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You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Occupational asthma and explain in detail? | Occupational asthma is new onset asthma or the recurrence of previously quiescent asthma directly caused by exposure to an agent at workplace. It is an occupational lung disease and a type of work-related asthma. Agents that can induce occupational asthma can be grouped into sensitizers and irritants.Sensitizer-induced occupational asthma is an immunologic form of asthma which occurs due to inhalation of specific substances (i.e., high-molecular-weight proteins from plants and animal origins, or low-molecular-weight agents that include chemicals, metals and wood dusts) and occurs after a latency period of several weeks to years.Irritant-induced (occupational) asthma is a non-immunologic form of asthma that results from a single or multiple high dose exposure to irritant products. It is usually develops early after exposure; however can also develop insidiously over a few months after a massive exposure to a complex mixture of alkaline dust and combustion products, as shown in the World Trade Center disaster. Unlike those with sensitizer-induced occupational asthma, subjects with irritant-induced occupational asthma do not develop work-related asthma symptoms after re-exposure to low concentrations of the irritant that initiated the symptoms. Reactive airways dysfunction syndrome (RADS) is a severe form of irritant induced asthma where respiratory symptoms usually develop in the minutes or hours after a single accidental inhalation of a high concentration of irritant gas, aerosol, vapor, or smoke.Another type of work-related asthma is work-exacerbated asthma (WEA) which is asthma worsened by workplace conditions but not caused by it. WEA is present in about a fifth of patients with asthma and a wide variety of conditions at work, including irritant chemicals, dusts, second-hand smoke, common allergens that may be present at work, as well as other "exposures" such as emotional stress, worksite temperature, and physical exertion can exacerbate asthma symptoms in these patients. Both occupational asthma and work-exacerbated asthma can be present in an individual.
A number of diseases have symptoms that mimic occupational asthma, such as asthma due to nonoccupational causes, chronic obstructive pulmonary disease (COPD), irritable larynx syndrome, hyperventilation syndrome, hypersensitivity pneumonitis, and bronchiolitis obliterans.
Signs and symptoms
Like other types of asthma, it is characterized by airway inflammation, reversible airways obstruction, and bronchospasm, but it is caused by something in the workplace environment. Symptoms include shortness of breath, tightness of the chest, coughing, sputum production and wheezing. Some patients may also develop upper airway symptoms such as itchy eyes, tearing, sneezing, nasal congestion and rhinorrhea.Symptoms may develop over many years as in sensitizer induced asthma or may occur after a single exposure to a high-concentration agent as in case of RADS.
Risk factors
At present, over 400 workplace substances have been identified as having asthmagenic or allergenic properties. Agents such as flour, diisocyanates, latex, persulfate salts, aldehydes, animals, wood dusts, metals, enzymes usually account for the majority cases, however, the distribution of causal agents may vary widely across geographic areas, depending on the pattern of industrial activities. For example, in France the industries most affected are bakeries and cake-shops, automobile industry and hairdressers, whereas in Canada the principal cause is wood dust, followed by isocyanates. Furthermore, the most common cause of occupational asthma in the workplace are isocyanates. Isocyanates are used in the production of motor vehicles and in the application of orthopaedic polyurethane and fibreglass casts.The occupations most at risk are: adhesive handlers (e.g. acrylate), animal handlers and veterinarians (animal proteins), bakers and millers (cereal grains), carpet makers (gums), electronics workers (soldering resin), forest workers, carpenters and cabinetmakers (wood dust), hairdressers (e.g. persulfate), health care workers (latex and chemicals such as glutaraldehyde), janitors and cleaning staff (e.g. chloramine-T), pharmaceutical workers (drugs, enzymes), seafood processors, shellac handlers (e.g. amines), solderers and refiners (metals), spray painters, insulation installers, plastics and foam industry workers (e.g. diisocyanates), textile workers (dyes) and users of plastics and epoxy resins (e.g. anhydrides)The following tables show occupations that are known to be at risk for occupational asthma, the main reference for these is the Canadian Centre for Occupational Health and Safety.
Diagnosis
To diagnose occupational asthma it is necessary to confirm the symptoms of asthma and establish the causal connection with the work environment. Various diagnostic tests can be used to aid in diagnoses of work related asthma.A spirometer is a device used to measure timed expired and inspired volumes, and can be used to help diagnose asthma.
Peak expiratory flow rate (PEFR) is a hand held device which measures how fast a person can exhale and is a reliable test for occupational asthma. Serial PEFR can be measured to see if there is a difference in ability to exhale at work compared to that in a controlled environment.
A non-specific bronchial hyperreactivity test can be used to support the diagnose occupational asthma. It involves measuring the forced expiratory volume in 1 second (FEV-1) of the patient before and after exposure to methacholine or mannitol. Presence of airway responsiveness i.e. significant drop in FEV-1 can be seen in patients with occupational asthma.Specific inhalation challenges test consist of exposing the subjects to the suspected occupational agent in the laboratory and/or at the workplace and assess for asthma symptoms as well as a reduction in FEV1.Other tests such as skin prick test, serum immunologic testing and measurement of sputum eosinophils can also be useful in establishing the diagnosis of occupational asthma.
Prevention
Several forms of preventive measures have been suggested to prevent development of occupational asthma and also detect risk or disease early to allow intervention and improve outcomes. These include: comprehensive programs, education and training, medical examinations, use of medications, reduction of exposures and elimination of exposures.
Asthma symptoms and airway hyperresponsiveness can persist for several years after removal from the offending environment |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Snowman appearance on x-ray is seen in which cardiac pathology - and explain in detail? | Ans. is 'b' i.e., TAPVC o Snowman's sign is seen in supracardiac TAPVC.Cardiac configrationo "Boot-shaped" heart (cour en sabot)o "Egg on side" heart ("egg in cup" heart)o "Egg in cup" Hearto "Snowman" sign ("figure of 8, or cottage loaf" sign)o "Ground - glass" appearance of lungo "Sitting-duck" hearto "Water-bottle" or flashed shaped or money bag hearto "Box-shaped" hearto Tubular hearto "Tear -drop" hearto "Cor-triatum"o "Jug handle" appearanceo "Pentagon-shaped" hearto "Triangular-shaped" heartFallot's tetralogyTransposition of great arteriesConstrictive pericarditisSupracardiac TAPVCObstructive TAPVCPersistent truncus arteriosusPericardial effusion, hypothyroidismTricuspid atresia, Ebstein's anomalyAddison's disease, emphysemaChronic emphysemaPulmonary vein obstructionPrimary pulmonary hypertensionMitral incompetenceConstrictive pericarditis |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Interferon gamma release assay measures IFN release against which M. TB antigen - and explain in detail? | Ans. is 'a' i.e., ESAT-6 o Interferon-yam mu release assays (IGRAs! are diasnostic tools for latent tuberculosis infection (LTBI).o They are surrogate markers of Mycobacterium tuberculosis infection and indicate a cellular immune response to M. tuberculosis.o IGRAs cannot distinguish between latent infection and active tuberculosis (TB) disease and should not be used for diagnosis of active TB. which is a microbiological diagnosis. A positive 1GR.4 result may not necessarily indicate active TB. and a negative IGRA result may not ride out active TB .o Because IGRAs are not affected by Bacille Calmette-Guerin (BCG) vaccination status, IGRAs are useful for evaluation ofL TBI in BCG-vaccinated individuals, particularly in settings where BCG vaccination is administered after infancy or multiple (booster) BCG vaccinations are given.Assay antigenso M. tuberculosis-specific antigens include :-# Early secreted antigenic target 6 (ESAT-6) and# Culture filtrate protein 10 (CFP-10).o These are encoded by genes located within the region of difference 1 (RD1) segment of the M. tuberculosis genome.o They are more specific for M. tuberculosis than purified protein derivative (PPD) because they are not shared with any BCG vaccine strains or most species of NTM other than M. marinum, M kansasii, M. szulgai, and M. flavescens.Types of assayso Two IGRAs are available in many countries :-The QuantiFERON-TB Gold In-Tube (QFT-GIT) assay, which has replaced the second-generation Quantiferon- TB Gold (QFT-G) assay, and the T-SPOT.TB assay.o The QFT-GIT assay is an enzyme-linked immunosorbent assay (ELISA)-based, whole-blood test that uses peptides from three TB antigens i.e.,ESAT-6CFP-10, andTB 7.7) in an in-tube formato The result is reported as quantification of interferon (IFN)-gamma in international units (IU) per mL.o A newer assay, the QuantiFEROM-TB Gold Plus (QFT-Plus), became available in 2015.This test is available in Europe but not in North America. The QFT-Plus assay has m-o TB antigen tubes, unlike the QFT assay (which has a single TB antigen tube).Sensitivity and specificityo IGRAs have specificity >95 percent for diagnosis oflatent TB infection. The sensitivity for T-SPOT.TB appears to be higher than for QFT-GIT or TST (approximately 90, 80, and 80 percent, respectively) . The higher sensitivity of T-SPOT.TB may be useful for evaluating individuals with immunosuppressive conditions. o TST specificity is high in populations not vaccinated with BCG (97 percent). Among populations where BCG is administered, it is much lower although variable (approximately 60 percent). |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Glycolytic enzymes (s) inhibited by fluoride: and explain in detail? | C i.e. EnolaseFor blood glucose estimation in the laboratory, fluoride is added to the blood to prevent glycolysis by the cells by inhibiting 'enolase' so that blood glucose is correctly estimated.Q. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Instrument used to plane buccoproximal and linguoproximal walls in class II cavity is: and explain in detail? | With the enamel hatchet or the bin-angle chisel or both, the dentist can cleave away any remaining undermined proximal enamel, establishing the proper direction to the mesiolingual and mesiofacial walls. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following is not a feature of hypothyroidism ? and explain in detail? | Hypothyroidism characterized by open and widened fontanelle results in large head and mental retardation. Reference: ghai essential of pediatrics, eighth edition, p.no:517,table 17.6 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Branching enzyme in used in - and explain in detail? | Ans. is 'a' i.e., Glycogenesis o Enzymes involved in glycogen metabolism areGlycogenesisGlycogen synthase-a (activej/Glycogen synthase - b (inactive)Branching enzyme (amylo-1,4 - 1,6 transglucosidase)GlycogenolysisGlycogen phosphorylase-a (active)/Glycogen phosphorylase-b (inactive)Glucan transferase (oligo a-1,4 -a-1,4 glucan transferase)Debranching enzyme (amylo-1,6 glucosidase) |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following is not associated with Renal cell carcinoma: and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Drug of choice for pneumocystis carinii is? and explain in detail? | Question repeated |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is X-ray feature of pyloric stenosis is - and explain in detail? | The plain XR will show a "single bubble" with air in a distended stomach. An elongated and narrowedpyloric canal (2-4cm in length) results in a "string" sign when a small amount of barium streaks through the pyloric canal |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following is the best indicator of community health? and explain in detail? | Infant moality rate is universally regarded as the best indicator of the community health. Infant moality is defined by the number of infant deaths (before age one) per 1,000 live bihs and is an indication of the quality and accessibility of prenatal care for pregnant women. The infant moality rate is a critical indicator in the overall health and welfare of a nation. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following conditions causes maximum hearing loss - and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following Antihypertensive is preferred in cases of comorbid Diabetes Mellitus and explain in detail? | ACE inhibitors are the drug of choice for Hypertension with Diabetes Mellitus. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Number connection test is used in and explain in detail? | Number connection test or constructional apraxia are a clinical features of hepatic encephalopathy. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Investigation of choice for Neuroangiofibroma is? and explain in detail? | ANSWER: (C) Contrast enhanced CTREF: Thoracic imaging: a practical approach - Page 197, Pol J Radiol, 2005; 70(3): 90-92"Contrast enhanced CT scan is the investigation of choice for Neuroangiofibroma' |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Excision of the submandibular gland for calculus or tumours is done by incision below angle of the jaw. Special care should be taken to avoid which nerve? and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is The first visible sign of puberty in boys - and explain in detail? | Ans. is 'b' i.e., Enlargement of testes o In girls, the first visible sign of puberty is the appearance of breast buds (Thelarche), between 8-12 years of age. In boys the first visible sign of puberty is testicular enlargement, beginning as early as 9 1/2 yr |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Under ESI act, the state government's share of expenditure on medical care is? and explain in detail? | |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following is common to all types of shock? and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Prepyloric or channel ulcer in the stomach is termed as and explain in detail? | Type 1- in the antrum, near the lesser curvature, type 2: combined gastric ulcer (in the body ) with duodenal ulcer, type 3. Prepyloric, type 4 gastric ulcer in the proximal stomach of the cardia type 5- ulcer anywhere associated with NSAIDs. SRB edition 5 page no. 824 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Zero order kinetics is seen with and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Hyperiglyceridemia is seen in - and explain in detail? | Ans is 'b' i.e., Dys-beta-lipoproteinemia |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Lymph node metastasis in testicular tumor. First lymph node involved is: and explain in detail? | Ans. (b) Para aorticRef Harrison 19th ed. / 589Points to Remember about testicular tumor* In metastatic disease-retroperitoneal LN is Most commonly involved* Metastasis- Lymphatic >> Blood (m/c lung)* Exception is Choriocarcinoma where blood metastasis (m/c lung)>> lymphatic metastasis.* Most common testicular tumor- in general - seminoma# Prepubertal adults- teratoma# Infant and children- yolk sac tumor* Most common presentation- nodule or painless swelling of one gonad* Most common bilateral testicular tumor- Malignant lymphoma* Most common bilateral primary testicular tumor- Seminoma* FNAC contraindicated* Intial IOC- USG(hypo echoic area within tunica albuginea is suspicious)* HPE diagnosis by-radical orchiectomy (inguinal approach)* Scrotal orchiectomy- contraindicated* Chavesseac maneuver- soft clamp applied to cord- biopsy from suspicious area- sent for frozen section- if+ ligate cord, do orchiectomy- final HPE |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which amino acid is scarce in pulses? and explain in detail? | Amino acids most deficient in proteins of a food item are 'limiting amino acids'. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is In a class V preparation, during application of rubber
dam the punch of the tooth to be restored should be made: and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Ectopic rest of normal tissue is known as ? and explain in detail? | Ans. is 'a' i.e., Choristoma o Normally arranged tissue at a different anatomical site (ectopic site) --> Choristoma. o Abnormally arranged tissue present at normal site -->Hamaoma |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Duchenne muscular dystrophy and explain in detail? | Duchenne muscular dystrophy (DMD) is a severe type of muscular dystrophy that primarily affects boys. Muscle weakness usually begins around the age of four, and worsens quickly. Muscle loss typically occurs first in the thighs and pelvis followed by the arms. This can result in trouble standing up. Most are unable to walk by the age of 12. Affected muscles may look larger due to increased fat content. Scoliosis is also common. Some may have intellectual disability. Females with a single copy of the defective gene may show mild symptoms.The disorder is X-linked recessive. About two thirds of cases are inherited from a persons mother, while one third of cases are due to a new mutation. It is caused by a mutation in the gene for the protein dystrophin. Dystrophin is important to maintain the muscle fibers cell membrane. Genetic testing can often make the diagnosis at birth. Those affected also have a high level of creatine kinase in their blood.Although there is no known cure, physical therapy, braces, and corrective surgery may help with some symptoms. Assisted ventilation may be required in those with weakness of breathing muscles. Medications used include steroids to slow muscle degeneration, anticonvulsants to control seizures and some muscle activity, and immunosuppressants to delay damage to dying muscle cells. Gene therapy, as a treatment, is in the early stages of study in humans. A small initial study using gene therapy has given some children improved muscle strength, but long term effects are unknown as of 2020.DMD affects about one in 3,500 to 6,000 males at birth. It is the most common type of muscular dystrophy. The life expectancy is 26; however, with excellent care, some may live into their 30s or 40s. The disease is much more rare in girls, occurring approximately once in 50,000,000 live female births.
Signs and symptoms
DMD causes progressive muscle weakness due to muscle fiber disarray, death, and replacement with connective tissue or fat. The voluntary muscles are affected first, especially those of the hips, pelvic area, thighs, calves. It eventually progresses to the shoulders and neck, followed by arms, respiratory muscles, and other areas. Fatigue is common.Signs usually appear before age five, and may even be observed from the moment a boy takes his first steps. There is general difficulty with motor skills, which can result in an awkward manner of walking, stepping, or running. They tend to walk on their toes, in part due to shortening of the Achilles tendon, and because it compensates for knee extensor weakness. Falls can be frequent. It becomes harder and harder for the boy to walk; his ability to walk usually completely disintegrates before age 13. Most men affected with DMD become essentially "paralyzed from the neck down" by the age of 21. Cardiomyopathy, particularly dilated cardiomyopathy, is common, seen in half of 18-year-olds. The development of congestive heart failure or arrhythmia (irregular heartbeat) is only occasional. In late stages of the disease, respiratory impairment and swallowing impairment can occur, which can result in pneumonia.
A classic sign of DMD is trouble getting up from lying or sitting position, as manifested by a positive Gowerss sign. When a child tries to arise from lying on his stomach, he compensates for pelvic muscle weakness through use of the upper extremities: first by rising to stand on his arms and knees, and then "walking" his hands up his legs to stand upright. Another characteristic sign of DMD is pseudohypertrophy (enlarging) of the muscles of the tongue, calves, buttocks, and shoulders (around age 4 or 5). The muscle tissue is eventually replaced by fat and connective tissue, hence the term pseudohypertrophy. Muscle fiber deformities and muscle contractures of Achilles tendon and hamstrings can occur, which impair functionality because the muscle fibers shorten and fibrose in connective tissue. Skeletal deformities can occur, such as lumbar hyperlordosis, scoliosis, anterior pelvic tilt, and chest deformities. Lumbar hyperlordosis is thought to be compensatory mechanism in response to gluteal and quadriceps muscle weakness, all of which cause altered posture and gait (e.g.: restricted hip extension).Non musculoskeletal manifestations of DMD occur. There is a higher risk of neurobehavioral disorders (e.g., ADHD), learning disorders (dyslexia), and non-progressive weaknesses in specific cognitive skills (in particular short-term verbal memory), which are believed to be the result of absent or dysfunctional dystrophin in the brain.
Cause
DMD is caused by a mutation of the dystrophin gene, located on the short arm of the X chromosome (locus Xp21) that codes for dystrophin protein. Mutations can either be inherited or occur spontaneously during germline transmission, causing to a large reduction or absence of dystrophin, a protein that provides structural integrity in muscle cells. Dystrophin is responsible for connecting the actin cytoskeleton of each muscle fiber to the underlying basal lamina (extracellular matrix), through a protein complex containing many subunits. The absence of dystrophin permits excess calcium to penetrate the sarcolemma (the cell membrane). Alterations in calcium and signalling pathways cause water to enter into the mitochondria, which then burst.In skeletal muscle dystrophy, mitochondrial dysfunction gives rise to an amplification of stress-induced cytosolic calcium signals and an amplification of stress-induced reactive-oxygen species production. In a complex cascading process that involves several pathways and is not clearly understood, increased oxidative stress within the cell damages the sarcolemma and eventually results in the death of the cell. Muscle fibers undergo necrosis and are ultimately replaced with adipose and connective tissue.
