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Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wreden's test is to demonstrate: MP 09; NEET 15, with the following options: A: Live bih, B: Insanity, C: Putrefaction, D: Assault ### Response:

Ans. Live bih

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wreden's test is to demonstrate: MP 09; NEET 15, with the following options: A: Live bih, B: Insanity, C: Putrefaction, D: Assault ### Response: Ans. Live bih ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A pateint with cervix cancer is mised by a screeing test and later diagnosed with advanced disease. This time interval is called, with the following options: A: Lead time, B: Screening time, C: Serial interval, D: Generation time ### Response:

.lead time is actually the advantage gained by screening.the priod between the diagnosis by early detection and diagnosis by other means.detection programmes should therfore concentrate on those conditions where the time lag between the disease&;s onset and its final critical point is sufficiently long to be suitable for population screening. ref:park&;s textbook,ed 22,pg no 128

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A pateint with cervix cancer is mised by a screeing test and later diagnosed with advanced disease. This time interval is called, with the following options: A: Lead time, B: Screening time, C: Serial interval, D: Generation time ### Response: .lead time is actually the advantage gained by screening.the priod between the diagnosis by early detection and diagnosis by other means.detection programmes should therfore concentrate on those conditions where the time lag between the disease&;s onset and its final critical point is sufficiently long to be suitable for population screening. ref:park&;s textbook,ed 22,pg no 128 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Serotonin, a mediator of inflammation in our body, is secreted /released by:, with the following options: A: Leukocytes, B: Endothelial cell, C: Mast cell, D: Platelet ### Response:

Answer- D. PlateletSerotonin :It is found in the intestinal mucosa, brain tissue & platelets.Release of serotonin (and histamine) from platelets is stimulated when platelets aggregate after contact with collagen, thrombin, adenosine diphosphate (ADP), and antigen-antibody complexes.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Serotonin, a mediator of inflammation in our body, is secreted /released by:, with the following options: A: Leukocytes, B: Endothelial cell, C: Mast cell, D: Platelet ### Response: Answer- D. PlateletSerotonin :It is found in the intestinal mucosa, brain tissue & platelets.Release of serotonin (and histamine) from platelets is stimulated when platelets aggregate after contact with collagen, thrombin, adenosine diphosphate (ADP), and antigen-antibody complexes. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A child presents with abdominal mass. Biopsy showed a triphasic tumour with areas of small blue cells. Which of the following is a feature of this tumour?, with the following options: A: MYCN amplification, B: C-MYC overexpression, C: WT1 mutation, D: RB deletion ### Response:

Small blue round tumour cells seen in- retinoblastoma, medulloblastoma, Ewing sarcoma, neuroblastoma, Wilms tumor, ALL Microscopically, Wilms tumors are characterized by recognizable attempts to recapitulate different stages of nephrogenesis. The classic triphasic combination of blastemal, stromal, and epithelial cell types is observed in the majority of Wilms tumours. Sheets of small blue cells with few distinctive features characterize the blastemal component. Epithelial differentiation is usually in the form of aboive tubules or glomeruli. Stromal cells are usually fibroblastic or myxoid in nature. Nephrogenic rests are putative precursor lesions of Wilms tumors and are seen in the renal parenchyma adjacent. WT1 protein is critical for normal renal and gonadal development. Wilms tumors demonstrate WT1 mutations. MYCN amplification - neuroblastoma C-MYC overexpression - Burkitt lymphoma RB deletion - retinoblastoma

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A child presents with abdominal mass. Biopsy showed a triphasic tumour with areas of small blue cells. Which of the following is a feature of this tumour?, with the following options: A: MYCN amplification, B: C-MYC overexpression, C: WT1 mutation, D: RB deletion ### Response: Small blue round tumour cells seen in- retinoblastoma, medulloblastoma, Ewing sarcoma, neuroblastoma, Wilms tumor, ALL Microscopically, Wilms tumors are characterized by recognizable attempts to recapitulate different stages of nephrogenesis. The classic triphasic combination of blastemal, stromal, and epithelial cell types is observed in the majority of Wilms tumours. Sheets of small blue cells with few distinctive features characterize the blastemal component. Epithelial differentiation is usually in the form of aboive tubules or glomeruli. Stromal cells are usually fibroblastic or myxoid in nature. Nephrogenic rests are putative precursor lesions of Wilms tumors and are seen in the renal parenchyma adjacent. WT1 protein is critical for normal renal and gonadal development. Wilms tumors demonstrate WT1 mutations. MYCN amplification - neuroblastoma C-MYC overexpression - Burkitt lymphoma RB deletion - retinoblastoma ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not seen in iron deficiency anemia?, with the following options: A: Hyper-segmented neutrophils, B: Microcytosis and hypochromia in red cells, C: Low serum ferritin, D: Commonest cause of anemia in India ### Response:

- Hypersegmented neutrophils - is a feature of megaloblastic anemia - caused d/t Vit B12 / folic acid deficiency. - Remaining all features given in options are characteristic to Iron deficiency anemia

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not seen in iron deficiency anemia?, with the following options: A: Hyper-segmented neutrophils, B: Microcytosis and hypochromia in red cells, C: Low serum ferritin, D: Commonest cause of anemia in India ### Response: - Hypersegmented neutrophils - is a feature of megaloblastic anemia - caused d/t Vit B12 / folic acid deficiency. - Remaining all features given in options are characteristic to Iron deficiency anemia ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: MC type of ca vulva is:, with the following options: A: Squamous cell carcinoma, B: Melanoma, C: Adenocarcinoma, D: Adenosquamous carcinoma ### Response:

Ans. is 'a' i.e., Squamous cell carcinoma * MC variety of vulvar cancer= Squamous cell carcinoma.* MC site= labia (majora and minora) followed by clitoris.* Risk factors for Ca vulva=HPV infection, cigarette smoking, lichen sclerosis, squamous hyperplasia, VIN.* Most patients are asymptomatic at the time of diagnosis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: MC type of ca vulva is:, with the following options: A: Squamous cell carcinoma, B: Melanoma, C: Adenocarcinoma, D: Adenosquamous carcinoma ### Response: Ans. is 'a' i.e., Squamous cell carcinoma * MC variety of vulvar cancer= Squamous cell carcinoma.* MC site= labia (majora and minora) followed by clitoris.* Risk factors for Ca vulva=HPV infection, cigarette smoking, lichen sclerosis, squamous hyperplasia, VIN.* Most patients are asymptomatic at the time of diagnosis. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not a component of APACHE score ?, with the following options: A: Serum Potassium, B: Serum Sodium, C: Serum Calcium, D: Creatinine ### Response:

.APACHE II (Acute Physiology and Chronic Health Evaluation II) point score is calculated from a patient&;s age and 12 routine physiological measurements: PaO2 Temperature Mean aerial pressure pH aerial Hea rate Respiratory rate Serum Sodium Serum Potassium Creatinine Hematocrit White blood cell count Glasgow Coma Scale S.Ca is pa of Ransons criteria

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not a component of APACHE score ?, with the following options: A: Serum Potassium, B: Serum Sodium, C: Serum Calcium, D: Creatinine ### Response: .APACHE II (Acute Physiology and Chronic Health Evaluation II) point score is calculated from a patient&;s age and 12 routine physiological measurements: PaO2 Temperature Mean aerial pressure pH aerial Hea rate Respiratory rate Serum Sodium Serum Potassium Creatinine Hematocrit White blood cell count Glasgow Coma Scale S.Ca is pa of Ransons criteria ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Norplant contains how many capsules of levonorgestrel:, with the following options: A: 4, B: 6, C: 8, D: 10 ### Response:

Norplant contains a set of 6 capsules each containing 36mg levonorgestrel for subcutaneous implantation-placed subcutaneously in the medial aspect of upper arm (Ref.Essentials of medical pharmacology TD Tripathi 6th edition page no.323)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Norplant contains how many capsules of levonorgestrel:, with the following options: A: 4, B: 6, C: 8, D: 10 ### Response: Norplant contains a set of 6 capsules each containing 36mg levonorgestrel for subcutaneous implantation-placed subcutaneously in the medial aspect of upper arm (Ref.Essentials of medical pharmacology TD Tripathi 6th edition page no.323) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Congenital adrenal hyperplasia is associated with -, with the following options: A: Hypoglycemia, B: Hyponatremia, C: Hypokalemia, D: All ### Response:

Ans. is 'a' i.e., Hypoglycemia, 'b' i.e., Hyponatremia, 'c' i.e., Hypokalamia o Also see previous explanations : ? o Depending into type of deficiency, congenital adrenal hyperplasia (CAH) may be divided into : ? 1. Salt retaining (17-a hydroxylase or 11-13 hydroxylase deficiency) Due to excessive mineralocoicoids there is --> i) Hypernatremia iii) Increased chloride ii) Hypokalemia iv) Hypeension 2. Salt losing (21 hydroxylase or 3-13 HSD) deficiency Due to mineralocoicoid deficiency threre is i) Hyponatremia iii) Hyperkalemia ii) Low chloride iv) Low BP dehydration o In all types of CAH, there is deficiency of glucocoicoid that results in hypoglycemia.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Congenital adrenal hyperplasia is associated with -, with the following options: A: Hypoglycemia, B: Hyponatremia, C: Hypokalemia, D: All ### Response: Ans. is 'a' i.e., Hypoglycemia, 'b' i.e., Hyponatremia, 'c' i.e., Hypokalamia o Also see previous explanations : ? o Depending into type of deficiency, congenital adrenal hyperplasia (CAH) may be divided into : ? 1. Salt retaining (17-a hydroxylase or 11-13 hydroxylase deficiency) Due to excessive mineralocoicoids there is --> i) Hypernatremia iii) Increased chloride ii) Hypokalemia iv) Hypeension 2. Salt losing (21 hydroxylase or 3-13 HSD) deficiency Due to mineralocoicoid deficiency threre is i) Hyponatremia iii) Hyperkalemia ii) Low chloride iv) Low BP dehydration o In all types of CAH, there is deficiency of glucocoicoid that results in hypoglycemia. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Positive hepatojugular reflux is found in all of the following conditions except aEUR', with the following options: A: Tricuspid regurgitation, B: Right hea failure, C: Decreased after load, D: Increased capillary bed pressure ### Response:

