes mellitus (B) Diarrhoea (C) Acute glomerulonephritis (D) High fever

Last Answer : B

What is the reason for polyuria in diabetes mellitus?

Description : What is the reason for polyuria in diabetes mellitus?

Last Answer : When the blood glucose level exceeds the renal threshold glucose is excreted in urine. Due to osmotic effect, more water accompanies the glucose.

When urine is passed out several -fold more than in a normal subject, the condition is referred to as (a) Diabetes mellitus (b) Diabetes insipidus (c) Diabetes aqua (d) Diabetes polydipsia

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Last Answer : Ans:(c)

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Description : A 19 year-old female is referred following a visit to the dentist where marked erosion of her teeth was noted. She was entirely asymptomatic and her only medication was the oral contraceptive pill ... ) Bulimia nervosa 2) Conn's syndrome 3) Laxative abuse 4) Pregnancy 5) Primary hypoparathyroidism

Last Answer : Answers-5 This patient has tooth erosion associated with hypokalaemic metabolic alkalosis and hypocalcaemia. This suggests a diagnosis of hypoparathyroidism. Conn's is unlikely in this age group, is ... raised alkaline phosphatase would not be expected. Early pregnancy would not fit this picture.

Which of the following condition is characterized by ketonuria but without glycosuria? (A) Diabetes mellitus (B) Diabetes insipidus (C) Prolonged starvation (D) Addison’s disease

Description : Which of the following condition is characterized by ketonuria but without glycosuria? (A) Diabetes mellitus (B) Diabetes insipidus (C) Prolonged starvation (D) Addison’s disease

Last Answer : Answer : C

Glucose tolerance is decreased in (A) Diabetes mellitus (B) Hypopituitarisme (C) Addison’s disease (D) Hypothyroidism

Description : Glucose tolerance is decreased in (A) Diabetes mellitus (B) Hypopituitarisme (C) Addison’s disease (D) Hypothyroidism

Last Answer : A

Glucose tolerance is increased in (A) Diabetes mellitus (B) Adrenalectomy (C) Acromegaly (D) Thyrotoxicosis

Description : Glucose tolerance is increased in (A) Diabetes mellitus (B) Adrenalectomy (C) Acromegaly (D) Thyrotoxicosis

Last Answer : B

Presence of which of the following conditions in urine are indicative of diabetes mellitus? (a) Uremia and Ketonuria (b) Uremia and Renal Calculi (c) Ketonuria and Glycosuria (d) Renal calculi and Hyperglycaemia

Description : Presence of which of the following conditions in urine are indicative of diabetes mellitus? (a) Uremia and Ketonuria (b) Uremia and Renal Calculi (c) Ketonuria and Glycosuria (d) Renal calculi and Hyperglycaemia

Last Answer : (c) Ketonuria and Glycosuria

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Description : A 15-year-old girl was seen by her family physician because of increasing lethargy. She had a recent history of the "flu". Biochemistry tests show that she has renal impairement. ... will likely develop a restrictive lung disease 5) She will probably improve with additional corticosteroid therapy

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In normal individuals glycosuria occurs when the venous blood glucose concentration exceeds (A) 5–6 mmol/L (B) 7–8 mmol/L (C) 8.5–9 mmol/L (D) 9.5–10 mmol/L

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Last Answer : Answer : D

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Description : Serum biochemistry of a 60 year old man revealed calcium of 1.98 mmol/l and phosphate of 0.55 mmol/l with an alkaline phosphatase of 450 IU/l.Which among the following mosts suits ... biochemistry? 1) Osteoporosis 2) Osteomalacia 3) Pagets Disease 4) Secondary Hyperparathyroidism 5) Renal failure

Last Answer : Answers-2 Osteomalacia is associated with low calcium and phosphate with raised alkaline phosphatase. Serum biochemistry is normal in osteoporosis. Pagets disease is associated with normal ... renal failure when tertiary hyperparathyroidism sets in there is low calcium with raised phosphate.