DMD is inherited in an X-linked recessive pattern. Females typically are carriers of the genetic trait while males are affected. A female carrier will be unaware she carries a mutation until she has an affected son. The son of a carrier mother has a 50% chance of inheriting the defective gene from his mother. The daughter of a carrier mother has a 50% chance of being a carrier and a 50% chance of having two normal copies of the gene. In all cases, an unaffected father either passes a normal Y to his son or a normal X to his daughter. Female carriers of an X-linked recessive condition, such as DMD, can show symptoms depending on their pattern of X-inactivation.DMD is extremely rare in females (about 1 in 50,000,000 female births). It can occur in females with an affected father and a carrier mother, in those who are missing an X chromosome, or those who have an inactivated X chromosome (the most common of the rare reasons). The daughter of a carrier mother and an affected father will be affected or a carrier with equal probability, as she will always inherit the affected X-chromosome from her father and has a 50% chance of also inheriting the affected X-chromosome from her mother.Disruption of the blood-brain barrier has been seen to be a noted feature in the development of DMD.
Diagnosis
Genetic counseling is advised for people with a family history of the disorder. DMD can be detected with about 95% accuracy by genetic studies performed during pregnancy. Creatine kinase (CPK-MM) levels in the bloodstream are extremely high. An electromyography (EMG) shows that weakness is caused by destruction of muscle tissue rather than by damage to nerves.
DNA test
The muscle-specific isoform of the dystrophin gene is composed of 79 exons, and DNA testing (blood test) and analysis can usually identify the specific type of mutation of the exon or exons that are affected. DNA testing confirms the diagnosis in most cases.
Muscle biopsy
If DNA testing fails to find the mutation, a muscle biopsy test may be performed. A small sample of muscle tissue is extracted using a biopsy needle. The key tests performed on the biopsy sample for DMD are immunohistochemistry, immunocytochemistry, and immunoblotting for dystrophin, and should be interpreted by an experienced neuromuscular pathologist. These tests provide information on the presence or absence of the protein. Absence of the protein is a positive test for DMD. Where dystrophin is present, the tests indicate the amount and molecular size of dystrophin, helping to distinguish DMD from milder dystrophinopathy phenotypes. Over the past several years, DNA tests have been developed that detect more of the many mutations that cause the condition, and muscle biopsy is not required as often to confirm the presence of DMD.
Prenatal tests
A prenatal test can be considered when the mother is a known or suspected carrier.Prenatal tests can tell whether the unborn child has one of the most common mutations. Many mutations are responsible for DMD, and some have not been identified, so genetic testing may be falsely negative if the suspected mutation in the mother has not been identified.Prior to invasive testing, determination of the fetal sex is important; while males are sometimes affected by this X-linked disease, female DMD is extremely rare. This can be achieved by ultrasound scan at 16 weeks or more recently by free fetal DNA (cffDNA) testing. Chorion villus sampling (CVS) can be done at 11–14 weeks, and has a 1% risk of miscarriage. Amniocentesis can be done after 15 weeks, and has a 0.5% risk of miscarriage. Non invasive prenatal testing can be done around 10–12 weeks. Another option in the case of unclear genetic test results is fetal muscle biopsy.
Treatment
No cure for DMD is known, and an ongoing medical need has been recognized by regulatory authorities. Gene therapy has shown some success.Treatment is generally aimed at controlling symptoms to maximize the quality of life which can be measured using specific questionnaires, and include:
Corticosteroids such as prednisolone and deflazacort lead to short-term improvements in muscle strength and function up to 2 years. Corticosteroids have also been reported to help prolong walking, though the evidence for this is not robust.
Randomised control trials have shown that β2 agonists increase muscle strength, but do not modify disease progression. Follow-up time for most RCTs on β2 agonists is only around 12 months, hence results cannot be extrapolated beyond that time frame.
Mild, nonjarring physical activity such as swimming is encouraged. Inactivity (such as bed rest) can worsen the muscle disease.
Physical therapy is helpful to maintain muscle strength, flexibility, and function.
Orthopedic appliances (such as braces and wheelchairs) may improve mobility and the ability for self-care. Form-fitting removable leg braces that hold the ankle in place during sleep can defer the onset of contractures.
Appropriate respiratory support as the disease progresses is important.
Cardiac problems may require a pacemaker.The medication eteplirsen, a Morpholino antisense oligo, has been approved in the United States for the treatment of mutations amenable to dystrophin exon 51 skipping. The US approval has been controversial as eteplirsen failed to establish a clinical benefit; it has been refused approval by the European Medicines Agency.The medication ataluren (Translarna) is approved use in the European Union.The antisense oligonucleotide golodirsen (Vyondys 53) was approved for medical use in the United States in 2019, for the treatment of cases that can benefit from skipping exon 53 of the dystrophin transcript.The Morpholino antisense oligonucleotide viltolarsen (Viltepso) was approved for medical use in the United States in August 2020, for the treatment of Duchenne muscular dystrophy (DMD) in people who have a confirmed mutation of the DMD gene that is amenable to exon 53 skipping. It is the second approved targeted treatment for people with this type of mutation in the United States. Approximately 8% of people with DMD have a mutation that is amenable to exon 53 skipping.Casimersen was approved for medical use in the United States in February 2021, and it is the first FDA-approved targeted treatment for people who have a confirmed mutation of the DMD gene that is amenable to exon 45 skipping.Comprehensive multidisciplinary care guidelines for DMD have been developed by the Centers for Disease Control and Prevention, and were published in two parts in The Lancet Neurology in 2010. An update was published in 2018.
Physical therapy
Physical therapists are concerned with enabling patients to reach their maximum physical potential. Their aim is to:
minimize the development of contractures and deformity by developing a programme of stretches and exercises where appropriate
anticipate and minimize other secondary complications of a physical nature by recommending bracing and durable medical equipment
monitor respiratory function and advise on techniques to assist with breathing exercises and methods of clearing secretions
Respiration assistance
Modern "volume ventilators/respirators", which deliver an adjustable volume (amount) of air to the person with each breath, are valuable in the treatment of people with muscular dystrophy-related respiratory problems. The ventilator may require an invasive endotracheal or tracheotomy tube through which air is directly delivered, but for some people, noninvasive delivery through a face mask or mouthpiece is sufficient. Positive airway pressure machines, particularly bilevel ones, are sometimes used in this latter way. The respiratory equipment may easily fit on a ventilator tray on the bottom or back of a power wheelchair with an external battery for portability.Ventilator treatment may start in the mid- to late teens when the respiratory muscles can begin to collapse. If the vital capacity has dropped below 40% of normal, a volume ventilator/respirator may be used during sleeping hours, a time when the person is most likely to be underventilating (hypoventilating). Hypoventilation during sleep is determined by a thorough history of sleep disorder with an oximetry study and a capillary blood gas (see pulmonary function testing).
A cough assist device can help with excess mucus in lungs by hyperinflation of the lungs with positive air pressure, then negative pressure to get the mucus up. If the vital capacity continues to decline to less than 30 percent of normal, a volume ventilator/respirator may also be needed during the day for more assistance. The person gradually will increase the amount of time using the ventilator/respirator during the day as needed. However, there are also people with the disease in their 20s who have no need for a ventilator.
Future developments
There is no cure for any of the muscular dystrophies. Several drugs designed to address the root cause are under development, including gene therapy (Microdystrophin), and antisense drugs (Ataluren, Eteplirsen etc.). Other medications used include corticosteroids (Deflazacort), calcium channel blockers (Diltiazem) to slow skeletal and cardiac muscle degeneration, anticonvulsants to control seizures and some muscle activity, and immunosuppressants (Vamorolone) to delay damage to dying muscle cells. Physical therapy, braces, and corrective surgery may help with some symptoms while assisted ventilation may be required in those with weakness of breathing muscles. Outcomes depend on the specific type of disorder.A paper published by Stanford University on 10 March 2022 demonstrated that patients with muscular dystrophies could benefit from new therapies targeting the specific pathways contributing directly to muscle disorders. Three recent advances are likely to enhance the landscape of treatments for muscular dystrophies such as DMD. First, induced pluripotent stem cells (iPSCs) allow researchers to design effective treatment strategies. Second, artificial intelligence (AI) can help identify therapeutic targets. Third, a high volume of multi-omics data gathered from diverse sources through disease models can provide valuable information about converging and diverging pathways.
Prognosis
Duchenne muscular dystrophy is a rare progressive disease which eventually affects all voluntary muscles and involves the heart and breathing muscles in later stages. Life expectancy is estimated to be around 25–26, but this varies. With excellent medical care, affected men often live into their 30s. David Hatch of Paris, Maine, may be the oldest person in the world with the disease; as of 2021, he was 58.The most common direct cause of death in people with DMD is respiratory failure. Complications from treatment, such as mechanical ventilation and tracheotomy procedures, are also a concern. The next leading cause of death is cardiac-related conditions such as heart failure brought on by dilated cardiomyopathy. With respiratory assistance, the median survival age can reach up to 40. In rare cases, people with DMD have been seen to survive into their forties or early fifties, with proper positioning in wheelchairs and beds, and the use of ventilator support (via tracheostomy or mouthpiece), airway clearance, and heart medications. Early planning of the required supports for later-life care has shown greater longevity for people with DMD.Curiously, in the mdx mouse model of Duchenne muscular dystrophy, the lack of dystrophin is associated with increased calcium levels and skeletal muscle myonecrosis. The intrinsic laryngeal muscles (ILMs) are protected and do not undergo myonecrosis. ILMs have a calcium regulation system profile suggestive of a better ability to handle calcium changes in comparison to other muscles, and this may provide a mechanistic insight for their unique pathophysiological properties. The ILM may facilitate the development of novel strategies for the prevention and treatment of muscle wasting in a variety of clinical scenarios. In addition, patients with Duchenne muscular dystrophy also have elevated plasma lipoprotein levels, implying a primary state of dyslipidemia in patients.