Associated with decreased afterload Hepatojugular reflux This is done by applying firm pressure with the palm of the hand to the right upper quadrant of the abdomen for 1030 seconds with the patients breathing quietly while the jugular vein is observed. In normal subjects (Negative hepatojugular reflux) - Jugular venous pressure rises only transiently with rapid return to the baseline. Positive hepatojugular reflux (Left ventricular,failureQ) - A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds. Explanation Pushing on the liver (or even midabdomen) for about 15 seconds increases the amount of blood returned to the right atrium and right ventricle (increased preload). Concurrently, there is increase in right ventricle afterload, owing to upward movement of the diaphragm which reduces intrathoracic volumes. (Pulmonary aery pressure is increased due to reduced intrathoracic volumes).(Leading to increased right ventricle afterload) In a normal person the jugular venous pressure would rise temporarily and then normalize quickly as the healthy right ventricle pumps out the additional blood i.e. it handles the increase in preload and afterload quite well. A dysfunctioning right ventricle however fails to accept this increase in preload and afterload and therefore there is persistent elevation of systemic venous pressure. The abdominojugular reflux is not specific to any disorder but rather is a reflection of the inability of the right ventricle to accept or reject the transiently increased venous return. "Positive abdominojugular reflux is most commonly associated with left ventricular failure". In the absence of left hea failure a positive abdominal jugular reflex sign should prompt consideration of :- Impaired right ventricular proload - A Decrease in right ventricular compliance. - A decrease in right ventricular systolic function or - An elevation in right ventricular afterload. Conditions associated with abdominojugular reflux ? Left ventricularfailtereo (MC) Right hea .failureQ Constrictive pericarditis() Right ventricular infarction() Restrictive cardiomyopathyg Note - Both pulmonary stenosis and tricuspid regurgitation cause right hea failure.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Positive hepatojugular reflux is found in all of the following conditions except aEUR', with the following options: A: Tricuspid regurgitation, B: Right hea failure, C: Decreased after load, D: Increased capillary bed pressure ### Response: Associated with decreased afterload Hepatojugular reflux This is done by applying firm pressure with the palm of the hand to the right upper quadrant of the abdomen for 1030 seconds with the patients breathing quietly while the jugular vein is observed. In normal subjects (Negative hepatojugular reflux) - Jugular venous pressure rises only transiently with rapid return to the baseline. Positive hepatojugular reflux (Left ventricular,failureQ) - A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds. Explanation Pushing on the liver (or even midabdomen) for about 15 seconds increases the amount of blood returned to the right atrium and right ventricle (increased preload). Concurrently, there is increase in right ventricle afterload, owing to upward movement of the diaphragm which reduces intrathoracic volumes. (Pulmonary aery pressure is increased due to reduced intrathoracic volumes).(Leading to increased right ventricle afterload) In a normal person the jugular venous pressure would rise temporarily and then normalize quickly as the healthy right ventricle pumps out the additional blood i.e. it handles the increase in preload and afterload quite well. A dysfunctioning right ventricle however fails to accept this increase in preload and afterload and therefore there is persistent elevation of systemic venous pressure. The abdominojugular reflux is not specific to any disorder but rather is a reflection of the inability of the right ventricle to accept or reject the transiently increased venous return. "Positive abdominojugular reflux is most commonly associated with left ventricular failure". In the absence of left hea failure a positive abdominal jugular reflex sign should prompt consideration of :- Impaired right ventricular proload - A Decrease in right ventricular compliance. - A decrease in right ventricular systolic function or - An elevation in right ventricular afterload. Conditions associated with abdominojugular reflux ? Left ventricularfailtereo (MC) Right hea .failureQ Constrictive pericarditis() Right ventricular infarction() Restrictive cardiomyopathyg Note - Both pulmonary stenosis and tricuspid regurgitation cause right hea failure. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In AIDs control programme. For treatment of STDs, blue colored pack is used for treatment of-, with the following options: A: Urethral discharge, B: Scrotal swelling, C: Genital ulcers, D: Ano-rectal discharge ### Response:

Am. is 'c' i.e., Genital ulcersNACO centers providing ART (as of sept 2006)o The National AIDS control organization (NACO) has increased the numbers of centres providing ART from 54 to 91 centres with another 9 more centres also getting operational soon,o All the 91centres have specially appointed and trained doctors, counsellors and laboratory technicians to help initiate patients on ART and follow them regularly,o At these 91 centres medicines for treating 85000 patients have been made available.o The ART is a combination of three potent drugs, which is being given to the persons with advanced stage of AIDS.o Apart from providing free treatment, all the ART centres are providing counselling to the infected persons so that they maintain regularly of their medication.o NACO has branded the STI/RTI sendees as "Suraksha clinic" and has developed a communication strategy for generating demand for these services.o Pre-packed colour coded STI/RTI kits have been provided for free supply to all designated STI/RTI clinics.Kit 1 - Grey, for urethral discharge, ano-rectal discharge, cervicitis.Kit 2 - Green, for vaginitisKit 3 - White, for genital ulcersKit 4 - Blue, for genital ulcersKit 5 - Red, for genital ulcersKit 6 - Yellow, for lower abdominal painKit 7 - Black, for scortal swelling.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In AIDs control programme. For treatment of STDs, blue colored pack is used for treatment of-, with the following options: A: Urethral discharge, B: Scrotal swelling, C: Genital ulcers, D: Ano-rectal discharge ### Response: Am. is 'c' i.e., Genital ulcersNACO centers providing ART (as of sept 2006)o The National AIDS control organization (NACO) has increased the numbers of centres providing ART from 54 to 91 centres with another 9 more centres also getting operational soon,o All the 91centres have specially appointed and trained doctors, counsellors and laboratory technicians to help initiate patients on ART and follow them regularly,o At these 91 centres medicines for treating 85000 patients have been made available.o The ART is a combination of three potent drugs, which is being given to the persons with advanced stage of AIDS.o Apart from providing free treatment, all the ART centres are providing counselling to the infected persons so that they maintain regularly of their medication.o NACO has branded the STI/RTI sendees as "Suraksha clinic" and has developed a communication strategy for generating demand for these services.o Pre-packed colour coded STI/RTI kits have been provided for free supply to all designated STI/RTI clinics.Kit 1 - Grey, for urethral discharge, ano-rectal discharge, cervicitis.Kit 2 - Green, for vaginitisKit 3 - White, for genital ulcersKit 4 - Blue, for genital ulcersKit 5 - Red, for genital ulcersKit 6 - Yellow, for lower abdominal painKit 7 - Black, for scortal swelling. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At isoelectric pH protein, with the following options: A: Have Net charge 'O', B: Are positively charged, C: Are negatively charge, D: Don't migrate ### Response:

Proteins are least soluble at their isoelectric pH . Significance of isoelectric proteind : The amonoacid composition will determine the isoelectric pH of protein . The alpha amino acids and carboxyl group are utilized for peptide bond formation, and hence are not ionizable.All other ionizable groups present in the protein will influence pl of the protein. At the isoelectric point,the number of anioins andcations present on the protein molecule will be equal and the net charge is zero. At the pl value,the proteins will not migrate in an electrical field.At the pl, solubility,buffering capacity and viscosity will be minimum; and precipatation will be maximum. On the acidic side of pl, the proteins are cations and on alkaline side, they are anions in nature. REFERENCE : DM VASUDEVAN TEXTBOOK SEVENTH EDITION ; PAGE NO :41

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At isoelectric pH protein, with the following options: A: Have Net charge 'O', B: Are positively charged, C: Are negatively charge, D: Don't migrate ### Response: Proteins are least soluble at their isoelectric pH . Significance of isoelectric proteind : The amonoacid composition will determine the isoelectric pH of protein . The alpha amino acids and carboxyl group are utilized for peptide bond formation, and hence are not ionizable.All other ionizable groups present in the protein will influence pl of the protein. At the isoelectric point,the number of anioins andcations present on the protein molecule will be equal and the net charge is zero. At the pl value,the proteins will not migrate in an electrical field.At the pl, solubility,buffering capacity and viscosity will be minimum; and precipatation will be maximum. On the acidic side of pl, the proteins are cations and on alkaline side, they are anions in nature. REFERENCE : DM VASUDEVAN TEXTBOOK SEVENTH EDITION ; PAGE NO :41 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wiskott Aldrich syndrome is characterized by all Except:, with the following options: A: Thrombocytopenia, B: Autosomal recessive, C: Failure of aggregation of platelets in response to agonists, D: Eczema ### Response:

Answer is B (Autosomal Recessive) Wiskot Aldrich syndrome is an X linked Recessive syndrome and not an autosonzal recessive syndrome. Wiskott Aldrish Syndrome is associated with an impaired platelet aggregation response. `Several platelet abnormalities have been repoed in Wiskott Aldrich syndrome including impaired aggregation responses'

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wiskott Aldrich syndrome is characterized by all Except:, with the following options: A: Thrombocytopenia, B: Autosomal recessive, C: Failure of aggregation of platelets in response to agonists, D: Eczema ### Response: Answer is B (Autosomal Recessive) Wiskot Aldrich syndrome is an X linked Recessive syndrome and not an autosonzal recessive syndrome. Wiskott Aldrish Syndrome is associated with an impaired platelet aggregation response. `Several platelet abnormalities have been repoed in Wiskott Aldrich syndrome including impaired aggregation responses' ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wickmann's straie seen in ?, with the following options: A: Lichen planus, B: Psoriasis, C: Dermatomyositis, D: Was ### Response:

Ans. is 'a' i.e., Lichen planus

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wickmann's straie seen in ?, with the following options: A: Lichen planus, B: Psoriasis, C: Dermatomyositis, D: Was ### Response: Ans. is 'a' i.e., Lichen planus ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Embryonic period is upto -, with the following options: A: 8 week, B: 10 week, C: 12 week, D: 6 week ### Response:

Ans. is 'a' i.e., 8 week o Embryonic period = from fertilization to end of 8 week,o Fetal period = from 9 week on ward,o In prenatal period - following events are seen.Milestones of Prenatal DevelopmentWKDevelopmental events1.Fertilization and implantation: beginning of embryonic period2.Endoderm and ectoderm appear (bilaminar embryo)3.First missed menstrual period; mesoderm appears (trilaminar embryo); somites begin to form4.Neural folds fuse; folding of embryo into human-like shape; arm and leg buds appear; crowm-rump length 4-5 mm5.Lens placodes, primitive mouth, digital rays on hands6.Primitive nose, philtrum, primaty palate; crown-ramp length 21-23 mm7.Eyelids begin8.Ovaries and testes distinguishable9.Fetal period begins; crown-rump length 5 cm; weight 9 g10.External genitals distinguishable20.Usual lower limit of viability; weight 460 g; length 19 cm25Third trimester begins; weight 900 g; length 25 cm28Eyes open; fetus turns head down; weight 1,000 g38.Term

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Embryonic period is upto -, with the following options: A: 8 week, B: 10 week, C: 12 week, D: 6 week ### Response: Ans. is 'a' i.e., 8 week o Embryonic period = from fertilization to end of 8 week,o Fetal period = from 9 week on ward,o In prenatal period - following events are seen.Milestones of Prenatal DevelopmentWKDevelopmental events1.Fertilization and implantation: beginning of embryonic period2.Endoderm and ectoderm appear (bilaminar embryo)3.First missed menstrual period; mesoderm appears (trilaminar embryo); somites begin to form4.Neural folds fuse; folding of embryo into human-like shape; arm and leg buds appear; crowm-rump length 4-5 mm5.Lens placodes, primitive mouth, digital rays on hands6.Primitive nose, philtrum, primaty palate; crown-ramp length 21-23 mm7.Eyelids begin8.Ovaries and testes distinguishable9.Fetal period begins; crown-rump length 5 cm; weight 9 g10.External genitals distinguishable20.Usual lower limit of viability; weight 460 g; length 19 cm25Third trimester begins; weight 900 g; length 25 cm28Eyes open; fetus turns head down; weight 1,000 g38.Term ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: After an accident a male patient had come for his routine evaluation. His RBCs showed Cabot's ring. What is the likely condition responsible?, with the following options: A: Acquired hemolytic anemia, B: Hemochromatosis, C: Thalassemia, D: After splenectomy ### Response:

Cabot'srings are red cell inclusions consist of mitotic spindle remnants appearing as fine, threadlike filaments of bluish purple color in the shape of a single ring or a double ring (figure-eight shape). They stain red or reddish purple with Wright's stain and have no internal structure. These are arginine rich and acidophilic. Cabot's rings are present in anemia (severe, pernicious), lead poisoning, myelofibrosis, and myeloid metaplasia, but are typical of post splenectomy. Ref: Medical Laboratory Technology By Sood, 2005, Page 201 ; Wintrobe's Clinical Hematology, 11th Ed p. 22 Table 1.4 ; Laboratory Medicine Hematology 6th ed. CV Mosby Co., 1982, p. 488