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Description : Normal range of plasma total phospholipids is (A) 0.2–0.6 mmol/L (B) 0.9–2.0 mmol/L (C) 1.8–5.8 mmol/L (D) 2.8–5.3 mmol/L

Last Answer : Answer : C

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Description : The following feature disfavours use of oral hypoglycaemics in diabetes mellitus: A. Age at onset of disease over 40 years B. Insulin requirement more than 40 U/day C. Fasting blood sugar level between 100–200 mg/dl D. Associated obesity

Last Answer : B. Insulin requirement more than 40 U/day

A person is undergoing prolonged fasting. His urine will be found to contain abnormal quantities of (a) fats (b) amino acids (c) glucose (d) ketones.

Description : A person is undergoing prolonged fasting. His urine will be found to contain abnormal quantities of (a) fats (b) amino acids (c) glucose (d) ketones.

Last Answer : d) ketones.

There is polyuria without glycosuria in this disorder (A) Diabetes insipidus (B) Diabetes millitus (C) Bronze diabetes (D) Juvenile diabetes

Description : There is polyuria without glycosuria in this disorder (A) Diabetes insipidus (B) Diabetes millitus (C) Bronze diabetes (D) Juvenile diabetes

Last Answer : Answer : A

The following metabolic abnormalities occur in Diabetes mellitus except (A) Increased plasma FFA (B) Increased pyruvate carboxylase activate (C) Decreased lipogenesis (D) Decreased gluconeogenesis

Description : The following metabolic abnormalities occur in Diabetes mellitus except (A) Increased plasma FFA (B) Increased pyruvate carboxylase activate (C) Decreased lipogenesis (D) Decreased gluconeogenesis

Last Answer : B

A man suffering from diabetes mellitus drinks water more frequently as he has to eliminate from the blood extra (1) glucose (2) insulin (4) glucagon (4) salt

Description : A man suffering from diabetes mellitus drinks water more frequently as he has to eliminate from the blood extra (1) glucose (2) insulin (4) glucagon (4) salt

Last Answer : (1) glucose Explanation: The diabetic person has higher sugar in blood. Glucose is a form of sugar.

A young medical student has come to you with complaints of oligomenorrrhea, hirsuitism and weight gain, ultrasound reveals bulky ovaries with sub-capsular cysts. Most likely diagnosis is: a) Ovarian cancer. b) Cushing’s syndrome. c) Polycystic ovarian disease. d) Diabetes mellitus. e) Pelvic inflammatory disease

Description : A young medical student has come to you with complaints of oligomenorrrhea, hirsuitism and weight gain, ultrasound reveals bulky ovaries with sub-capsular cysts. Most likely diagnosis is: a) Ovarian ... syndrome. c) Polycystic ovarian disease. d) Diabetes mellitus. e) Pelvic inflammatory disease

Last Answer : c) Polycystic ovarian disease.

A young patient with sudden painless loss of vision, with systolic murmur and ocular examination reveals a cherry red spot with clear AC, the likely diagnosis is: a. Central Retinal Artery Occlusion b. Central Retinal Vein Occlusion c. Diabetes Mellitus d. Branch Retinal Vein Occlusion

Description : A young patient with sudden painless loss of vision, with systolic murmur and ocular examination reveals a cherry red spot with clear AC, the likely diagnosis is: a. Central Retinal Artery Occlusion b. Central Retinal Vein Occlusion c. Diabetes Mellitus d. Branch Retinal Vein Occlusion  

Last Answer : ANSWER: A

The absorption of glucose in the digestive tract (A) Occurs in the small intestine (B) Is stimulated by the hormone Glucagon (C) Occurs more rapidly than the absorption of any other sugar (D) Is impaired in cases of diabetes mellitus

Description : The absorption of glucose in the digestive tract (A) Occurs in the small intestine (B) Is stimulated by the hormone Glucagon (C) Occurs more rapidly than the absorption of any other sugar (D) Is impaired in cases of diabetes mellitus

Last Answer : A

Renal threshold for glucose is decreased in (A) Diabetes mellitus (B) Insulinoma (C) Renal glycosuria (D) Alimentary glycosuria

Description : Renal threshold for glucose is decreased in (A) Diabetes mellitus (B) Insulinoma (C) Renal glycosuria (D) Alimentary glycosuria

Last Answer : C

Which of the following clinical characteristics is associated with Type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus [NIDDM])? a) Can control blood glucose through diet and exercise Oral hypoglycemic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful.