Epidemiology
DMD is the most common type of muscular dystrophy; it affects about one in 5,000 males at birth. DMD has an incidence of one in 3,600 male infants.In the US, a 2010 study showed a higher amount of those with DMD age ranging from 5 to 54 who are Hispanic compared to non-Hispanic Whites, and non-Hispanic Blacks.
History
The disease was first described by the Neapolitan physician Giovanni Semmola in 1834 and Gaetano Conte in 1836. However, DMD is named after the French neurologist Guillaume-Benjamin-Amand Duchenne (1806–1875), who in the 1861 edition of his book Paraplegie hypertrophique de lenfance de cause cerebrale, described and detailed the case of a boy who had this condition. A year later, he presented photos of his patient in his Album de photographies pathologiques. In 1868, he gave an account of 13 other affected children. Duchenne was the first to do a biopsy to obtain tissue from a living patient for microscopic examination.
Notable cases
Alfredo ("Dino", "Alfredino") Ferrari (born January 1932 in Modena), the son of Enzo Ferrari, designed the 1.5 L DOHC V6 engine for the model F2 at the end of 1955. But Dino never saw the engine produced: he died on 30 June 1956 in Modena at the age of 24, before his namesakes Dino and Fiat Dino were made.Rapper Darius Weems had the disease and used his notoriety to raise awareness and funds for treatment. He died at the age of 27 (his brother also had the disease, until his death at the age of 19). The film Darius Goes West documents Weemss journey of growth and acceptance of having the disease.Jonathan Evisons novel, The Revised Fundamentals of Caregiving, published in 2012, depicted a young man affected by the disease. In 2016, Netflix released The Fundamentals of Caring, a film based on the novel.
Research
Current research includes exon-skipping, stem cell replacement therapy, analog up-regulation, gene replacement, and supportive care to slow disease progression.Efforts are ongoing to find medications that either return the ability to make dystrophin or utrophin. Other efforts include trying to block the entry of calcium ions into muscle cells.
Exon-skipping
Antisense oligonucleotides (oligos), structural analogs of DNA, are the basis of a potential treatment for 10% of people with DMD. The compounds allow faulty parts of the dystrophin gene to be skipped when it is transcribed to RNA for protein production, permitting a still-truncated but more functional version of the protein to be produced. It is also known as nonsense suppression therapy.Two kinds of antisense oligos, 2-O-methyl phosphorothioate oligos (like drisapersen) and Morpholino oligos (like eteplirsen), have tentative evidence of benefit and are being studied. Eteplirsen is targeted to skip exon 51. "As an example, skipping exon 51 restores the reading frame of ~ 15% of all the boys with deletions. It has been suggested that by having 10 AONs to skip 10 different exons it would be possible to deal with more than 70% of all DMD boys with deletions." This represents about 1.5% of cases.
People with Beckers muscular dystrophy, which is milder than DMD, have a form of dystrophin which is functional even though it is shorter than normal dystrophin. In 1990 England et al. noticed that a patient with mild Becker muscular dystrophy was lacking 46% of his coding region for dystrophin. This functional, yet truncated, form of dystrophin gave rise to the notion that shorter dystrophin can still be therapeutically beneficial. Concurrently, Kole et al. had modified splicing by targeting pre-mRNA with antisense oligonucleotides (AONs). Kole demonstrated success using splice-targeted AONs to correct missplicing in cells removed from beta-thalassemia patients Wiltons group tested exon skipping for muscular dystrophy.
Gene therapy
Researchers are working on a gene editing method to correct a mutation that leads to Duchenne muscular dystrophy (DMD). Researchers used a technique called CRISPR/Cas9-mediated genome editing, which can precisely remove a mutation in the dystrophin gene in DNA, allowing the bodys DNA repair mechanisms to replace it with a normal copy of the gene. The benefit of this over other gene therapy techniques is that it can permanently correct the "defect" in a gene rather than just transiently adding a "functional" one.Genome editing through the CRISPR/Cas9 system is not currently feasible in humans. However, it may be possible, through advancements in technology, to use this technique to develop therapies for DMD in the future. In 2007, researchers did the worlds first clinical (viral-mediated) gene therapy trial for Duchenne MD.Biostrophin is a delivery vector for gene therapy in the treatment of Duchenne muscular dystrophy and Becker muscular dystrophy.
References
Further reading
Birnkrant DJ, Bushby K, Bann CM, Apkon SD, Blackwell A, Brumbaugh D, et al. (March 2018). "Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management". Lancet Neurol. 17 (3): 251–267 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is 'C' in CRP stands for and explain in detail? | C i.e. C polysaccharide of pneumococcus C-reactive protein (CRP), discovered by Tillet and Francis in 1930, is so named because it reacts with the C polysaccharide of pneumococci.Q Acute phase proteins (or reactants) are proteins that increase during acute inflammatory states or secondary to ceain types of tissue damages. These include - al- antitrypsin, al acid glycoprotein, CRP, haptoglobin and fibrinogee. Interleukin-1 (IL-1), a polypeptide released from mononuclear phagocytic cells, is the principal - but not the sole -stimulator of synthesis of majority of acute phase reactants by hepatocytes. Cytokine IL-6 are also involved. Nuclear factor Kappa-B (NFKB) is a transcription factor that has been involved in the stimulation of synthesis of acute phase proteins. CRP (a type of pentraxin protein) is synthesized by liver in response to factors released by fat cells. It binds to phosphotholine expressed on surface of dead or dying cells in order to activate classic complement pathway C1q. Its level is mainly determined by rate of production (rises within 6 hours, peak in 48 hours & t1/2 is constant) |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is All the following amoebae live in the large intestine except- and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which among the following will not present with fever and rash and explain in detail? | Ans) b (Rabies) Ref Park 20th ed p 240Measles, Rubella and chickenpox all will present as fever with characteristic rash.Rabies may present with headache, malaise, sorethroat and slight fever in the prodromal stage, rash is not included as a characteristic feature. About 80% of patients complain of pain or tingling at the site of bite which is the only prodromal symptom considered specific.The characteristic symptom of rabies, hydrophobia, which is pathogno-monic is absent in animals. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Ischaemia is characterized by all except and explain in detail? | Ischaemia results in thinning of skin. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Carex is a fluoride containing varnish with the following characteristics except- and explain in detail? | Carex is another fluoride varnish and contains a lower fluoride concentration than Duraphat (1.8% fluoride) and has efficacy equivalent to that of Duraphat as a caries -preventive agent.
Technique of varnish application :
After prophylaxis, teeth are dried, but not isolated with cotton rolls since varnish sticks to cotton.
A total of 0.3 - 0.5 ml of varnish equivalent to 6.9-11.5 mg F is required to cover the full dentition.
Application is done first on the lower arch and then on the upper arch, using a single tufted small brush, starting with the proximal surfaces.
After application, the patient is made to sit with the mouth open for 4 minutes before spitting to let Duraphat set on teeth which is further enhanced by saliva. (FIuorprotector sets faster than Duraphat).
Patient is asked not to rinse or drink anything at all for one hour and not to eat anything solid but take liquids and semisolids only till the next morning, so that contact between varnish and tooth surfaces for about 18 hours is maintained for prolonged interaction between fluoride and enamel. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Lepra cells are seen in abundance in: and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Hepatotoxicity is seen in poisoning with- and explain in detail? | Adult human hepatocytes in chemically defined culture conditions were incubated with morphine, heroin, meperidine, and methadone to investigate their potential hepatotoxicity to human liver. Cytotoxic effects were observed at about 100 times the plasma concentrations required to produce analgesia in human nonaddicts. Concentrations of 1 mM morphine, heroin, and meperidine reduced the glycogen content by 50%, while even 0.2 mM methadone produced a depletion of 70% after 24 h of treatment. Concentrations of 0.8 mM morphine and heroin, 0.4 mM meperidine, and 0.005 mM methadone inhibited the albumin synthesis by about 50% after 24 h of pretreatment. Intracellular glutathione was reduced to 50% of that of controls after 2-3 h of incubation with 2 mM morphine and 1 mM heroin, while 1 mM meperidine and 0.2 mM methadone produced a reduction of about 30% after 6 h incubation. The results show that therapeutic doses of the opioids is unlikely to produce irreversible damage to human hepatocytes, but opiate doses during tolerance or abuse may be a cause of liver dysfunction. Ref Davidson 23rd edition pg 847 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is A 2 year old boy presents with fever for 3 days which responded to administration of paracetamol. Three days later he developed acute renal failure, marked acidosis and encephalopathy? His urine showed plenty of oxalate crystals. The blood anion gap and osmolal gap were increased. Which of the following is the most likely diagnosis - and explain in detail? | Ans. is 'b' i.e., Diethyl glycol poisoning It is case of Ethylene glycol poisoning.The key to the diagnosis of Ethylene glycol poisoning is recognition of-Anion gap acidosisIncreased osmolar gapIncreased oxalate crystals in urine Ethylene glycol poisoningEthylene glycol is readily available as a constituent of antifreezes for car radiatorsYoung children are sometimes attracted by the sweet taste of ethylene glycol and it has sometimes been used criminally to give 'body' and sweetness to white table wines.Ethylene glycol, itself, can only cause direct depression of central nervous system, however their oxidized products i.e., aldehyde and oxalates can cause severe metabolic acidosis and renal failure.Ethylene glycol poisoning can be divided into three stages.Management of Ethylene glycol poisoningSodium bicarbonate to correct acidemiaThiamine, folinic acid, magnesium and high dose pyridoxine to facilitate metabolism.Ethanol or Fomepizole is given to competitively inhibit the metabolism of Ethylene glycol. (Ethanol or Fomepizole occupies the enzyme alcohol dehydrogenase, and are metabolized instead of Ethylene glycol).Hemodialysis to eliminate ethylene glycol. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Chemical used in vaginal sponge is and explain in detail? | Vaginal sponge is a small polyurethane foam sponge saturated with spermicide, nonoxynol-9 It comes under barrier method of contraception Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 495 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Defect in Chediak Hegashi syndrome is? and explain in detail? | Ans. is 'a' i.e., Fusion of lysosome Chediak higashi syndrome* It is an autosomal recessive disorder caused by mutation in LYST gene, which codes for a protein known as lysosomal trafficking regulator. Defect in this protein leads to disruption of size, structure and function of lysosomes.* Lysosomes cannot fuse with phagosome to form phagolysosomes. Thus there is impaired bactericidal activity due to impaired phagolysosome formation.* Neutrophils also have defective chemotaxis. The neutrophils (polymorphs) shows giant primary granules. The other cells affected are melanocytes (causing albinism), platelets (causing bleeding) and schwann cells (causing neurological symptoms like peripheral neuropathy). |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is All are precancerous lesions for carcinoma of esophagus except and explain in detail? | Refer Robbins page no Pg 758-9 A Zenker's diveiculum, more formally known as a hypopharyngeal diveiculum, is a pouch that can form at the junction of the hypopharynx (lower pa of the throat) and the esophagus, an area known as Killian's Triangle |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Common precursor of mineralocoicoid, glucocoicoids and sex steroids ? and explain in detail? | Ans. is 'a' i.e., Pregnenolone |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Late complication of Acetabular fracture and explain in detail? | Avascular necrosis - osteonecrosis of the femoral head may occur even if the hip is not fully dislocated.