Description : Which of the following clinical characteristics is associated with Type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus [NIDDM])? a) Can control blood glucose ... islet cell antibodies Individuals with Type 2 diabetes do not demonstrate islet cell antibodies.

Last Answer : a) Can control blood glucose through diet and exercise Oral hypoglycemic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful.

A 32-year-old man suffers a spinal cord injury with a resultant paraplegia in a motorcycle accident. He presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his diagnosis and management? a. The low blood pressure can be assumed to be due to neurogenic shock b. The sole cause of hypotension is the loss of sympathetic input to the venous system c. Despite significant hypotension, secondary organ injury will be uncommon d. There is no role for pharmacologic intervention to maintain blood pressure

Description : A 32-year-old man suffers a spinal cord injury with a resultant paraplegia in a motorcycle accident. He presents to the emergency room with hypotension. Which of the following statement(s) is/ ... injury will be uncommon d. There is no role for pharmacologic intervention to maintain blood pressure

Last Answer : Answer: c Neurogenic shock results from interruption of sympathetic vasomotor input and develops after spinal cord injury, spinal anesthesia, and severe head injury. Under normal conditions, baseline ... the cause is not neurogenic and search for occult blood loss or cardiogenic causes of shock

A 22-year-old man sustains a single stab wound to the left chest and presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his diagnosis and management? a. The patient likely is suffering from hypovolemic shock and should respond quickly to fluid resuscitation b. Beck’s triad will likely be an obvious indication of compressive cardiogenic shock due to pericardial tamponade c. Echocardiography is the most sensitive noninvasive approach for diagnosis of pericardial tamponade d. The placement of bilateral chest tubes will likely resolve the problem

Description : A 22-year-old man sustains a single stab wound to the left chest and presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his ... diagnosis of pericardial tamponade d. The placement of bilateral chest tubes will likely resolve the problem

Last Answer : Answer: c Shock from cardiac compression occurs when external pressure on the heart impairs ventricular filling. Because ventricular filling is a function of venous return and myocardial compliance, ... sternotomy. Chest tube placement would not be appropriate as the sole treatment in this patient

An Afro-Carribean male aged 48 years presents with gradual onset of exertional dyspnoea, non productive cough, malaise, weight loss and polyarthralgia. Schirmers test indicates a dry eye. X-ray of the hand shows punched out osteopenic lesions. Which of the following investigation is unlikely to be helpful in establishing the diagnosis of this condition: 1) Serum calcium 2) Serum phosphorus 3) Urea and electrolytes 4) Thallium Scan 5) Quantitative Immunoglobulins.

Description : An Afro-Carribean male aged 48 years presents with gradual onset of exertional dyspnoea, non productive cough, malaise, weight loss and polyarthralgia. Schirmers test indicates a dry eye. X-ray ... 2) Serum phosphorus 3) Urea and electrolytes 4) Thallium Scan 5) Quantitative Immunoglobulins.

Last Answer : Answers-4 This condition is sarcoidosis. Serum calcium, Serum phosphorus, Chem7 and Chem 20 and Quantitative Immunoglobulins are all used in establishing the diagnosis. Gallium scan is helpful in ... areas of poor perfusion. It is particularly used in cardiology to detect areas of ischaemia.

A 75 year old man presents with a long history of shortness of breath and ankle oedema. His serum biochemistry shows sodium 122 mmols/l and potassium of 2.9 mmols/l. He now complains of weakness.Which of the following is likely to explain the above biochemical picture? 1) Addison's Disease 2) Nephrotic syndrome 3) Primary hyperaldosteronism 4) SIADH 5) Diuretic therapy

Description : A 75 year old man presents with a long history of shortness of breath and ankle oedema. His serum biochemistry shows sodium 122 mmols/l and potassium of 2.9 mmols/l. He now complains of ... ? 1) Addison's Disease 2) Nephrotic syndrome 3) Primary hyperaldosteronism 4) SIADH 5) Diuretic therapy

Last Answer : Answers-5 The long history of his symptoms and serum biochemistry suggests that his condition is due to treatment with frusemide for CCF.