The condition is probably overdiagnosed because of an erroneous interpretation of x-ray appearance following impacted marginal fractures of the acetabulum.
Other complications : *iliofemoral venous thrombosis *sciatic nerve injury *heterotopic bone formation *loss of joint movement & secondary osteoarthritis |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is A 25year old male presents with painless sudden loss of vision, ocular and systemic examination is not contributory. What is probable diagnosis and explain in detail? | Ans is Eale's disease Both Eale's disease and Retinal detachment are causes of painless sudden loss of vision, however Eale's disease is a much more common cause than RD in a young male. Ocular and systemic examinations in both the conditions may be normal.Eale's diseaseIt is a disease of young adult males, who otherwise are healthy, in developing countries (especially India).It is an idiopathic inflammation of peripheral retinal veins; characterized by recurrent vitreous hemorrhage.(Periphlebitis leads to obliteration of the affected vessels. Hypoxia leads to neovascularization which lead to recurrent vitreous hemorrhage)The etiology is unknown. Hypersensitivity to tuberculin protein has been reported, however no clear relationship to tuberculosis has been found.Usually bilateral.The common presenting symptoms are sudden appearance of floaters or painless loss of vision.The vitreous hemorrhage clears spontaneously, but after a few recurrence the hemorrhage may organize, and may cause fractional retinal detachment or secondary glaucoma.Treatment:systemic steroids in early vasculitis stageLaser photocoagulation for abnormal vessels is used in neovascularization stagevitreoretinal surgery is required for marked vitreous traction threatening the macula.Causes of sudden, painless loss of visionUnilateralBilateralSubluxation or dislocation of lensVitreous hemorrhageRetinal hemorrhageRetinal detachmentRetinal vascular occlusionExudative age-related macular degenerationPosterior uveitis Diabetic retinopathyGrade IV hypertensive retinopathy with macular star Atypical optic neuritis Toxic optic neuropathy Bilateral occipital infarction |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following does not pass through normal kidneys? and explain in detail? | Albumin is not excreted and beta globulin is excreted because circulating albumin is negatively charged. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Pheochromocytoma is a tumour of the: and explain in detail? | Most adrenal medullary tumors (pheochromocytomas) secrete norepinephrine or epinephrine or both and produce sustained hypertension.
Pheochromocytoma is a tumour of the adrenal medulla.
Reference: Ganong’s Review of Medical Physiology T W E N T Y - F I F T H E D I T I O N page no 356 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Drug-induced enlargement never occur in mouths with little or no plaque;
It can be absent in mouths with abundant deposits: and explain in detail? | |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is The following are complications of gallstone except and explain in detail? | Hemobilia is bleeding from liver or gall bladder into the biliary tree due to an abnormal communication between a blood vessel and a bile duct.it is very rare in case of gallstones.It is commonly iatrogenic or due to accidental trauma. Cholangitis and pancreatitis are impoant complications of gallstones along with cholecystoduodenal /enteric/Choledochal fistula. Reference:SRB's manual of surgery,5th edition,page no:662. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Release of synaptic transmitter by exocytosis would be blocked most effectively by preventing the: and explain in detail? | Preventing the flow of Ca2+ into the cell would prevent the release of transmitter, because Ca2+ initiates the intracellular events leading to the docking of the vesicle to its binding site on the active zone. Although Ca2+ normally enters the cell through voltage-operated channels that are opened by the depolarization of the nerve terminal that occurs as the action potential propagates along the nerve axon, release of transmitter will not occur if Ca2+ does not enter the nerve terminal. The flow of Na+ into the nerve terminal would depolarize the membrane and open Ca2+ channels, leading to Ca2+ entry and exocytosis. However, Na+ entry does not directly stimulate exocytosis. K+ does not affect the nerve terminal membrane. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Best method to diagnose Bronchiectasis is – and explain in detail? | Investigation of choice for Bronchiectasis is HRCT. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following is true about Constitutional Delay in growth? and explain in detail? | Constitutional growth delay is a physiological variant of sho stature. Here children grow normally upto 6-12 months of life. Thereafter, there is deceleration such that the height and weight fall below the 3rd centile. By 3 yrs of age,normal height velocity is resumed and continues to grow below and parallel to the 3rd centile. Here pubey is delayed; And the bone age is consistent with the child&;s height age, but lower than the chronological age by 2-3 yrs , unlike in the familial sho stature. Hence IGF-1 produced is low for the chronological age but consistent with the bone age that corresponds to the height age. Ref. OP.Ghai ,9th edition, chapter 2 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which type of immune responses responsible for caseation necrosis in TB?- and explain in detail? | Type 4 or delayed hypersensitivity or T cell mediated reaction is an immune response without formation of antibodies but is instead a slow and prolonged response .examples:reaction against mycobacterium infection ,virally infected cell,malignant cells and organ transplantation.Harshmohan textbook of pathology 7th edition |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Fumarase is a: and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Cecum forms the posterior wall of which hernia and explain in detail? | |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Suicidal enzyme is: and explain in detail? | Ans. B. CycloxygenaseCyclooxygenase is a "Suicide Enzyme" "Switching off" of prostaglandin activity is partly achieved by are markable property of cyclooxygenase -- that of self-catalyzed destruction; i.e., it is a "suicide enzyme." Quickreview-CyclooxygenaseCyclooxygenase (COX) (also called prostaglandin H synthase)Involved in Prostanoid (Prostaglandin Thromboxane and Prostacyclin) synthesisThis enzyme has two activities, acyclo oxygenase and peroxidase.COX is present as two isoenzymes, COX-1 and COX-2.Drugs acting as inhibitors COXNSAID-Aspirin-inhibits COX-1 and COX-2.-Indomethacin and ibuprofen-inhibit cyclooxygenases by competing with arachidonate.-Coxibs--selectively inhibit COX-2-Some coxibs have been withdrawn or suspended from the market due to undesirable side effects and safety issues.Anti-inflammatory Corticosteroids-Transcription of COX-2-- but not of COX-1-- is completely inhibited by corticosteroids. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is In dermatomyositis which is not seen- and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Lown–Ganong–Levine syndrome and explain in detail? | Lown–Ganong–Levine syndrome (LGL) is a pre-excitation syndrome of the heart. Those with LGL syndrome have episodes of abnormal heart racing with a short PR interval and normal QRS complexes seen on their electrocardiogram when in a normal sinus rhythm. LGL syndrome was originally thought to be due to an abnormal electrical connection between the atria and the ventricles, but is now thought to be due to accelerated conduction through the atrioventricular node in the majority of cases |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is All are true about chronic osteomyelitis except ? and explain in detail? | Ans. is 'c' i.e., Involucrum is dead bone Pathology in chronic osteomyelitis Chronic osteomyelitis occurs most commonly in long bones. Bone is destroyed or devitalized in the affected pa. Cavities containing pus and pieces of dead bone (sequestra) are surrounded by vascular tissue, and beyond that by areas of sclerosis due to reaction new bone formation, which may take the form of a distinct bony sheath (involucrum) Often sinus track leads to the skin surface; the sinus tends to heal and present down recurrently, but if a sequestrum is present it never heals permanently. This is because sequestra act as substrate for bacterial adhesion in much the same way as foreign implants, ensuring the persistence of infection until they are removed or discharged through perforations in the involucrum and sinuses that drain to the skin. Sequestrum Sequestrum is apiece of dead bone, surrounded by infected granulation tissue trying to eat the sequestrum away. The sequestrum is hard, rough, porus, light in weight and lighter in colour than normal. Normal pattern of bone is lost.(Note : Sequestrum in syphilis and TB is heavier than normal bone because sclerosis usually precedes the death of the bone). On x-ray, sequestra show up as unnatural dense fragments, in contrast to the surrounding osteopenic bone. Involucrum Involucrum is reactive new bone overlying a sequestrum. There may be some holes in the involucrum for pus to drain out. These holes are called cloaca. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Indications of circumcision are all except: and explain in detail? | Indications of Circumcision Phimosis Religion (Jews and Muslims) Paraphimosis Balanitis or balanoposthitis Recurrent UTI BXO (balanitis xerotica obliterans) |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Hyperacute graft rejection is caused by ? and explain in detail? | Ans. is 'a' i.e., Preformed antibodies |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is The following angle is associated with fracture of and explain in detail? | It is flattening of angle subtended by the posterior articular surface and the upper surface of body posterior to the joint (Bohler angle) occurs in fracture of calcaneum. It is 25—40° normally. It is also known as tuber joint angle. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Feature of Acute severe Asthma include all of the following, Except: and explain in detail? | Answer is D (None: All are Features of Acute severe Asthma) : Tachycardia (HR>120/min). PEFR < 50%, Pulsus paradoxus and Respiratory Acidosis are all features of Acute severe Asthma. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Iso osmolar urine is seen in - and explain in detail? | Acute tubular necrosis (ATN) is a medical condition involving the death of tubular epithelial cells that form the renal tubules of the kidneys. ATN presents with acute kidney injury (AKI) and is one of the most common causes of AKI. Common causes of ATN include low blood pressure and use of nephrotoxic drugs Acute tubular necrosis is classified as a "renal" (i.e. not pre-renal or post-renal) cause of acute kidney injury. Diagnosis is made by a FENa (fractional excretion of sodium) > 3% and presence of muddy casts (a type of granular cast) in urinalysis. On histopathology, there is usually tubulorrhexis, that is, localized necrosis of the epithelial lining in renal tubules, with focal rupture or loss of basement membrane. Proximal tubule cells can shed with variable bility and not be purely "necrotic".isosmolar urine is seen Ref Harrison20th edition pg 234 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Following tumour produce a marked elevation of: and explain in detail? | • Yolk sac tumors are those that resemble the yolk sac, allantois, and extraembryonic, mesenchyme.
• They are also known as endodermal sinus tumors.
• Yolk sac tumors can be seen in males and females, involving the testis, ovary, and other sites, such as the
mediastinum.
• Pure yolk sac tumor is the most common testicular neoplasm in prepubertal children.
• Almost all the patients with a yolk sac tumor either in pare form or mixed form have a significantly elevated serum
Alpha fetoprotein (AFP). |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Burst abdomen is seen after how many days of surgery and explain in detail? | In 1-2% of cases, mostly between the sixth and eighth day after operation, an abdominal wound bursts open and viscera are extruded. This is called burst abdomen or abdominal wound dehiscence. The sutures apposing the deep layers (peritoneum, posterior rectus sheath) tear through or even become untied.Reference : page 986 Bailey and Love's sho practice of surgery 25th edition |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Most common complication of extracapsular cataract surgery is - and explain in detail? | In extracapsular cataract extraction (ECCE), major poion of anterior capsule with epithelium, nucleus and coex are removed; leaving behind intact posterior capsule. So, opacificatiton of posterior capsule is the most common complication of extracapsular cataract surgery. Corneal complications and iritis/other inflammation are common post-operative complications. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is A patient is going skiing high in the Rockies and is given acetazolamide to protect against altitude sickness. Unfortunately, the patient is also a type 1 diabetic. He is admitted to the hospital in a worsening ketoacidosis. In which of the following cells has acetazolamide inhibited a reaction that has led to the severity of the metabolic acidosis? and explain in detail? | Acetazolamide is a carbonic anhydrase inhibitor, which is found primarily in red blood cells. The red blood cells contain carbonic anhydrase that catalyzes the reaction that forms carbonic acid from CO2 andH2 O. Under high- altitude conditions, the inhibition of carbonic anhydrase will lead to a decrease in blood pH, which stabilizes the deoxygenated form of Hb. This is due to an increased loss of bicarbonate in the urine by the inhibition of carbonic anhydrase within the kidney. The change in pH increases oxygen delivery to the tissues and can overcome, in part, the symptoms of altitude sickness.However, in the case of the person with type I diabetes who begins to produce ketone bodies, the body's main compensatory mechanism to overcome the acidosis is blocked. As ketone bodies are formed and protons generated, the H+ will react with bicarbonate to form carbonic acid. Carbonic anhydrase, which catalyzes a reversible reaction, will then convert the carbonic acid to CO2 andH2 O, with the CO2 being exhaled. These reactions soak up excess protons and help to buffer against the acidosis. If, however, carbonic anhydrase has been inhibited by acetazolamide, then the bicarbonate cannot buffer the blood pH, and the acidosis could become more severe. White blood cells, muscle cells, liver cells, and the lens of the eye do not contribute to the buffering of the blood, and inhibition of carbonic anhydrase in those cells would not affect the ability to overcome an acidosis. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Most common cells of connective tissue are: and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Calibre of a firearm is? and explain in detail? | Distance between two diagonally opposite lands REF: Parikh 6th edition page 4.26 Caliber technicically means diameter of the inside of the bore (land to land) in 1/100' of an inch. Thus, caliber 22 means 22/100 inch= 0.22 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is All the following are preliminary investigations in primary coagulation defects except - and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following vitamins can act without phosphorylation? and explain in detail? | Ans. B. LipoamideAll the vitamins listed except lipoamide contain at least one phosphate in their cofactor form. Thiamine (vitamin B1) is converted to thiamine pyrophosphate simply by the addition of pyrophosphate. It is involved in aldehyde group transfer. Niacin (nicotinic acid) is esterified to adenine dinucleotide and its two phosphates to form nicotinamide adenine dinucleotide. Pyridoxine (vitamin B6) is converted to either pyridoxal phosphate or pyridoxamine phosphate before complexing with enzymes. Riboflavin becomes Flavin mononucleotide by obtaining one phosphate (riboflavin 5'- phosphate). If it complexes with adenine dinucleotide via a pyrophosphate ester linkage, it becomes flavine adenine dinucleotide. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is True about Stage III B Endometrial Ca: and explain in detail? | Ans: A (Vaginal metastasis) FIGO staging of endometrial cancerStage 1Cancer confined to the corpus uteriIATumour limited to the endometriumIBTumour involving half or less than half the myometriai thicknessICTumour involves more than half the myometriai thicknessStage IITumour involves cervix but does not extend beyond uterus5IIAEndocervicai gland involvement only1IBCervical stromal invasionStage IIILocal and/or regional spread'3IIIATumour involves serosa, spreads to adnexa, positive peritoneal cytologyIII BPresence of vaginal metastasis3 incNode metastasis to pelvisand para-aortic lymph nodesStage IVTumour widespreadIVATumour involves bladder and/or bowel mucosaIVBTumour shows distant metastasis (intra-abdominal and inguinal lymph nodes)NoteNuclear atypia raises the grade of tumour 1 and 2 by 1Nuclear grading of adenocarcinomas is based on nuclear grading of the glandular component.Nuclear grading takes precedence in all carcinomas.Management of Stage 111 Endometrial Ca#"Surgical procedure includes- peritoneal washings' for cvtological examination, selective paraaortic & pelvic lymphadenoectomy, removal of any enlarged lymph node, biopsy or excision of any suspicious areas within the peritoneal cavity & partial omentectomy & peritoneal biopsies"- Novak's 14th/1376# Except in patients with bulky parametrial disease, total abdominal hysterectomy & b/1 salpingo-oophorectomy should be performed. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is The health indicator obtained by dividing height by cube root of weight is and explain in detail? | Park's textbook of preventive and social medicine 23rd edition. ponders index= height (cm)/cube root of body wgt quetelet's index= wgt (kg)/height square. Brocca index =height -100 Corpulence index= actual wgt/ desirable wgt |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which one of the following is not a wound closure technique? and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is The Most Common site for Amoebiasis: and explain in detail? | Caecum |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Unit of radiation absorption is: and explain in detail? | Ans. c (Gray). (Ref. Park PSM, 17th ed. 363, 522)RADIATION UNITS QuantityOld unitNew SI unit1ActivityCurieBecquerel2ExposureRoentgenCoulomb/kg3Absorbed doseRadGray4Dose equivalentRemSievert5Effective dosemSv Radiation units1) Becquerel (Bq) - Unit of activity (1 Bq = 1 disintegration/second)2) Curie (Ci) - Was unit of activity formerly (1 Bq = 27 picocuries)3) Roentgen - Unit of exposure (1 mrad = 0.001 rad)New SI Units1) Coulomb/kg - Replaced Roentgen2) Gray - Replaced Rad (1 rad = 0.01 Gy)3) Sievert - Replaced Rem (1 Sv = 100 rems) |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Okuda staging for HCC includes all except and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Amino acid with double chiral carbon- and explain in detail? | All amino acids have 1 assymetric or chiral C (means this C has all 4 valencies occupied by different atoms or group of atoms) EXCEPTIONS: * 0 - Glycine (So it lacks chilarity. Hence glycine won't show any optical activity) * 2 - Isoleucine, Threonine (double chiral carbons) |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is A study of patients with postmenopausal uterine bleeding reveals that some of them have malignant neoplasms that arise from prior atypical hyperplastic lesions. The peak incidence is between 55 and 65 years of age in women who have obesity, hypertension, and/or diabetes mellitus. Molecular analysis reveals mutations of the PTEN tumor suppressor gene in most of them. Their malignancies tend to remain localized for years before spreading to local lymphatics. Which of the following neoplasms is most likely to have these characteristics? and explain in detail? | Most endometrial cancers have the endometrioid pattern and are classified as type I endometrial carcinomas. They arise in the setting of unopposed estrogen stimulation and may also have PTEN mutations as well as microsatellite instability. In contrast, type II endometrial carcinomas occur at an older age in the background of atrophic endometrium; they usually have a serous carcinoma pattern, but may also exhibit clear cell and mullerian mixed patterns, and TP53 mutations are common. Leiomyosarcomas and stromal sarcomas are far less common than endometrial carcinomas, and they have no known risk factors. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is The parotid duct opens in the oral cavity opposite to the level of: and explain in detail? | Ans. C. Crown of upper second molar tooth. (Ref. BD Chaurasia, Anatomy, 3rd/Vol III - 110).Parotid duct opens into the vestibule of mouth opposite the crown of upper Second molar tooth. Submandibular duct opens on the floor of mouth, on summit of sublingual papilla, at the sides of frenulum of tongue. Both these ducts are 5 cm in length. About 15 ducts emerge from sublingual gland; most of them open directly into the floor of mouth on the summit of sublingual fold and a few join submandibular ducts.Q.Ans.1 The parotid (Stensen's) duct opens intraorally?Opposite the second upper molar.2 The parotid acinar cells are?Serous cells3 The sublingual acinar cells are?Mucous cells.4 The submandibular acinar cells are?Both serous and mucous types.5 The submandibular gland (Wharton) duct opens?Intra-orally lateral to the lingual frenulum on the floor of the mouth.6 The sublingual gland has approximately 10 small ducts that exit through the superior aspect of the gland to open?Intraorally along the sublingual fold.7 Saliva is formed by the salivary gland acinar cells and modified by the ductal cells into:Hypotonic fluid. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is What is this teeth abnormality seen in congenital syphilis known as? and explain in detail? | b. Hutchinson's teethSmaller & more widely spaced teeth with notches on their biting surfaces are 'Hutchinson's teeth' seen in Congenital Syphilis |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is False statement regarding phenytoin is: March 2007 and explain in detail? | Ans. D: Follows zero order kinetics at lower doses Phenytoin acts to dampen the unwanted, runaway brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage gated sodium channels. Absorption of phenytoin by oral route is slowit is widely distributed in the body and 80-90% bound to plasma proteins. Phenytoin is metabolized in liver by hydroxylation and glucuronide conjugation. The kinetics of metabolism is capacity limited; changes from first order to zero order over the therapeutic range-small increments in dose produce dispropoionately high plasma concentrations. The plasma half life (12-24 hours) progressively increases (upto 60 hours) when plasma concentration rises above 10 microgram/ ml as metabolizing enzyme gets saturated. Aside from seizures, it is an option in the treatment of trigeminal neuralgia as well as ceain cardiac arrhythmias. At therapeutic doses, phenytoin produces horizontal gaze nystagmus At toxic doses, patients experience sedation, cerebellar ataxia, and ophthalmoparesis, as well as paradoxical seizures. Idiosyncratic side effects of phenytoin, as with other anticonvulsants, include rash and severe allergic reactions. Phenytoin causes a reduction in folic acid levels, predisposing patients to megaloblastic anemia. Folic acid is presented as polyglutamate in foods, it is then conveed into monoglutamates by intestinal conjugase. Phenytoin acts by inhibiting this enzyme therefore causing folate deficiency. Phenytoin is a known teratogen. The syndrome consists of craniofacial anomalies (broad nasal bridge, cleft lip and palate, microcephaly) and a mild form of mental retardation (average IQ=71).This syndrome resembles the well-described Fetal Alcohol Syndrome and has also been called the "fetal hydantoin syndrome." Phenytoin may accumulate in the cerebral coex over long periods of time, as well as causing atrophy of the cerebellum when administered at chronically high levels. Despite this, the drug has a long history of safe use and it is a common "first line of defense" in seizure cases. Phenytoin has been known to cause Drug-induced Lupus. Phenytoin has been associated with drug induced gingival enlargement (hyperplasia) in the oral cavity probably due to folate defiency. Patients whose epilepsy is treated with drugs face about twice the risk of suicidal thoughts compared to placebo-takers Phenobarbitone competitively inhibits phenytoin metabolism, while by enzyme induction both enhance each other's degradation. Phenytoin induces microsomal enzymes and increases degradation of steroids (failure of oral contraceptives), digitoxin, doxycycline, theophylline. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Chlamydia escape killing by: and explain in detail? | Molecular mimickry |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is HIV binds to macrophages having and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is All of the following are true about mammography except - and explain in detail? | Answer- D. It has a significant radiation riskMammographyIs X-ray imaging of breasts to detect tumors or other abnormalities.Mammography is the screening modality of choice for breast cancer as it can detect microcalcifications which is often the bonly early manifestation of ductal ca in situ.It is of two types -Screening mammography is used to detect breast changes in women who have no signs or symptoms of any breastabnormality. This usually requires at least 2 mammograms from different angles of each breast - a) the cranio-caudal (cc) view and b) the mediolateral-oblique (MLO) view.Diagnostic mammography- used to evaluate abnormal findings on a screening mammogram. Radiation risk (Risk of carcinoma)- No doubt that ionizing radiation (X rays) can itself cause breast cancer. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Depressor reflex, Bezold-Jarisch reflex, produced by the following stimulus: and explain in detail? | Ventricular distension can produce a powerful depressor reflex called the Bezold-Jarisch reflex; vagal afferents of this cardiopulmonary reflex are also activated by chemical stimulation (eg, prostanoids, cytokines, serotonin, and classically, Veratrum alkaloids). The central connections for this reflex are in the nucleus tractus solitarii, which has both sympathetic and parasympathetic synapses. Ref: Hoit B.D., Walsh R.A. (2011). Chapter 5. Normal Physiology of the Cardiovascular System. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is QT interval is shortened in - and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is All are characteristics of Rett syndrome Except and explain in detail? | The genetics of Rett syndrome has not yet been determined. Although it is thought to be a genetic syndrome, no inheritance pattern and no enzymatic deficiency or other metabolic explanation has been established for Rett syndrome. The other characteristics (autistic behavior, microcephaly, the peculiar wringing motion of the hand, dementia) are common in patients with this disorder |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Normal serum calcium level is: and explain in detail? | Normal Blood Calcium level-9 : 11 mg/dl
Total Calcium level in the body is 1.5 kg. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Which of the following has maximum density - and explain in detail? | Ans. is 'c- i.e., HDL ChylomicronVLDLLDLHDL1. Particle mass (kD)400,00010000-80,0002300175-3602. Density (g/.cm1)<0.950.95-1.0061.018-1.0631.063-1.213. Diameter (A)1000-10,000300-700150-25075-1004. ApolipoproteinsA, B, C, EB.C.EBA, C, D.E5. Components (% dry weight)ApolipoproteinsTriacylglvcerolsCholesterolPhospholipids1.5-234-87-95-10 50-6515-2315-2020-257-1040-5015-2040-553-515-1820-35 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is The renal biopsy of a 6 years old boy with recurrent gross hematuria shows IgA nephropathy. The urinary protein excretion is 130 mg/day. Which of the following is the most appropriate next step in the management: and explain in detail? | a. Administer corticosteroids(Ref: Nelson's 20/e p 2497, Ghai 8/e p 476)Treatment of IgA nephropathy: The primary t/t is proper BP control; Other drugs found useful are:Fish oil (omega-3 fatty acids): An anti-inflammatory agent and it prevents the rate of renal progressionImmunosuppressive therapy: Done with corticosteroids with or without cytotoxic therapyACE inhibitors and Angiotensin II receptor antagonists: role in reducing proteinuriaProphylactic antibiotics and tonsillectomy: may reduce frequency of gross hematuria but no effect on progression of renal ds. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Oral vancomycin is indicated in the following condition and explain in detail? | GLYCOPEPTIDE ANTIBIOTICS Vancomycin Mech of action:- Vancomycin acts by inhibiting bacterial cell wall synthesis. It binds to the terminal dipeptide 'D-ala-D-ala' sequence of peptidoglycan units-- prevents its release from the bactoprenol lipid carrier so that assembly of the units at the cell membrane and their cross linking to form the cell wall cannot take place. pharmacokinetics:- Vancomycin is not absorbed orally. After i.v. administration, it is widely distributed, penetrates serous cavities, inflamed meninges and is excreted mainly unchanged by glomerular filtration with a t 1/2 of 6 hours. Dose reduction is needed in renal insufficiency. Toxicity:- Systemic toxicity of vancomycin is high. It can cause plasma concentration dependent nerve deafness which may be permanent. Kidney damage is also dose-related. Other oto- and nephrotoxic drugs like aminoglycosides must be very carefully administered when vancomycin is being used. Skin allergy and fall in BP during i.v. injection can occur. Vancomycin has the potential to release histamine by direct action on mast cells. Rapid i.v. injection has caused chills, fever, uicaria and intense flushing-- called 'Red man syndrome'. Uses:- Given orally (125-500 mg 6 hourly), it is the second choice drug to metronidazole for antibiotic associated pseudomembranous enterocolitis caused by C. difficile. Staphylococcal enterocolitis is another indication of oral vancomycin. Ref:- kd tripathi; pg num:-757 |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Toxic megacolon is seen in – and explain in detail? | Features of UC
Ulcerative colitis involves the rectum and extends proximally.
In severe cases, entire colon may be involved Pancolitis.
It is a disease of continuity, and skip lesions are not found.
In some patients, distal ileum may also develop mucosal inflammation → backwash ileitis.
Only mucosa and submucosal layers of the colon are involvement, deep layer are not involved usually.
Isolated islands of regenerating mucosa bulge upward to create pseudopolyp.
There are a superficial mucosal ulcer but they are not serpentine as seen in CD.
Neutrophilic infiltration into crypts leads to the formation of crypt abscess.
In sever cases of UC, toxic damage to the muscular propria and neural plexus lead to complete shutdown of neuromuscular function → colon progressively swells to create toxic megacolon.