A 20 yr. old female patient presents with pain in thyroid region of the neck since few days. She gives recent history of mumps. On palpation thyroid is tender and her thyroid function test reveals raised levels of T3, T4 and low TSH. Iodine uptake is also low. Probable diagnosis in this case is:

Description : Which of the following is the most common cause of Hypothyroidism in iodine sufficient area? Options: 1) Iatrogenic hypothyroidism 2) Post-partum thyroiditis 3) Autoimmune thyroiditis 4) Thyroid aplasia

Last Answer : Correct Answer: 3) Autoimmune thyroiditis

A 20 yr. old female patient presents with pain in thyroid region of the neck since few days. She gives recent history of mumps. On palpation thyroid is tender and her thyroid function test reveals raised levels of T3, T4 and low TSH. Iodine uptake is also low. Probable diagnosis in this case is:1) de Quervain’s thyroiditis 2) Silent thyroiditis 3) Primary thyrotoxicosis 4) Hashimoto’s thyroiditis

Description : A 20 yr. old female patient presents with pain in thyroid region of the neck since few days. She gives recent history of mumps. On palpation thyroid is tender and her thyroid function ... 1) de Quervain's thyroiditis 2) Silent thyroiditis 3) Primary thyrotoxicosis 4) Hashimoto's thyroiditis

Last Answer : Correct Answer: 1) de Quervain’s thyroiditis

The concentration of ketone bodies in the blood does not normally exceed (A) 0.2 mmol/L (B) 0.4 mmol/L (C) 1 mmol/L (D) 2 mmol/L

Description : The concentration of ketone bodies in the blood does not normally exceed (A) 0.2 mmol/L (B) 0.4 mmol/L (C) 1 mmol/L (D) 2 mmol/L

Last Answer : Answer : A

A physician refers a nine years-old boy to you to confirm diagnosis. The boy has a fever of 40°C and coughing. When you focus your light into his eyes he turns away. Intra-orally there are white spots surrounded by red margins. The disease and lesions are: A. Measles and Koplik’s spots B. AHGS vesicles

Description : A physician refers a nine years-old boy to you to confirm diagnosis. The boy has a fever of 40°C and coughing. When you focus your light into his eyes he turns away. Intra-orally there are white ... by red margins. The disease and lesions are: A. Measles and Koplik's spots B. AHGS vesicles

Last Answer : A. Measles and Koplik’s spots

Which of the following conditions may be detectable by growth monitoring? 1) Hyperthyroidism 2) Hypothyroidism 3) Pseudohypoparathyroidism 4) XYY Syndrome 5) Insulin dependent diabetes mellitus

Description : Which of the following conditions may be detectable by growth monitoring? 1) Hyperthyroidism 2) Hypothyroidism 3) Pseudohypoparathyroidism 4) XYY Syndrome 5) Insulin dependent diabetes mellitus

Last Answer : Answers-2

A patient of diabetes mellitus excreted glucose in urine even when he was kept in a carhbohydrate-free diet. It is because

Description : A patient of diabetes mellitus excreted glucose in urine even when he was kept in a carhbohydrate-free diet. It is because

Last Answer : A patient of diabetes mellitus excreted glucose in urine even when he was kept in a ... muscles are discharged in blood stream from liver

Which of the following statements is NOT true about diabetes mellitus? A) Type II diabetes is much more common than type I. B) Insulin injections are required in both type I and type II diabetes. C) Type I diabetes occurs as a result of destruction of the insulin-producing cells. D) One method of treating type II diabetes is exercise and a low-fat, low-sugar diet. E) Symptoms of diabetes include excessive thirst, frequent urination, and glucose in the urine.

Description : Which of the following statements is NOT true about diabetes mellitus? A) Type II diabetes is much more common than type I. B) Insulin injections are required in both type I and type II ... -sugar diet. E) Symptoms of diabetes include excessive thirst, frequent urination, and glucose in the urine.

Last Answer : B) Insulin injections are required in both type I and type II diabetes.