There may be epithelial dysplasia with progression to frank carcinoma. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is A Pap smear of a 23-year-old woman demonstrates squamous cells with enlarged, hyperchromatic nuclei and prominent perinuclear halos. The Pap smear is graded as cervical intraepithelial neoplasia, grade II (CIN II). Which of the following viruses is most likely to be etiologically related to this neoplastic growth? and explain in detail? | CIN II corresponds to moderate dysplasia of the cervix. The CIN lesions of all grades (including condyloma) and the cervical cancers that can arise from them appear to be associated with infection with ceain subtypes of human papillomavirus (HPV). Koilocytotic atypia (enlarged, hyperchromatic nuclei and prominent perinuclear halos) is commonly observed with HPV infection. HPV is usually spread through sexual contact and also causes penile and anal condyloma and carcinomas. EBV is associated with nasopharyngeal carcinoma and Burkitt's lymphoma. HBV is associated with hepatocellular carcinoma. HHV 8 is associated with Kaposi's sarcoma. Ref: Ray C.G., Ryan K.J. (2010). Chapter 19. Papilloma and Polyoma Viruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is A 48-year-old male patient complains of diplopia (double vision). On neurologic examination he is unable to adduct his left eye and lacks a corneal reflex on the left side. Where is the most likely location of the lesion resulting in the symptoms? and explain in detail? | The superior orbital fissure is the opening that allows the passage of the oculomotor nerve and the trochlear nerve; the lacrimal, frontal, and nasociliary branches of ophthalmic division of the trigeminal nerve; the abducens nerve; the superior and inferior divisions of the ophthalmic vein; and the sympathetic fibers from the cavernous plexus. The sensory and motor components of the corneal reflex are the ophthalmic division of the trigeminal nerve and the oculomotor nerve, whereas the eye impairment is due to a lesion to the oculomotor nerve, all of which are transmitted through the superior orbital fissure. The inferior orbital fissure contains the maxillary nerve, infraorbital vessels, and branches of the sphenopalatine (pterygopalatine) ganglion. The optic canal contains the ophthalmic artery and optic nerve, in addition to sympathetic fibers. The foramen rotundum contains the maxillary nerve. The foramen ovale contains the lesser petrosal nerve, the mandibular division of the trigeminal nerve, the accessory middle meningeal artery, and the emissary veins. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is True about ranula is: and explain in detail? | A mucocele in the floor of the mouth due to trauma of the submandibular or sublingual gland duct is called as Ranula. These are painless slow-growing lesions and move along with the movement of the tongue. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Following are the clinical tests used in diagnosis ofCDH - and explain in detail? | Ans. is "c' i.e., Both of the above Clinical tests for CDH/DDHo In infancy two tests are used.Barlow's testo This test is done within 2-3 days of birth.o The test has two partsPart 1 Infant is in supine position with hip and knee in 90deg of flexion. The hip is slowly adducted & pushed to dislocate the hip and one can hear a clunck of exit of femoral head out of the acetabulum.Part 2 Now the hip is gentely abducted and pulled to reduce the hip. This will cause 'clunk' indicating reduction of hip.o It is quite obvious that part 1 can be done only dislocatable hip; but not in already dislocated hip as the head is already out of the acetabulum.Ortolanfs testo This test is similar to 2nd - part of Barlow's test, i.e. slow abduction of hip in flexed position of hip & knee to reduce the hip. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Cabotegravir and explain in detail? | Cabotegravir, sold under the brand name Vocabria among others, is a antiretroviral medication used for the treatment of HIV/AIDS. It is available in the form of tablets and as an intramuscular injection, as well as in an injectable combination with rilpivirine under the brand name Cabenuva.It is an integrase inhibitor with a carbamoyl pyridone structure similar to that of dolutegravir.In December 2021, the U.S. Food and Drug Administration approved cabotegravir for pre-exposure prophylaxis (PrEP) in at-risk people under the brand name Apretude.
Medical uses
Cabotegravir in combination with rilpivirine is indicated for the treatment of human immunodeficiency virus type-1 (HIV-1) in adults. The combination injection is intended for maintenance treatment of adults who have undetectable HIV levels in the blood (viral load less than 50 copies/mL) with their current antiretroviral treatment, and when the virus has not developed resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and integrase strand transfer inhibitors. The tablets are used to check whether a person tolerates the treatment before the injection therapy is started.The two medicines are the first antiretroviral drugs that come in a long-acting injectable formulation.Cabotegravir (Apretude) is indicated for use in at-risk people weighing at least 35 kilograms (77 lb) for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV.
Contraindications and interactions
Cabotegravir must not be combined with the drugs rifampicin, rifapentine, carbamazepine, oxcarbazepine, phenytoin or phenobarbital, which induce the enzyme UGT1A1. These drugs significantly decrease cabotegravir concentrations in the body and thus may reduce its effectiveness. Additionally, they induce the enzyme CYP3A4, which leads to reduced rilpivirine concentrations in the body. Additionally, patients who are breastfeeding or plan to breastfeed should not take Cabotegravir because it is not known if it will pass within the breast milk.
Adverse effects
The most common side effects of the injectable combination therapy with rilpivirine are reactions at the injection site (in up to 84% of patients) such as pain and swelling, as well as headache (up to 12%) and fever or feeling hot (in 10%). For the tablets, headache and a hot feeling were slightly less frequent. Less common side effects (under 10%) for both formulations are depressive disorders, insomnia, and rashes.
Pharmacology
Mechanism of action
Cabotegravir is an integrase strand transfer inhibitor. This means it blocks the HIVs enzyme integrase, thereby preventing its genome from being integrated into the human cells DNA. As this is a necessary step for the virus to replicate, its further spread is hampered.
Pharmacokinetics
When taken by mouth, cabotegravir reaches highest blood plasma levels after three hours. Taking the drug together with food slightly increases its concentrations in the blood, but this is not clinically relevant. After injection into the muscle, cabotegravir is slowly absorbed into the bloodstream, reaching its highest blood plasma levels after about seven days.Over 99% of the substance are bound to plasma proteins. The drug is inactivated in the body by glucuronidation, mainly by the enzyme UGT1A1, and to a much lesser extent by UGT1A9. More than 90% of the circulating substance are the unchanged cabotegravir, however. The biological half-life is 41 hours for the tablets and 5.6 to 11.5 weeks for the injection.Elimination has only been studied for oral administration: Most of the drug is eliminated via the faeces in unchanged form (47%). It is not known how much of this amount comes from the bile, and how much was not absorbed in the first place. (The bile actually contains the glucuronide, but this could be broken up again in the gut lumen to give the parent substance that is observed in the faeces.) To a lesser extent it is excreted via the urine (27%), almost exclusively as the glucuronide.
Pharmacogenomics
UGT1A1 poor metabolizers have 1.3- to 1.5-fold increased cabotegravir concentrations in the body. This is not considered clinically significant.
Chemistry
Cabotegravir is a white to off-white, crystalline powder that is practically insoluble in aqueous solutions under pH 9, and slightly soluble above pH 10. It is slightly acidic with a pKa of 7.7 for the enolic acid and 1.1 (calculated) for the carboxamide. The molecule has two asymmetric carbon atoms; only one of the four possible configurations is present in the medication.
Formulation
In studies, the agent was packaged into nanoparticles (GSK744LAP) conferring a biological half-life of 21 to 50 days following a single dose. The marketed injection achieves its long half-life not via nanoparticles but with a suspension of the free cabotegravir acid. The tablets contain cabotegravir sodium salt.
History
Cabotegravir was examined in the clinical trials HPTN 083 and HPTN 084. In 2020, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Vocabria intended for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in combination with rilpivirine injection. The EMA also recommended marketing authorization be given for rilpivirine and cabotegravir injections to be used together for the treatment of people with HIV-1 infection. Cabotegravir was approved for medical use in the European Union in December 2020.
Society and culture
Names
Cabotegravir is the United States Adopted Name (USAN) and the international nonproprietary name (INN).
Research
Pre-exposure prophylaxis
In 2020, results for some studies were released showing success in using injectable cabotegravir for long-acting pre-exposure prophylaxis (PrEP) with greater efficacy than the emtricitabine/tenofovir combination being widely used for PrEP at the time.The safety and efficacy of cabotegravir to reduce the risk of acquiring HIV were evaluated in two randomized, double-blind trials that compared cabotegravir to emtricitabine/tenofovir, a once daily oral medication for HIV PrEP. Trial 1 included HIV-uninfected men and transgender women who have sex with men and have high-risk behavior for HIV infection |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is The hea assumes its normal four chambered shape by the end of:- and explain in detail? | - The hea assumes its normal four chambered shape by the end of 6 weeks of intrauterine life. - From then, only minor changes occur & consist mainly on growth of the hea as a whole with increasing age of fetus. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is Earliest ocular finding in acoustic neuroma: and explain in detail? | Earliest nerve involved by acoustic neuroma - Vth nerve / trigeminal nerve. Earliest manifestation of Vth nerve involvement is decreased corneal sensitivity leading to loss of corneal reflex. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is A patient complained to his dentist about a draining lesion in his mouth. A Gram's stain of the pus showed a few Gram-positive cocci, leukocytes, and many branched Gram-positive rods. The most likely cause of the disease is and explain in detail? | The patient presented with typical symptoms of actinomycosis. Actinomyces israelii is normal flora in the mouth. However, it causes a chronic draining infection, often around the maxilla or the mandible, with osteomyelitic changes. Treatment is high-dose penicillin for 4 to 6 weeks. The diagnosis of actinomycosis is often complicated by the failure of A. israelii to grow from the clinical specimen. It is an obligate anaerobe. Fluorescent antibody (FA) reagents are available for direct staining of A. israelii. A rapid diagnosis can be made from the pus. FA conjugates are also available for A. viscosus and A. odontolyticus, anaerobic actinomycetes that are rarely involved in actinomycotic abscesses. |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is For long span distal extension bases where rigidity is critical the major connector of choice is: and explain in detail? | None |
You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. | What is A 50–year old man has a history of frequent episodes of renal colic with high calcium renal stones. The most useful diuretic in the treatment of recurrent calcium stones is : and explain in detail? | Thiazides cause hypercalcemia by decreasing the renal excretion of Ca2+. These are useful in a patient having hypercalciuria.
In such a patient, thiazides decrease the excretion of Ca2+ in the kidney and thus reduces the chances of stone formation. |