Which of the following symptoms is NOT characteristic of diabetes mellitus? A) cells unable to take up glucose B) increased breakdown of fats and protein C) frequent urination D) sugar in the urine E) bronzing of the skin

Description : Which of the following symptoms is NOT characteristic of diabetes mellitus? A) cells unable to take up glucose B) increased breakdown of fats and protein C) frequent urination D) sugar in the urine E) bronzing of the skin

Last Answer : E) bronzing of the skin

Choose the correct statement about nateglinide: A. It is a long acting oral hypoglycaemic drug B. Taken just before a meal, it limits postprandial hyperglycaemia in type 2 diabetes mellitus C. It lowers blood glucose in both type 1 and type 2 diabetes mellitus D. It acts by opening K+ channels in myocytes and adipocytes

Description : Choose the correct statement about nateglinide: A. It is a long acting oral hypoglycaemic drug B. Taken just before a meal, it limits postprandial hyperglycaemia in type 2 diabetes mellitus C. It lowers ... 1 and type 2 diabetes mellitus D. It acts by opening K+ channels in myocytes and adipocytes

Last Answer : B. Taken just before a meal, it limits postprandial hyperglycaemia in type 2 diabetes mellitus

Hypermagnesemia may be observed in (A) Hyperparathyroidism (B) Diabetes mellitus (C) Kwashiorkar (D) Primary aldosteronism

Description : Hypermagnesemia may be observed in (A) Hyperparathyroidism (B) Diabetes mellitus (C) Kwashiorkar (D) Primary aldosteronism

Last Answer : Answer : B

Deficiency of magnesium may occur with (A) Alcoholism (B) Diabetes mellitus (C) Hypothyroidism (D) Advanced renal failure

Description : Deficiency of magnesium may occur with (A) Alcoholism (B) Diabetes mellitus (C) Hypothyroidism (D) Advanced renal failure

Last Answer : Answer : A

Bence Jones proteins may be excreted in urine of patients suffering from (A) Tuberculosis (B) Diabetes mellitus (C) Multiple myeloma (D) Hyperthyroidism

Description : Bence Jones proteins may be excreted in urine of patients suffering from (A) Tuberculosis (B) Diabetes mellitus (C) Multiple myeloma (D) Hyperthyroidism

Last Answer : Answer : C

Metabolic actions of estrogens tend to cause the following except: A. Anabolism B. Impaired glucose tolerance C. Rise in plasma LDL-cholesterol D. Salt and water retention

Description : Metabolic actions of estrogens tend to cause the following except: A. Anabolism B. Impaired glucose tolerance C. Rise in plasma LDL-cholesterol D. Salt and water retention

Last Answer : C. Rise in plasma LDL-cholesterol

Urine examination (Benedict’s test) of a 40 yr old obese male showed a brick red precipitate. This can result from all except Options: 1) Diabetes Mellitus 2) Drugs 3) Acute post-streptococcal glomerulonephritis 4) Cushing’s syndrome

Description : Urine examination (Benedict’s test) of a 40 yr old obese male showed a brick red precipitate. This can result from all except Options: 1) Diabetes Mellitus 2) Drugs 3) Acute post-streptococcal glomerulonephritis 4) Cushing’s syndrome

Last Answer : Correct Answer: 3) Acute post-streptococcal glomerulonephritis

a 20 year old medical student presents with five years history of weight gain, irregular periods and worsening fascial hair. What is the most likely diagnosis? a) Polycystic ovarian disease. b) Hypothyroidism. c) Obesity. d) Cushing’s Syndrome. e) Nephrotic Syndrome.

Description : a 20 year old medical student presents with five years history of weight gain, irregular periods and worsening fascial hair. What is the most likely diagnosis? a) Polycystic ovarian disease. b) Hypothyroidism. c) Obesity. d) Cushing’s Syndrome. e) Nephrotic Syndrome.

Last Answer : a) Polycystic ovarian disease.

Impaired galactose tolerance test suggests (A) Defect in glucose utilisation (B) Liver cell injury (C) Renal defect (D) Muscle injury

Description : Impaired galactose tolerance test suggests (A) Defect in glucose utilisation (B) Liver cell injury (C) Renal defect (D) Muscle injury

Last Answer : Answer : B