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: After an accident a male patient had come for his routine evaluation. His RBCs showed Cabot's ring. What is the likely condition responsible?, with the following options: A: Acquired hemolytic anemia, B: Hemochromatosis, C: Thalassemia, D: After splenectomy ### Response: Cabot'srings are red cell inclusions consist of mitotic spindle remnants appearing as fine, threadlike filaments of bluish purple color in the shape of a single ring or a double ring (figure-eight shape). They stain red or reddish purple with Wright's stain and have no internal structure. These are arginine rich and acidophilic. Cabot's rings are present in anemia (severe, pernicious), lead poisoning, myelofibrosis, and myeloid metaplasia, but are typical of post splenectomy. Ref: Medical Laboratory Technology By Sood, 2005, Page 201 ; Wintrobe's Clinical Hematology, 11th Ed p. 22 Table 1.4 ; Laboratory Medicine Hematology 6th ed. CV Mosby Co., 1982, p. 488 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Biochemical test in thiamine deficiency is:, with the following options: A: FIGLU test, B: Histidine test, C: Erythrocyte transketolase test, D: Ferric chloride test ### Response:

Ans. C. Erythrocytes transketolase testa. In thiamine deficiency - the most reliable is the measurement of whole blood or Erythrocytes Transketolase activity.b. FIGLU test and Histidine test - Formimino-glutamate (FIGLU), a catabolite of histidine, transfers its formimino group to H4- to form N5 formimino-H4 folate. In folate deficiency FIGLU will accumulate after oral challenges with histidine.c. FeCl3 test: -i. In phenyl ketonuria - gives Emerald green, when tested with fresh urineii. In maple-syrup urine disease - gives navy blue colour when tested with urineiii. Also used to detect aceto-acetic acid in Gerhardt's test

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Biochemical test in thiamine deficiency is:, with the following options: A: FIGLU test, B: Histidine test, C: Erythrocyte transketolase test, D: Ferric chloride test ### Response: Ans. C. Erythrocytes transketolase testa. In thiamine deficiency - the most reliable is the measurement of whole blood or Erythrocytes Transketolase activity.b. FIGLU test and Histidine test - Formimino-glutamate (FIGLU), a catabolite of histidine, transfers its formimino group to H4- to form N5 formimino-H4 folate. In folate deficiency FIGLU will accumulate after oral challenges with histidine.c. FeCl3 test: -i. In phenyl ketonuria - gives Emerald green, when tested with fresh urineii. In maple-syrup urine disease - gives navy blue colour when tested with urineiii. Also used to detect aceto-acetic acid in Gerhardt's test ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At the level of Arch of aoa, the relationship of left vagus nerve and left phrenic nerve?, with the following options: A: Phrenic nerve anterior, vagus nerve posterior, B: Phrenic nerve posterior, vagus nerve anterior, C: Both in same plane anteroposteriorly, D: Variable in relationship ### Response:

Phrenic nerve anterior, vagus nerve posterior

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At the level of Arch of aoa, the relationship of left vagus nerve and left phrenic nerve?, with the following options: A: Phrenic nerve anterior, vagus nerve posterior, B: Phrenic nerve posterior, vagus nerve anterior, C: Both in same plane anteroposteriorly, D: Variable in relationship ### Response: Phrenic nerve anterior, vagus nerve posterior ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Problem of bias is maximum with, with the following options: A: Coho study, B: Case study, C: Case control study, D: Experimental study ### Response:

Bias is any systemic error in the determination of the association between exposure and disease. The relative risk may increase or decrease as a result of the bias it reflects some type of no compatibility between the study and control groups. The possibility of bias must be considered when evaluating a possible cause and effect relationship. (refer pgno 73, park 23rd edition)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Problem of bias is maximum with, with the following options: A: Coho study, B: Case study, C: Case control study, D: Experimental study ### Response: Bias is any systemic error in the determination of the association between exposure and disease. The relative risk may increase or decrease as a result of the bias it reflects some type of no compatibility between the study and control groups. The possibility of bias must be considered when evaluating a possible cause and effect relationship. (refer pgno 73, park 23rd edition) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is a strategy used to increase the yield of protein produced in recombinant protein synthesis?, with the following options: A: Promoter induction, B: Genes for protease inhibitors, C: Translation initiation, D: Translation and transcription termination ### Response:

B i.e. Genes for protease inhibitors Expression vector is a vector which synthesize/produce/express the protein coded by a gene introduced DNA recombination technology. So it is used to produce protein by genetic engineering and detect specific c-DNA molecules in library. Expression vectors are specially constructed so that they contain very active inducible promoters, proper in phase translation initiation codons, both transcription & translation termination signalsQ (to increase transcription & translation) and appropriate protein processing signals, if needed (to produce processed function protein). To enhance the final yield of protein product, some expression vectors even contain genes that code for protease inhibitorsQ.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is a strategy used to increase the yield of protein produced in recombinant protein synthesis?, with the following options: A: Promoter induction, B: Genes for protease inhibitors, C: Translation initiation, D: Translation and transcription termination ### Response: B i.e. Genes for protease inhibitors Expression vector is a vector which synthesize/produce/express the protein coded by a gene introduced DNA recombination technology. So it is used to produce protein by genetic engineering and detect specific c-DNA molecules in library. Expression vectors are specially constructed so that they contain very active inducible promoters, proper in phase translation initiation codons, both transcription & translation termination signalsQ (to increase transcription & translation) and appropriate protein processing signals, if needed (to produce processed function protein). To enhance the final yield of protein product, some expression vectors even contain genes that code for protease inhibitorsQ. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Route of administration of BCG for bladder cancer is:, with the following options: A: Oral, B: Subcutaneous, C: Intravenous, D: None of the above ### Response:

(Ref: Goodman & Gilman 11/e p1422) Intravesical route is used for BCG in the treatment of bladder carcinoma.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Route of administration of BCG for bladder cancer is:, with the following options: A: Oral, B: Subcutaneous, C: Intravenous, D: None of the above ### Response: (Ref: Goodman & Gilman 11/e p1422) Intravesical route is used for BCG in the treatment of bladder carcinoma. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Dicumarol interferes with-, with the following options: A: Vitamin K, B: Antithrombin, C: Platelets, D: Plasminogen ### Response:

Ans. is 'a' i.e., Vitamin K o Dicumarol (an oral anticoagulant) acts by inhibiting Vitamin K dependent clotting factors.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Dicumarol interferes with-, with the following options: A: Vitamin K, B: Antithrombin, C: Platelets, D: Plasminogen ### Response: Ans. is 'a' i.e., Vitamin K o Dicumarol (an oral anticoagulant) acts by inhibiting Vitamin K dependent clotting factors. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Pulmonary lymph flow rate is, with the following options: A: 20 ml/hour, B: 40 ml/hour, C: 50 ml/hour, D: 60 ml/hour ### Response:

Pulmonary lymph flow rate is 20 ml per hour Ref: guyton and hall textbook of medical physiology 12 edition

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Pulmonary lymph flow rate is, with the following options: A: 20 ml/hour, B: 40 ml/hour, C: 50 ml/hour, D: 60 ml/hour ### Response: Pulmonary lymph flow rate is 20 ml per hour Ref: guyton and hall textbook of medical physiology 12 edition ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Warthin Finkeldey giant cells are seen in?, with the following options: A: Tuberculosis, B: Sarcoidosis, C: Herpes, D: Measles ### Response:

Ans. is 'd' i.e., Measles o Warthin-Finkeldey cell is a type of giant multinucleate cell found in hyperplastic lymph nodes early in the course of measles.Also found ino HIV-infectiono Kimura disease,o lymphoma and non-neoplastic lymph node disorders.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Warthin Finkeldey giant cells are seen in?, with the following options: A: Tuberculosis, B: Sarcoidosis, C: Herpes, D: Measles ### Response: Ans. is 'd' i.e., Measles o Warthin-Finkeldey cell is a type of giant multinucleate cell found in hyperplastic lymph nodes early in the course of measles.Also found ino HIV-infectiono Kimura disease,o lymphoma and non-neoplastic lymph node disorders. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: _______________ of Fluid is required to produce costophrenic angle bluting** on erect chest X-ray, in cases of pleural effusion:, with the following options: A: 100ml, B: 300ml, C: 500ml, D: 750ml ### Response:

At least 100ml of fluid is required to detect by USG. A minimum of 300ml is required to produce bluttening of costophrenic angle on erect chest X-ray. About 500ml of effusion is required for detection on clinical examination.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: _______________ of Fluid is required to produce costophrenic angle bluting** on erect chest X-ray, in cases of pleural effusion:, with the following options: A: 100ml, B: 300ml, C: 500ml, D: 750ml ### Response: At least 100ml of fluid is required to detect by USG. A minimum of 300ml is required to produce bluttening of costophrenic angle on erect chest X-ray. About 500ml of effusion is required for detection on clinical examination. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which aery is formed by joining of 2 veebral aeries?, with the following options: A: Basal aery, B: Middle cerebralaery, C: Posterior cerebral aery, D: Basilar aery ### Response:

Basilar aery is formed by the union of two veebral aeries at the lower border of pons. Middle cerebral aery is a branch of internal carotid aery. Posterior cerebral aery is a branch of basilar aery. (Ref: Vishram Singh textbook of clinical neuroanatomy, second edition pg-174,176)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which aery is formed by joining of 2 veebral aeries?, with the following options: A: Basal aery, B: Middle cerebralaery, C: Posterior cerebral aery, D: Basilar aery ### Response: Basilar aery is formed by the union of two veebral aeries at the lower border of pons. Middle cerebral aery is a branch of internal carotid aery. Posterior cerebral aery is a branch of basilar aery. (Ref: Vishram Singh textbook of clinical neuroanatomy, second edition pg-174,176) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Prolactin levels are highest in which of the following?, with the following options: A: After 24 hrs of ovulation, B: After 24 hrs of paurition, C: After nipple stimulation, D: Just before paurition ### Response:

Prolactin levels in maternal plasma increase markedly during normal pregnancy. Concentrations are usually 10 fold greater at term- about 150 ng/mL compared to non pregnant women. Paradoxically, plasma concentrations drop after delivery even in women who are breast feeding. During lactation, pulsatile bursts of prolactin are a response to suckling. The alveolar cells are the principal sites for production of milk. "Although some secretory activity is evident during pregnancy and accelerated following delivery, milk secretion actually stas on 3rd or 4th postpaum day Probably, steroids -- estrogen and progesterone circulating during pregnancy make the breast tissues unresponsive to prolactin. When the estrogen and progesterone are withdrawn following delivery, prolactin begins its milk secretory activity in previously fully developed mammary glands.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Prolactin levels are highest in which of the following?, with the following options: A: After 24 hrs of ovulation, B: After 24 hrs of paurition, C: After nipple stimulation, D: Just before paurition ### Response: Prolactin levels in maternal plasma increase markedly during normal pregnancy. Concentrations are usually 10 fold greater at term- about 150 ng/mL compared to non pregnant women. Paradoxically, plasma concentrations drop after delivery even in women who are breast feeding. During lactation, pulsatile bursts of prolactin are a response to suckling. The alveolar cells are the principal sites for production of milk. "Although some secretory activity is evident during pregnancy and accelerated following delivery, milk secretion actually stas on 3rd or 4th postpaum day Probably, steroids -- estrogen and progesterone circulating during pregnancy make the breast tissues unresponsive to prolactin. When the estrogen and progesterone are withdrawn following delivery, prolactin begins its milk secretory activity in previously fully developed mammary glands. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which one of the following statements regarding water reabsorption in the tubules is true?, with the following options: A: The bulk of water reabsorption occurs secondary to Na+ reabsorption, B: Majority of facultative reabsorption occurs in proximal tubule, C: Obligatory reabsorption is ADH dependent, D: 20% of water is always reabsorbed irrespective of water balance ### Response:

Maximum of filtered water (60-70%) is reabsorbed in the proximal tubule, with or without Vasopressin. This is independent of the fluid and electrolyte status of the body and is caused by the osmotic gradient created by Na+ reabsorption. Obligatory water reabsorption- (Independent of ADH)- 85% -        Proximal tubule- 60-70% -        Descending limb of loop of Henle- 15% Facultative water reabsorption- (ADH dependent)- 15% This depends on fluid and electrolyte status of the body -        Late distal tubule -        Cortical collecting duct Medullary collecting duct

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which one of the following statements regarding water reabsorption in the tubules is true?, with the following options: A: The bulk of water reabsorption occurs secondary to Na+ reabsorption, B: Majority of facultative reabsorption occurs in proximal tubule, C: Obligatory reabsorption is ADH dependent, D: 20% of water is always reabsorbed irrespective of water balance ### Response: Maximum of filtered water (60-70%) is reabsorbed in the proximal tubule, with or without Vasopressin. This is independent of the fluid and electrolyte status of the body and is caused by the osmotic gradient created by Na+ reabsorption. Obligatory water reabsorption- (Independent of ADH)- 85% -        Proximal tubule- 60-70% -        Descending limb of loop of Henle- 15% Facultative water reabsorption- (ADH dependent)- 15% This depends on fluid and electrolyte status of the body -        Late distal tubule -        Cortical collecting duct Medullary collecting duct ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: PID does not include:, with the following options: A: Cervicitis, B: Endometritis, C: Peritonitis, D: Salpingitis ### Response:

Ans: A (Cervicitis) Ref: Dutta Textbook of Gynecology 5th Ed pg 124Explanation:PELVIC INFLAMMATORY DISEASE (PID)Infection of upper genital tract involvingEndometriumFallopian tubesOvariesPelvic peritoneum and surrounding structuresCervicitis is not included in PIDRisk factorsMenstruating teenagersMultiple sexual partnersNo OCP useIUCD usageSTDsProtective factorsCondomsOCPsPregnancyMenopauseWomen whose partner has done vasectomyHusband is azoospermicCausative organismsNeisseria gonorrhoae Chlamydia trachomatisMycoplasma hominisSymptomsLower abdominal painFeverLassitudeExcessive vaginal bleedingPurulent vaginal dischargeDyspareuniaFitz-Hugh Curtis syndrome--Acute salpingitis with perihepatitis causes pain in right hypochondiiumInvestigationsDischarge sent for stain and cultureLeucocytosisLaparoscopy USGTreatmentDoxy 100 mg bd.Erythromycin 500 mg qid.Tetracycline 500 mg qid. Metronidazole 500 mg bd.Azithromycin Ism single dose. Ofloxacin 400 mg bd for 7 to 14 days.For N. gonorrhoea Ceftriaxone 250 mg deep IM single dose, Ciproflox 500 mg orally single dose.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: PID does not include:, with the following options: A: Cervicitis, B: Endometritis, C: Peritonitis, D: Salpingitis ### Response: Ans: A (Cervicitis) Ref: Dutta Textbook of Gynecology 5th Ed pg 124Explanation:PELVIC INFLAMMATORY DISEASE (PID)Infection of upper genital tract involvingEndometriumFallopian tubesOvariesPelvic peritoneum and surrounding structuresCervicitis is not included in PIDRisk factorsMenstruating teenagersMultiple sexual partnersNo OCP useIUCD usageSTDsProtective factorsCondomsOCPsPregnancyMenopauseWomen whose partner has done vasectomyHusband is azoospermicCausative organismsNeisseria gonorrhoae Chlamydia trachomatisMycoplasma hominisSymptomsLower abdominal painFeverLassitudeExcessive vaginal bleedingPurulent vaginal dischargeDyspareuniaFitz-Hugh Curtis syndrome--Acute salpingitis with perihepatitis causes pain in right hypochondiiumInvestigationsDischarge sent for stain and cultureLeucocytosisLaparoscopy USGTreatmentDoxy 100 mg bd.Erythromycin 500 mg qid.Tetracycline 500 mg qid. Metronidazole 500 mg bd.Azithromycin Ism single dose. Ofloxacin 400 mg bd for 7 to 14 days.For N. gonorrhoea Ceftriaxone 250 mg deep IM single dose, Ciproflox 500 mg orally single dose. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Reactive depression is similar to:, with the following options: A: Dysthymia, B: Double depression, C: Adjustment disorder, D: Post-traumatic stress disorder ### Response:

Reactive depression: * Type of non-endogenous depression It is depression secondary to external events leading to significant psychological stress. External events like - Breakup, job loss, death of a close relative or friend In ideal case, the depression would not have occured without the stress to which it is a reaction. It continues as long as the event is present, and it terminates with the reversal of the event (e.g., return of the lover) Self limiting condition It is similar to adjustment disorder. Adjustment disorder is a disorder characterized by mild depressive and anxiety features characterized following a significant life event. It lasts for a maximum duration of 6 months and mostly resolves spontaneously.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Reactive depression is similar to:, with the following options: A: Dysthymia, B: Double depression, C: Adjustment disorder, D: Post-traumatic stress disorder ### Response: Reactive depression: * Type of non-endogenous depression It is depression secondary to external events leading to significant psychological stress. External events like - Breakup, job loss, death of a close relative or friend In ideal case, the depression would not have occured without the stress to which it is a reaction. It continues as long as the event is present, and it terminates with the reversal of the event (e.g., return of the lover) Self limiting condition It is similar to adjustment disorder. Adjustment disorder is a disorder characterized by mild depressive and anxiety features characterized following a significant life event. It lasts for a maximum duration of 6 months and mostly resolves spontaneously. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A test has high false positive rate in a community.True is, with the following options: A: High specificity, B: High sensitivity, C: High prevalence, D: Low prevalence ### Response:

Low prevalence Repeat form Nov 08 "In a population with a low prevalence of a paicular disease, it is likely that most of the positive results in a screening program for that disease would be falsely positive."- Epidemiology, biostatistics, and preventive medicine By James F. Jekel, David L. Katz, Joann G. Elmore 2/e p120 "In a high-prevalence population, the absolute number of false-positives is small in comparison with the absolute numbers of true positives. In a low-prevalence population, the absolute number of false-positives is large in comparison with the absolute number of true positives." -The basic science of oncology By Ian Tannock 4/e p486, 487 The no. of false positive varies inversely with the prevalence of disease in population. This means that when the same test is applied to two populations with differing prevalence; false positive cases would be more in the population with low prevalence and false positive cases would be low in the population with high prevalence. Also Note: Sensitivity and specificity are characteristic of a paicular test and do not depend on the prevalence of disease in the population being tested. The positive predictive value and the negative predictive value depend on characteristics of both the test (sensitivity and specificity) and the population being tested (prevalence of disease). The positive predictive value is directly propoional to the prevalence. The negative predictive value is inversely propoional to prevalence. As the prevalence of disease declines, the positive predictive value of the test declines and the negative predictive value increases.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A test has high false positive rate in a community.True is, with the following options: A: High specificity, B: High sensitivity, C: High prevalence, D: Low prevalence ### Response: Low prevalence Repeat form Nov 08 "In a population with a low prevalence of a paicular disease, it is likely that most of the positive results in a screening program for that disease would be falsely positive."- Epidemiology, biostatistics, and preventive medicine By James F. Jekel, David L. Katz, Joann G. Elmore 2/e p120 "In a high-prevalence population, the absolute number of false-positives is small in comparison with the absolute numbers of true positives. In a low-prevalence population, the absolute number of false-positives is large in comparison with the absolute number of true positives." -The basic science of oncology By Ian Tannock 4/e p486, 487 The no. of false positive varies inversely with the prevalence of disease in population. This means that when the same test is applied to two populations with differing prevalence; false positive cases would be more in the population with low prevalence and false positive cases would be low in the population with high prevalence. Also Note: Sensitivity and specificity are characteristic of a paicular test and do not depend on the prevalence of disease in the population being tested. The positive predictive value and the negative predictive value depend on characteristics of both the test (sensitivity and specificity) and the population being tested (prevalence of disease). The positive predictive value is directly propoional to the prevalence. The negative predictive value is inversely propoional to prevalence. As the prevalence of disease declines, the positive predictive value of the test declines and the negative predictive value increases. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The following types of reaction occur in glycolysis, except, with the following options: A: Hydration, B: Isomerisations, C: Phosphoryl transfer, D: Aldol cleavage ### Response:

Step 1: Uptake and Phosphorylation of Glucose Glucose is phosphorylated to form glucose-6-phosphate. The reaction is catalysed by the specific enzyme glucokinase in liver cells and by non-specific enzyme hexokinase in liver and extrahepatic tissue. The enzyme splits the ATP into ADP, and the Pi is added to the glucose. Hexokinase is a key glycolytic enzyme. Hexokinase catalyses a regulatory step in glycolysis that is irreversible. Hexokinase, like many other kinases, requires Mg2+ for its activity. Step 2: Isomerization of Glucose-6-Phosphate to Fructose-6-Phosphate Glucose-6-phosphate is isomerised to fructose-6-phosphate by phosphohexose isomerase. This reaction involves an aldose-ketose isomerisastion catalysed by phosphohexose isomerase. There is opening of the glucopyranose ring of glucose-6-phosphate to a linear structure which then changes to the furanose ring structure of fructose-6-phosphate. Step 3: Phosphorylation of F-6-P to Fructose 1,6-Biphosphate Fructose-6-phosphate is fuher phosphorylated to fructose 1,6-bisphosphate. The enzyme is phosphofructokinase-1. It catalyses the transfer of a phosphate group from ATP to fructose-6-phosphate. The reaction is irreversible. One ATP is utilised for phosphorylation. Phosphofructokinase-1 is the key enzyme in glycolysis which regulates breakdown of glucose. Step 4: Cleavage of Fructose 1,6-Biphosphate The 6 carbon fructose-1,6-bisphosphate is cleaved into two 3 carbon units; one glyceraldehyde-3-phosphate (GAP) and another molecule of dihydroxyacetone phosphate (DHAP). The enzyme which catalyses the reaction is aldolase. Since the backward reaction is an aldol condensation, the enzyme is called aldolase. The reaction is reversible. Step 5: Interconversion of the Triose Phosphates GAP is on the direct pathway of glycolysis, whereas DHAP is not. Hence Triose-phosphate isomerase conves DHAP into GAP useful for generating ATP. Thus net result Is that glucose is now cleaved into 2 molecules of glyceraldehyde-3-phosphate. This reaction is rapid and reversible. Step 6: Oxidative phosphorylation of GAP to 1,3-Bisphosphoglycerate The first step in the payoff phase is the oxidation of glyceraldehyde 3-phosphate to 1,3-bisphosphoglycerate. This reaction is catalyzed by glyceraldehyde 3-phosphate dehydrogenase. It is the energy-yielding reaction. Reactions of this type in which an aldehyde group is oxidised to an acid are accompanied by the liberation of large amounts of potentially useful energy. During this reaction, NAD+ is reduced to NADH. This is a reversible reaction. Step 7: Conversion of 1,3-Biphosphoglycerate to 3-Phosphoglycerate The enzyme phosphoglycerate kinase transfers the high-energy phosphoryl group from the carboxyl group of 1,3-bisphosphoglycerate to ADP, forming ATP and 3-phosphoglycerate. This is a unique example where ATP can be produced at substrate level without paicipating in electron transpo chain. This type of reaction where ATP is formed at substrate level is called as Substrate level phosphorylation. Step 8: Conversion of 3-Phosphoglycerate to 2-Phosphoglycerate 3-phosphoglycerate is isomerized to 2-phosphoglycerate by shifting the phosphate group from 3rd to 2nd carbon atom. The enzyme is phosphoglucomutase. This is a readily reversible reaction. Mg2+ is essential for this reaction. Step 9: Dehydration of 2-Phosphoglycerate to Phosphoenolpyruvate 2-phosphoglycerate is conveed to phosphoenolpyruvate by the enzyme enolase. One water molecule is removed. A high energy phosphate bond is produced. The reaction is reversible. Enolase requires Mg++. Step 10: Conversion of Phosphoenol Pyruvate to Pyruvate Phosphoenolpyruvate (PEP) is dephosphorylated to pyruvate, by pyruvate kinase. First PEP is made into a transient intermediary of enol pyruvate; which is spontaneously isomerized into keto pyruvate, the stable form of pyruvate. One mole of ATP is generated during this reaction. This is again an example of substrate level phosphorylation. The pyruvate kinase is a key glycolytic enzyme. This step is irreversible. REF:DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY,EIGHTH EDITION,PG.NO.,129.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The following types of reaction occur in glycolysis, except, with the following options: A: Hydration, B: Isomerisations, C: Phosphoryl transfer, D: Aldol cleavage ### Response: Step 1: Uptake and Phosphorylation of Glucose Glucose is phosphorylated to form glucose-6-phosphate. The reaction is catalysed by the specific enzyme glucokinase in liver cells and by non-specific enzyme hexokinase in liver and extrahepatic tissue. The enzyme splits the ATP into ADP, and the Pi is added to the glucose. Hexokinase is a key glycolytic enzyme. Hexokinase catalyses a regulatory step in glycolysis that is irreversible. Hexokinase, like many other kinases, requires Mg2+ for its activity. Step 2: Isomerization of Glucose-6-Phosphate to Fructose-6-Phosphate Glucose-6-phosphate is isomerised to fructose-6-phosphate by phosphohexose isomerase. This reaction involves an aldose-ketose isomerisastion catalysed by phosphohexose isomerase. There is opening of the glucopyranose ring of glucose-6-phosphate to a linear structure which then changes to the furanose ring structure of fructose-6-phosphate. Step 3: Phosphorylation of F-6-P to Fructose 1,6-Biphosphate Fructose-6-phosphate is fuher phosphorylated to fructose 1,6-bisphosphate. The enzyme is phosphofructokinase-1. It catalyses the transfer of a phosphate group from ATP to fructose-6-phosphate. The reaction is irreversible. One ATP is utilised for phosphorylation. Phosphofructokinase-1 is the key enzyme in glycolysis which regulates breakdown of glucose. Step 4: Cleavage of Fructose 1,6-Biphosphate The 6 carbon fructose-1,6-bisphosphate is cleaved into two 3 carbon units; one glyceraldehyde-3-phosphate (GAP) and another molecule of dihydroxyacetone phosphate (DHAP). The enzyme which catalyses the reaction is aldolase. Since the backward reaction is an aldol condensation, the enzyme is called aldolase. The reaction is reversible. Step 5: Interconversion of the Triose Phosphates GAP is on the direct pathway of glycolysis, whereas DHAP is not. Hence Triose-phosphate isomerase conves DHAP into GAP useful for generating ATP. Thus net result Is that glucose is now cleaved into 2 molecules of glyceraldehyde-3-phosphate. This reaction is rapid and reversible. Step 6: Oxidative phosphorylation of GAP to 1,3-Bisphosphoglycerate The first step in the payoff phase is the oxidation of glyceraldehyde 3-phosphate to 1,3-bisphosphoglycerate. This reaction is catalyzed by glyceraldehyde 3-phosphate dehydrogenase. It is the energy-yielding reaction. Reactions of this type in which an aldehyde group is oxidised to an acid are accompanied by the liberation of large amounts of potentially useful energy. During this reaction, NAD+ is reduced to NADH. This is a reversible reaction. Step 7: Conversion of 1,3-Biphosphoglycerate to 3-Phosphoglycerate The enzyme phosphoglycerate kinase transfers the high-energy phosphoryl group from the carboxyl group of 1,3-bisphosphoglycerate to ADP, forming ATP and 3-phosphoglycerate. This is a unique example where ATP can be produced at substrate level without paicipating in electron transpo chain. This type of reaction where ATP is formed at substrate level is called as Substrate level phosphorylation. Step 8: Conversion of 3-Phosphoglycerate to 2-Phosphoglycerate 3-phosphoglycerate is isomerized to 2-phosphoglycerate by shifting the phosphate group from 3rd to 2nd carbon atom. The enzyme is phosphoglucomutase. This is a readily reversible reaction. Mg2+ is essential for this reaction. Step 9: Dehydration of 2-Phosphoglycerate to Phosphoenolpyruvate 2-phosphoglycerate is conveed to phosphoenolpyruvate by the enzyme enolase. One water molecule is removed. A high energy phosphate bond is produced. The reaction is reversible. Enolase requires Mg++. Step 10: Conversion of Phosphoenol Pyruvate to Pyruvate Phosphoenolpyruvate (PEP) is dephosphorylated to pyruvate, by pyruvate kinase. First PEP is made into a transient intermediary of enol pyruvate; which is spontaneously isomerized into keto pyruvate, the stable form of pyruvate. One mole of ATP is generated during this reaction. This is again an example of substrate level phosphorylation. The pyruvate kinase is a key glycolytic enzyme. This step is irreversible. REF:DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY,EIGHTH EDITION,PG.NO.,129. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Cinnarizine used for motion sickness is a, with the following options: A: 5HT4 - antagonist, B: H2 - antagonist, C: Antihistamine, D: NK1 antagonist ### Response:

Cinnarizine is an antihistamine with anticholinergic property given for motion sickness & also used in the treatment of vertigo.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Cinnarizine used for motion sickness is a, with the following options: A: 5HT4 - antagonist, B: H2 - antagonist, C: Antihistamine, D: NK1 antagonist ### Response: Cinnarizine is an antihistamine with anticholinergic property given for motion sickness & also used in the treatment of vertigo. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: What is the World Health Organization (WHO) definition of osteoporosis?, with the following options: A: Bone mineral density less than 1 standard deviation below the mean of a young, healthy adult., B: Bone mineral density at least 2.5 standard deviations below the mean of a young, healthy adult., C: T score less than -2.5., D: (B) and (C). ### Response:

Ans. D. (B) and (C).In 1994, the WHO introduced definitions for osteoporosis and osteopenia in terms of T score thresholds of -2.5 and -1 respectively. A T score of -2.5 means that the bone mineral density in the lumbar spine (L2-L4) is at least 2.5 standard deviations below the mean of a young (age 25-35), healthy female. A T score of more than -2.5 implies it is more positive and hence could represent either osteopenia or normal bone density.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: What is the World Health Organization (WHO) definition of osteoporosis?, with the following options: A: Bone mineral density less than 1 standard deviation below the mean of a young, healthy adult., B: Bone mineral density at least 2.5 standard deviations below the mean of a young, healthy adult., C: T score less than -2.5., D: (B) and (C). ### Response: Ans. D. (B) and (C).In 1994, the WHO introduced definitions for osteoporosis and osteopenia in terms of T score thresholds of -2.5 and -1 respectively. A T score of -2.5 means that the bone mineral density in the lumbar spine (L2-L4) is at least 2.5 standard deviations below the mean of a young (age 25-35), healthy female. A T score of more than -2.5 implies it is more positive and hence could represent either osteopenia or normal bone density. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is false about Calciphylaxis, with the following options: A: It is Calcific arteriopathy in chronic kidney disease, B: Livedo reticularis can be seen, C: Vascular Calcification is seen, D: Associated with hypoparathyroidism ### Response:

Hyperparathyroidism , increased use of oral Calcium and warfarin treatment are risk factors.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is false about Calciphylaxis, with the following options: A: It is Calcific arteriopathy in chronic kidney disease, B: Livedo reticularis can be seen, C: Vascular Calcification is seen, D: Associated with hypoparathyroidism ### Response: Hyperparathyroidism , increased use of oral Calcium and warfarin treatment are risk factors. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following drugs are used for smoking cessation?, with the following options: A: Bupropion, B: Buspirone, C: Venlafaxine, D: Fluoxetine ### Response:

Ans. (A) Bupropion(Ref: Harrison 16th/e p2575; Katzung 11th/e p521,1110)Drugs used for smoking cessation are:Nicotine (gum, patch, nasal inhaler, oral inhaler)BupropionClonidine (oral, patch)NortriptylineRimonabantVarenicillineAmfebutamoneMecamylamine

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following drugs are used for smoking cessation?, with the following options: A: Bupropion, B: Buspirone, C: Venlafaxine, D: Fluoxetine ### Response: Ans. (A) Bupropion(Ref: Harrison 16th/e p2575; Katzung 11th/e p521,1110)Drugs used for smoking cessation are:Nicotine (gum, patch, nasal inhaler, oral inhaler)BupropionClonidine (oral, patch)NortriptylineRimonabantVarenicillineAmfebutamoneMecamylamine ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Black piedra is caused by -, with the following options: A: Piedraia hortae, B: Trichosporon asahii, C: Trichosporon ovoides, D: Trichosporon inkin ### Response:

Ans. is 'a' i.e., Piedraia hortae o Piedra is an asymptomatic superficial fungal infection of the hair shaft also known as trichomycosis nodu- laris. Black piedra is caused by Piedraia hortae, whereas white piedra is caused by pathogenic species of the Trichosporon genus, namely Trichosporon asahii, Trichosporon ovoides, Trichosporon inkin, Trichosporon mucoides, Trichosporon asteroides, and Trichosporon cutaneum.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Black piedra is caused by -, with the following options: A: Piedraia hortae, B: Trichosporon asahii, C: Trichosporon ovoides, D: Trichosporon inkin ### Response: Ans. is 'a' i.e., Piedraia hortae o Piedra is an asymptomatic superficial fungal infection of the hair shaft also known as trichomycosis nodu- laris. Black piedra is caused by Piedraia hortae, whereas white piedra is caused by pathogenic species of the Trichosporon genus, namely Trichosporon asahii, Trichosporon ovoides, Trichosporon inkin, Trichosporon mucoides, Trichosporon asteroides, and Trichosporon cutaneum. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vitamin E deficiency is associated with, with the following options: A: Ataxia, B: Cholestasis, C: Hyperkeratosis, D: Pseudotumour cerebri ### Response:

Vitamin E deficiency causes axonal degeneration of the large myelinated axons results in posterior column & spino cerebellar symptoms

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vitamin E deficiency is associated with, with the following options: A: Ataxia, B: Cholestasis, C: Hyperkeratosis, D: Pseudotumour cerebri ### Response: Vitamin E deficiency causes axonal degeneration of the large myelinated axons results in posterior column & spino cerebellar symptoms ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 45-year-old male presents to the emergency depament with 2 days of haemoptysis. He repos that he has been coughing up 1-3 tablespoons of blood each day. He does repo mild chest pain, low-grade fevers, and weight loss. He has had about 1 year of severe upper respiratory symptoms including frequent epistaxis and purulent discharge treated with several courses of antibiotics. His only medications are daily aspirin and lovastatin. On examination, he has normal vital signs, and upper airway is notable for saddle nose deformity and clear lungs. A CT scan of the chest shows multiple cavitating nodules, and urinalysis shows RBCs . Which of the following tests offers the highest diagnostic yield to make the appropriate diagnosis?, with the following options: A: Deep skin biopsy, B: Percutaneous kidney biopsy, C: Pulmonary angiogram, D: Surgical lung biopsy ### Response:

The patient presents with classic symptoms for granulomatosis with polyangiitis. C/F: Vasculitis of 1. U= Epistaxis (Oral cavity Strawberry gingivitis) 2. L= Haemoptysis (Cavity formation in lungs) 3. Kidney = Haematuria The average age of diagnosis is 40 years. Male predominance. The diagnosis is made by demonstration of necrotizing granulomatous vasculitis on biopsy. Pulmonary tissue offers the highest yield. Biopsy of the upper airway usually shows the granulomatous inflammation but infrequently shows vasculitis. Renal biopsy may show the presence of pauci-immune glomerulonephritis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 45-year-old male presents to the emergency depament with 2 days of haemoptysis. He repos that he has been coughing up 1-3 tablespoons of blood each day. He does repo mild chest pain, low-grade fevers, and weight loss. He has had about 1 year of severe upper respiratory symptoms including frequent epistaxis and purulent discharge treated with several courses of antibiotics. His only medications are daily aspirin and lovastatin. On examination, he has normal vital signs, and upper airway is notable for saddle nose deformity and clear lungs. A CT scan of the chest shows multiple cavitating nodules, and urinalysis shows RBCs . Which of the following tests offers the highest diagnostic yield to make the appropriate diagnosis?, with the following options: A: Deep skin biopsy, B: Percutaneous kidney biopsy, C: Pulmonary angiogram, D: Surgical lung biopsy ### Response: The patient presents with classic symptoms for granulomatosis with polyangiitis. C/F: Vasculitis of 1. U= Epistaxis (Oral cavity Strawberry gingivitis) 2. L= Haemoptysis (Cavity formation in lungs) 3. Kidney = Haematuria The average age of diagnosis is 40 years. Male predominance. The diagnosis is made by demonstration of necrotizing granulomatous vasculitis on biopsy. Pulmonary tissue offers the highest yield. Biopsy of the upper airway usually shows the granulomatous inflammation but infrequently shows vasculitis. Renal biopsy may show the presence of pauci-immune glomerulonephritis. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At equilibrium the concentrations of Cl- inside and outside a cell are 8 mmol/L and 120 mmol/L, respectively. The equilibrium potential for Cl- at 37oC is calculated to be (NOT RELATED), with the following options: A: +4.07 mV, B: -4.07 mV, C: +71.7 mV, D: -71.7 mV ### Response:

Nernst equation Ei - Eo = 61/-1 x log10 120/8 = -61 x 1.176 = -71.7 mV inside the cell. Note that for Cl-, the value for z (valence) is -1

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At equilibrium the concentrations of Cl- inside and outside a cell are 8 mmol/L and 120 mmol/L, respectively. The equilibrium potential for Cl- at 37oC is calculated to be (NOT RELATED), with the following options: A: +4.07 mV, B: -4.07 mV, C: +71.7 mV, D: -71.7 mV ### Response: Nernst equation Ei - Eo = 61/-1 x log10 120/8 = -61 x 1.176 = -71.7 mV inside the cell. Note that for Cl-, the value for z (valence) is -1 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Communicability of disease is assessed by means of:, with the following options: A: Secondary attack rate, B: Generation time, C: Serial interval, D: Incubation period ### Response:

Secondary attack rate

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Communicability of disease is assessed by means of:, with the following options: A: Secondary attack rate, B: Generation time, C: Serial interval, D: Incubation period ### Response: Secondary attack rate ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: True regarding barret's oesophagus is :, with the following options: A: Benign course, B: Premalignant condition, C: Sq. metaplasia of lower oesophagus, D: Medical T/t is not useful ### Response:

Ans is 'b' ie Premalignant condition As already explained Barrett's esophagus is an Intestinal metaplasia (not squamous metaplasia) which follows the metaplasia - dysplasia - cancer course (a Premalignant condition for adenocarcinoma of esophagus)About the medical t/t Though medical treatment does not revert back the metaplastic changes, it's given to treat the underlying reflux disorder and prevent further damage. CSDT, Bailey, Maingot's, all advice medical treatment for reflux esophagitis in cases of Barrett's esophagus.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: True regarding barret's oesophagus is :, with the following options: A: Benign course, B: Premalignant condition, C: Sq. metaplasia of lower oesophagus, D: Medical T/t is not useful ### Response: Ans is 'b' ie Premalignant condition As already explained Barrett's esophagus is an Intestinal metaplasia (not squamous metaplasia) which follows the metaplasia - dysplasia - cancer course (a Premalignant condition for adenocarcinoma of esophagus)About the medical t/t Though medical treatment does not revert back the metaplastic changes, it's given to treat the underlying reflux disorder and prevent further damage. CSDT, Bailey, Maingot's, all advice medical treatment for reflux esophagitis in cases of Barrett's esophagus. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not a specific protection method under primary level of prevention?, with the following options: A: Ribavirin to close contact meningitis patient, B: Health education about hand washing, C: Giving Pentavalent vaccination to children, D: Addition of iron with Wheat flour ### Response:

Ans. (B) Health education about hand washing(Ref: Park Text book of PSM 25th ed; pg. 410)Hand washing is not a specific protection measure under primary prevention. All other options are protection measures against specific disease.Health education about hand washing is usually primordial prevention.Ribavirin to close contact meningitis patient comes under chemoprophylaxis and primary prevention.Giving Pentavalent vaccination to children: Primary preventionAddition of iron with Wheat flour: Specific protection and primary prevention

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not a specific protection method under primary level of prevention?, with the following options: A: Ribavirin to close contact meningitis patient, B: Health education about hand washing, C: Giving Pentavalent vaccination to children, D: Addition of iron with Wheat flour ### Response: Ans. (B) Health education about hand washing(Ref: Park Text book of PSM 25th ed; pg. 410)Hand washing is not a specific protection measure under primary prevention. All other options are protection measures against specific disease.Health education about hand washing is usually primordial prevention.Ribavirin to close contact meningitis patient comes under chemoprophylaxis and primary prevention.Giving Pentavalent vaccination to children: Primary preventionAddition of iron with Wheat flour: Specific protection and primary prevention ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: What does the arrow point to in the fundus examination of a myopic patient?, with the following options: A: FosterFuchs spot, B: Lacquer cracks, C: Arlt line, D: Myopic crescent ### Response:

Fundus findings in degenerative myopia:1A pale tessellated ('tigroid') appearance is due to diffuse attenuation of the RPE with visibility of large choroidal vessels.2Focal chorioretinal atrophy is characterized by the visibility of the larger choroidal vessels and eventually the sclera.3Anomalous optic nerve head which may appear unusually small, large or anomalous with a 'tilted' conformation. Peripapillary chorioretinal atrophy is very common, and in milder cases taking the form of a temporal crescent of thinned or absent RPE exposing the choroid and/or sclera.4'Lacquer cracks' are ruptures in the RPE-Bruch membrane-choriocapillaris complex characterized clinically by fine, irregular, yellow lines, often branching and crisscrossing at the posterior pole. They are present in around 5% of highly myopic eyes and can precede the development of CNV, retinal hemorrhages without CNV, and geographic atrophy. It is thought that the flaw in the RPE barrier constituted by the cracks provides a route through which choriocapillaris tissue can grow.5Lattice degeneration.6Subretinal 'coin' hemorrhages, which may be intermittent, may develop from lacquer cracks in the absence of CNV.7A Fuchs spot is a raised, circular, pigmented lesion at the macula developing after a subretinal hemorrhage has absorbed.8A staphyloma is an ectasia or bulging of the posterior sclera due to focal expansion and thinning. It occurs in about a third of eyes with pathological myopia, and is viually always peripapillary or involves the macula. Staphyloma development can be associated with macular hole formation.Ref: Kanski; 7th edition; Pg. 637

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: What does the arrow point to in the fundus examination of a myopic patient?, with the following options: A: FosterFuchs spot, B: Lacquer cracks, C: Arlt line, D: Myopic crescent ### Response: Fundus findings in degenerative myopia:1A pale tessellated ('tigroid') appearance is due to diffuse attenuation of the RPE with visibility of large choroidal vessels.2Focal chorioretinal atrophy is characterized by the visibility of the larger choroidal vessels and eventually the sclera.3Anomalous optic nerve head which may appear unusually small, large or anomalous with a 'tilted' conformation. Peripapillary chorioretinal atrophy is very common, and in milder cases taking the form of a temporal crescent of thinned or absent RPE exposing the choroid and/or sclera.4'Lacquer cracks' are ruptures in the RPE-Bruch membrane-choriocapillaris complex characterized clinically by fine, irregular, yellow lines, often branching and crisscrossing at the posterior pole. They are present in around 5% of highly myopic eyes and can precede the development of CNV, retinal hemorrhages without CNV, and geographic atrophy. It is thought that the flaw in the RPE barrier constituted by the cracks provides a route through which choriocapillaris tissue can grow.5Lattice degeneration.6Subretinal 'coin' hemorrhages, which may be intermittent, may develop from lacquer cracks in the absence of CNV.7A Fuchs spot is a raised, circular, pigmented lesion at the macula developing after a subretinal hemorrhage has absorbed.8A staphyloma is an ectasia or bulging of the posterior sclera due to focal expansion and thinning. It occurs in about a third of eyes with pathological myopia, and is viually always peripapillary or involves the macula. Staphyloma development can be associated with macular hole formation.Ref: Kanski; 7th edition; Pg. 637 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Stone which is resistant to lithiotripsy, with the following options: A: Calcium oxalate, B: Triple phosphate stone, C: Cystine stone, D: Uric acid stone ### Response:

lithiotripsy  is a medical procedure involving the physical destruction of hardened masses like kidney stones.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Stone which is resistant to lithiotripsy, with the following options: A: Calcium oxalate, B: Triple phosphate stone, C: Cystine stone, D: Uric acid stone ### Response: lithiotripsy  is a medical procedure involving the physical destruction of hardened masses like kidney stones. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following are neurologic channelopathies, except?, with the following options: A: Hypokalemic periodic paralysis, B: Episodic ataxias, C: Familial hemiplegic migraine, D: Huntington's disease ### Response:

Choice 1 and 3 are calcium channel defect. Choice 2 is potassium channel defect. Huntington' disease is a disorder of trinucleotide repeats due to Huntington gene on chromosome 4.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following are neurologic channelopathies, except?, with the following options: A: Hypokalemic periodic paralysis, B: Episodic ataxias, C: Familial hemiplegic migraine, D: Huntington's disease ### Response: Choice 1 and 3 are calcium channel defect. Choice 2 is potassium channel defect. Huntington' disease is a disorder of trinucleotide repeats due to Huntington gene on chromosome 4. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A Malnourished child from a poor socioeconomic status, residing in overcrowded and diy areas present with a nodule around the limbus with hyperemia of surrounding conjunctiva in his left eye. He is also observed to have axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis:, with the following options: A: Phlyctenular conjunctivitis, B: Foreign body granuloma, C: Vernal keratoconjunctivitis, D: Episcleritis ### Response:

Ans. Phlyctenular conjunctivitis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A Malnourished child from a poor socioeconomic status, residing in overcrowded and diy areas present with a nodule around the limbus with hyperemia of surrounding conjunctiva in his left eye. He is also observed to have axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis:, with the following options: A: Phlyctenular conjunctivitis, B: Foreign body granuloma, C: Vernal keratoconjunctivitis, D: Episcleritis ### Response: Ans. Phlyctenular conjunctivitis ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following areas are commonly involved sites in pelvic fracture except, with the following options: A: Pubic rami, B: Alae of ilium, C: Acetabulum, D: Ischial tuberosities ### Response:

ref : maheswari 9th ed

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following areas are commonly involved sites in pelvic fracture except, with the following options: A: Pubic rami, B: Alae of ilium, C: Acetabulum, D: Ischial tuberosities ### Response: ref : maheswari 9th ed ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which one of the following is the treatment of choice for a desmoids tumor?, with the following options: A: Surgery, B: Radiotherapy, C: Chemotherapy, D: Radiotherapy + Chemotherapy ### Response:

Desmoid tumors are cytologically bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. Desmoid tumors are twice more common in females than in males. Primary surgery with negative surgical margins is the most successful primary treatment modality for desmoid tumors. Positive margins after surgery reflect a high risk for recurrence. Wide excision with a 2.5 cm margin is usually done.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which one of the following is the treatment of choice for a desmoids tumor?, with the following options: A: Surgery, B: Radiotherapy, C: Chemotherapy, D: Radiotherapy + Chemotherapy ### Response: Desmoid tumors are cytologically bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. Desmoid tumors are twice more common in females than in males. Primary surgery with negative surgical margins is the most successful primary treatment modality for desmoid tumors. Positive margins after surgery reflect a high risk for recurrence. Wide excision with a 2.5 cm margin is usually done. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Alcohol Dehydrogenase comes under which class of enzyme?, with the following options: A: Oxidoreductase, B: Dehydrogenase, C: Hydrolase, D: Oxidase ### Response:

Ans. A. OxidoreductaseHere the question is asking about class of enzyme, hence answer oxidoreductase. Dehydrogenase is the subclass not class of enzyme.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Alcohol Dehydrogenase comes under which class of enzyme?, with the following options: A: Oxidoreductase, B: Dehydrogenase, C: Hydrolase, D: Oxidase ### Response: Ans. A. OxidoreductaseHere the question is asking about class of enzyme, hence answer oxidoreductase. Dehydrogenase is the subclass not class of enzyme. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Oaubain acts by inhibiting, with the following options: A: Adenyl cyclase, B: Ca+ chanells, C: H+K+ ATPase, D: Na+K+ATPase ### Response:

Ouabain is a cardiac glycoside and in lower doses, can be used medically to treat hypotension and some arrhythmias. It acts by inhibiting the Na/K-ATPase, also known as the sodium-potassium ion pump Refer kDT 6/e p496

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Oaubain acts by inhibiting, with the following options: A: Adenyl cyclase, B: Ca+ chanells, C: H+K+ ATPase, D: Na+K+ATPase ### Response: Ouabain is a cardiac glycoside and in lower doses, can be used medically to treat hypotension and some arrhythmias. It acts by inhibiting the Na/K-ATPase, also known as the sodium-potassium ion pump Refer kDT 6/e p496 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: According to ICD-10, which letter is used to denote mental illness?, with the following options: A: Q, B: B, C: G, D: F ### Response:

Ref: International Classification of Diseases - Version 10 ICD-10. WHO documentExplanation:INTERNATIONAL CLASSIFICATION OF DISEASES (ICD)It is a system for coding all diseases of mankind.It also includes:o Signs and symptomso Abnormal findingso Social circumstanceso External causes of injury or distress.It is published by WHO (World Health Organization).The current version is 10th.Next version 11th is expected in 2015.It has 22 chapters (coded in Roman I to XXII).It also has codes as "alpha-numericaC (i.e. alphabets and numbers).The alphabets A to Z are there but put in chapters as ''blocks". For example, Chapter I contains A and B blocks.Mental health disorders are coded in Chapter V, F block.Each alphabet (block) has numbers in two digits which in turn followed by two decimal numbers.For example, moderate depressive episode with somatic syndrome is coded as F32.ll.Mental health disorders are coded from F00 to F99 in ten categories (F00-FO9, FIO-19. F20-29, F90-99).First organic conditions (F00-09), then substance use (F10-19) are coded and insist all of us to rule out these etiopathological factors first in any case of behavioral disturbance.Other classificatory systems are DSM (Diagnostic and Statistical Manual, Vth revision) and Chinese Classification of Mental Disorders (CCMD, 3rd edition).DSM is devised by APA ( American Psychiatric Association).In contrast to ICD. these classification systems are applicable for mental health problems ONLY (ICD codes all disorders).ICD system is used for medical insurance system in USA though DSM is used widely by clinicians.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: According to ICD-10, which letter is used to denote mental illness?, with the following options: A: Q, B: B, C: G, D: F ### Response: Ref: International Classification of Diseases - Version 10 ICD-10. WHO documentExplanation:INTERNATIONAL CLASSIFICATION OF DISEASES (ICD)It is a system for coding all diseases of mankind.It also includes:o Signs and symptomso Abnormal findingso Social circumstanceso External causes of injury or distress.It is published by WHO (World Health Organization).The current version is 10th.Next version 11th is expected in 2015.It has 22 chapters (coded in Roman I to XXII).It also has codes as "alpha-numericaC (i.e. alphabets and numbers).The alphabets A to Z are there but put in chapters as ''blocks". For example, Chapter I contains A and B blocks.Mental health disorders are coded in Chapter V, F block.Each alphabet (block) has numbers in two digits which in turn followed by two decimal numbers.For example, moderate depressive episode with somatic syndrome is coded as F32.ll.Mental health disorders are coded from F00 to F99 in ten categories (F00-FO9, FIO-19. F20-29, F90-99).First organic conditions (F00-09), then substance use (F10-19) are coded and insist all of us to rule out these etiopathological factors first in any case of behavioral disturbance.Other classificatory systems are DSM (Diagnostic and Statistical Manual, Vth revision) and Chinese Classification of Mental Disorders (CCMD, 3rd edition).DSM is devised by APA ( American Psychiatric Association).In contrast to ICD. these classification systems are applicable for mental health problems ONLY (ICD codes all disorders).ICD system is used for medical insurance system in USA though DSM is used widely by clinicians. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Mass spectrometry is used for:, with the following options: A: Pulp vitality assessment., B: Protein and body fluid assessment., C: Pulpal blood flow assessment., D: Pulpal nerve stimulation assessment. ### Response:

Mass Spectrometry (MS) is new chemical method used For Determination of the primary structure of proteins Assessment of body fluid Detection of post-translational modifications

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Mass spectrometry is used for:, with the following options: A: Pulp vitality assessment., B: Protein and body fluid assessment., C: Pulpal blood flow assessment., D: Pulpal nerve stimulation assessment. ### Response: Mass Spectrometry (MS) is new chemical method used For Determination of the primary structure of proteins Assessment of body fluid Detection of post-translational modifications ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A patient with burns presents to the emergency room. He was started on intravenous fluids. The best method to assess the adequacy of volume replacement is, with the following options: A: Pulse rate, B: Urine output, C: Systolic blood pressure, D: Central venous pressure ### Response:

Answer: b) Urine output (Merck manual & Handbook of Evidence based critical care)Treatment of shock is directed at maintainingCVP of 8-12 mm HgMean arterial pressure of >65 mmHg (systolic pressure >90 mmHg)Cardiac index of 2-4 L/min/m2The urine output rate should be kept at >0.5 mL/kg per hourAdequate end-organ perfusion is best indicated by urine output of > 0.5 to 1 mL/kg/hHeart rate, mental status, and capillary refill may be affected by the underlying disease process and are less reliable markers.Because of compensatory vasoconstriction, mean arterial pressure (MAP) is only a rough guideline; organ hypoperfusion may be present despite apparently normal values.An elevated arterial blood lactate level reflects hypoperfusion; however, levels do not decline for several hours after successful resuscitation.HEMODYNAMIC SUPPORT IN SHOCKNS or RL (crystalloids) is the first choice for acute stage of resuscitationWhen fluid requirements are high, colloids (Dextran, gelatin, 5% albumin) are of usePacked RBC should be given at 10 mL/kg to maintain hematocrit at 30% or Hb 9 g/dLBolus of 20ml/Kg given rapidly over 5-10 mins; if no response - repeat bolusPatients who do not respond to rapid boluses of 40-60ml/Kg in the first hour are labeled as fluid refractory shock and inotrophic support (dopamine or dobutamine) should be givenUse insulin only if it is needed to maintain the blood glucose concentration below 150 mg/dLFirst line Vasopressor inAnaphylactic shock: EpinephrineSeptic shock, Cardiogenic shock, Vasodilatory shock: NorepinephrineRefractory shock: EpinephrineIf shock persists - catecholamine resistant shock - give Hydrocortisone if adrenal insufficiency is suspectedACTH stimulation test is not useful for detecting less profound degrees of corticosteroid deficiency in patients who are critically illVasodilators (nitroprusside, nitroglycerine) in children remaining hypodynamic with high SVR despite fluid and ionotropic supportChildren remaining normotensive with low output state and high SVR despite epinephrine and vasodilator - phosphodiesterase III inhibitors (Amrinone, Milrinone) are givenRecombinant activated protein C (aPC) - for severe sepsis or septic shock

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A patient with burns presents to the emergency room. He was started on intravenous fluids. The best method to assess the adequacy of volume replacement is, with the following options: A: Pulse rate, B: Urine output, C: Systolic blood pressure, D: Central venous pressure ### Response: Answer: b) Urine output (Merck manual & Handbook of Evidence based critical care)Treatment of shock is directed at maintainingCVP of 8-12 mm HgMean arterial pressure of >65 mmHg (systolic pressure >90 mmHg)Cardiac index of 2-4 L/min/m2The urine output rate should be kept at >0.5 mL/kg per hourAdequate end-organ perfusion is best indicated by urine output of > 0.5 to 1 mL/kg/hHeart rate, mental status, and capillary refill may be affected by the underlying disease process and are less reliable markers.Because of compensatory vasoconstriction, mean arterial pressure (MAP) is only a rough guideline; organ hypoperfusion may be present despite apparently normal values.An elevated arterial blood lactate level reflects hypoperfusion; however, levels do not decline for several hours after successful resuscitation.HEMODYNAMIC SUPPORT IN SHOCKNS or RL (crystalloids) is the first choice for acute stage of resuscitationWhen fluid requirements are high, colloids (Dextran, gelatin, 5% albumin) are of usePacked RBC should be given at 10 mL/kg to maintain hematocrit at 30% or Hb 9 g/dLBolus of 20ml/Kg given rapidly over 5-10 mins; if no response - repeat bolusPatients who do not respond to rapid boluses of 40-60ml/Kg in the first hour are labeled as fluid refractory shock and inotrophic support (dopamine or dobutamine) should be givenUse insulin only if it is needed to maintain the blood glucose concentration below 150 mg/dLFirst line Vasopressor inAnaphylactic shock: EpinephrineSeptic shock, Cardiogenic shock, Vasodilatory shock: NorepinephrineRefractory shock: EpinephrineIf shock persists - catecholamine resistant shock - give Hydrocortisone if adrenal insufficiency is suspectedACTH stimulation test is not useful for detecting less profound degrees of corticosteroid deficiency in patients who are critically illVasodilators (nitroprusside, nitroglycerine) in children remaining hypodynamic with high SVR despite fluid and ionotropic supportChildren remaining normotensive with low output state and high SVR despite epinephrine and vasodilator - phosphodiesterase III inhibitors (Amrinone, Milrinone) are givenRecombinant activated protein C (aPC) - for severe sepsis or septic shock ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following is true about amoebic liver abscess except -, with the following options: A: It is common in the left lobe of the liver, B: CT and USG are helpful for diagnosis, C: Metronidazole is the mainstay of treatment, D: Entamoeba Histolytica is acquired through the faeco oral route ### Response:

Amoebic Liver abscess Caused by Entamoeba histolytica whose cysts are acquired through the feco-oral route and their trophozoites reach the liver through poal venous system Like pyogenic abscess they are also common in . lobe of liver Clinical Picture The typical clinical picture is of a patient 20-40 yrs of age who has travelled to an endemic area, presents with fever, chills, anorexia, . upper quadrant pain. Although liver abscess results from an obligatory colonic infection, a recent history of diarrhoea is uncommon. Jaundice is rare. (c.f. in pyogenic abscess jaundice is seen in -25% of pts.) Liver function tests may show mild abnormalities, hyperbilirubinemia is uncommon CT > U/S are the mainstay of investigation. Diagnosis is confirmed by serological tests (enzyme immuno assay) for antiamoebic antibodies Cultures of amoebic abscess are usually negative Treatment Metronidazole is the mainstay of t/t and is curative in over 90% of patients, (other nitroimidazoles i.e. secnidazole, tinidazole, are also effective) Therapeutic needle aspiration is avoided. Done only when Pt. fails to respond to metronidazole High risk of rupture Abscess secondarily infected with pyogenic organism Complications may occur uncommonly; these are Rupture into the peritoneum, pleural cavity or pericardium Ref srb manual of surgery 5e Liver p596

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following is true about amoebic liver abscess except -, with the following options: A: It is common in the left lobe of the liver, B: CT and USG are helpful for diagnosis, C: Metronidazole is the mainstay of treatment, D: Entamoeba Histolytica is acquired through the faeco oral route ### Response: Amoebic Liver abscess Caused by Entamoeba histolytica whose cysts are acquired through the feco-oral route and their trophozoites reach the liver through poal venous system Like pyogenic abscess they are also common in . lobe of liver Clinical Picture The typical clinical picture is of a patient 20-40 yrs of age who has travelled to an endemic area, presents with fever, chills, anorexia, . upper quadrant pain. Although liver abscess results from an obligatory colonic infection, a recent history of diarrhoea is uncommon. Jaundice is rare. (c.f. in pyogenic abscess jaundice is seen in -25% of pts.) Liver function tests may show mild abnormalities, hyperbilirubinemia is uncommon CT > U/S are the mainstay of investigation. Diagnosis is confirmed by serological tests (enzyme immuno assay) for antiamoebic antibodies Cultures of amoebic abscess are usually negative Treatment Metronidazole is the mainstay of t/t and is curative in over 90% of patients, (other nitroimidazoles i.e. secnidazole, tinidazole, are also effective) Therapeutic needle aspiration is avoided. Done only when Pt. fails to respond to metronidazole High risk of rupture Abscess secondarily infected with pyogenic organism Complications may occur uncommonly; these are Rupture into the peritoneum, pleural cavity or pericardium Ref srb manual of surgery 5e Liver p596 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Pringle maneuver may be required for treatment of:, with the following options: A: Injury to fail of pancreas, B: Mesenteric ischemia, C: Bleeding esophageal varices, D: Liver laceration ### Response:

Ans. (d) Liver Laceration* Pringle Maneuver is used to stop bleeding from liver during trauma as well as during surgery* It occludes the inflow totally - bleeding stops from Hepatic artery and portal vein.* Pringle maneuver can be tolerated by normal liver for 60 minutes and only for 30 minutes in Cirrhotic liver.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Pringle maneuver may be required for treatment of:, with the following options: A: Injury to fail of pancreas, B: Mesenteric ischemia, C: Bleeding esophageal varices, D: Liver laceration ### Response: Ans. (d) Liver Laceration* Pringle Maneuver is used to stop bleeding from liver during trauma as well as during surgery* It occludes the inflow totally - bleeding stops from Hepatic artery and portal vein.* Pringle maneuver can be tolerated by normal liver for 60 minutes and only for 30 minutes in Cirrhotic liver. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Advantage of laparoscopic sterilization over mini-laparotomy sterilization is, with the following options: A: Less failure rate, B: Less blood loss, C: Very small scar, D: Easy procedure ### Response:

Mini-laparotomy Vs Laparoscopic sterilization FeaturesMinilaparotomyLaparoscopic sterilizationAdvantages Safe, effective and convenient methodDone as outpatient procedureDone with minimal trainingDone in peripheral setting (PHCs and Camps)Used for mass sterilization for population controlDoes not need special training.Does not need special equipmentCan be performed during puerperium, after aboionCan be done for interval sterilizationEffective method of contraception (as effective as minilap).Very low complication rate.Can be done as outpatient procedure.Can be done in peripheral setting (PHCs and Camps).Very small scar.Postoperative pain and discomfo minimal.Daycare procedure (Patient can be discharged on the same day).Shoer convalescence.Highly reversible (when done with clips).Disadvantages High chances of wound and pelvic infectionsLonger duration and severity of postoperative painLonger convalescenceLonger incisional scarComplication rate is low, but it occurs, can be life-threatening.Costly equipment.Requires specially trained expes.(Refer: Shaw&;s Textbook of Gynaecology, 15th edition, pg no: 240)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Advantage of laparoscopic sterilization over mini-laparotomy sterilization is, with the following options: A: Less failure rate, B: Less blood loss, C: Very small scar, D: Easy procedure ### Response: Mini-laparotomy Vs Laparoscopic sterilization FeaturesMinilaparotomyLaparoscopic sterilizationAdvantages Safe, effective and convenient methodDone as outpatient procedureDone with minimal trainingDone in peripheral setting (PHCs and Camps)Used for mass sterilization for population controlDoes not need special training.Does not need special equipmentCan be performed during puerperium, after aboionCan be done for interval sterilizationEffective method of contraception (as effective as minilap).Very low complication rate.Can be done as outpatient procedure.Can be done in peripheral setting (PHCs and Camps).Very small scar.Postoperative pain and discomfo minimal.Daycare procedure (Patient can be discharged on the same day).Shoer convalescence.Highly reversible (when done with clips).Disadvantages High chances of wound and pelvic infectionsLonger duration and severity of postoperative painLonger convalescenceLonger incisional scarComplication rate is low, but it occurs, can be life-threatening.Costly equipment.Requires specially trained expes.(Refer: Shaw&;s Textbook of Gynaecology, 15th edition, pg no: 240) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common site for bone metastasis in carcinoma of the breast in women is:, with the following options: A: Skull, B: Ribs, C: Spine, D: Pelvis ### Response:

(C) Spine > It is by this route that skeletal metastases occur, although the initial spread may be via the lymphatic system. In order of frequency the lumbar vertebrae, femur, thoracic vertebrae, rib and skull are affected and these deposits are generally osteolytic.> Metastases may also commonly occur in the liver, lungs and brain and, occasionally, the adrenal glands and ovaries; they have, in fact, been described in most body sites.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common site for bone metastasis in carcinoma of the breast in women is:, with the following options: A: Skull, B: Ribs, C: Spine, D: Pelvis ### Response: (C) Spine > It is by this route that skeletal metastases occur, although the initial spread may be via the lymphatic system. In order of frequency the lumbar vertebrae, femur, thoracic vertebrae, rib and skull are affected and these deposits are generally osteolytic.> Metastases may also commonly occur in the liver, lungs and brain and, occasionally, the adrenal glands and ovaries; they have, in fact, been described in most body sites. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Nerve damaged in radical mastoidectomy is -, with the following options: A: Facial, B: Cochlear, C: Vestibular, D: All ### Response:

Complications of radical mastoidectomy Injury to facial nerve Dislocation of incus Injury to horizontal semicircular canal. The patient will have post-operative giddiness and nystagmus. Injury to sigmoid sinus with profuse bleeding. Injury to the dura of middle cranial fossa.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Nerve damaged in radical mastoidectomy is -, with the following options: A: Facial, B: Cochlear, C: Vestibular, D: All ### Response: Complications of radical mastoidectomy Injury to facial nerve Dislocation of incus Injury to horizontal semicircular canal. The patient will have post-operative giddiness and nystagmus. Injury to sigmoid sinus with profuse bleeding. Injury to the dura of middle cranial fossa. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 5 year old female patient complains of deformed shape of legs. Patient is a strict vegetarian. Lab investigations reveal elevated levels of alkaline phosphatase. This patient is suffering from deficiency of a vitamin whose recommended dietary allowance is-, with the following options: A: 300IU, B: 400IU, C: 500IU, D: 600IU ### Response:

Deficiency of vitamin D causes rickets in children and osteomalacia in adults. The weight bearing bones are bent to form bow-legs.  In rickets, the plasma level of calcitriol  is  decreased  and  alkaline phosphatase  activity  is  elevated. The daily requirement of vitamin D is 400IU or 10 mg of cholecalciferol. Satyanarayana- Biochemistry, 3rd edition, pg-127

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 5 year old female patient complains of deformed shape of legs. Patient is a strict vegetarian. Lab investigations reveal elevated levels of alkaline phosphatase. This patient is suffering from deficiency of a vitamin whose recommended dietary allowance is-, with the following options: A: 300IU, B: 400IU, C: 500IU, D: 600IU ### Response: Deficiency of vitamin D causes rickets in children and osteomalacia in adults. The weight bearing bones are bent to form bow-legs.  In rickets, the plasma level of calcitriol  is  decreased  and  alkaline phosphatase  activity  is  elevated. The daily requirement of vitamin D is 400IU or 10 mg of cholecalciferol. Satyanarayana- Biochemistry, 3rd edition, pg-127 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 25–year old male gives a history of redness, pain and mild diminished vision in one eye for past 3 days. There is also a history of a low backache for the past one year. On examination, there is circumcorneal congestion, the cornea is clear apart from a few fine keratic precipitates on the corneal endothelium, there are 2+ cells in the anterior chamber and the intraocular pressure is within normal limits. The patient is most likely suffering from –, with the following options: A: Acute attack of angle closure glaucoma, B: HLA B–27 related anterior uveitis, C: JRA associated uveitis, D: Herpetic keratitis ### Response:

Information in this question are :- Age → 25 years A low backache (most likely due to sacroiliitis) Circumcorneal congestion, KPs, aqueous cells (2 + cells in anterior chamber) Normal intraocular tension The diagnosis is anterior uveitis. A most common cause of anterior uveitis in young adults is HLA-B27 associated uveitis (ankylosing spondylitis). Low back pain (due to sacroiliitis) further supports the diagnosis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 25–year old male gives a history of redness, pain and mild diminished vision in one eye for past 3 days. There is also a history of a low backache for the past one year. On examination, there is circumcorneal congestion, the cornea is clear apart from a few fine keratic precipitates on the corneal endothelium, there are 2+ cells in the anterior chamber and the intraocular pressure is within normal limits. The patient is most likely suffering from –, with the following options: A: Acute attack of angle closure glaucoma, B: HLA B–27 related anterior uveitis, C: JRA associated uveitis, D: Herpetic keratitis ### Response: Information in this question are :- Age → 25 years A low backache (most likely due to sacroiliitis) Circumcorneal congestion, KPs, aqueous cells (2 + cells in anterior chamber) Normal intraocular tension The diagnosis is anterior uveitis. A most common cause of anterior uveitis in young adults is HLA-B27 associated uveitis (ankylosing spondylitis). Low back pain (due to sacroiliitis) further supports the diagnosis. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following inhalational agent sensitizes myocardium to catecholamine, with the following options: A: Sevoflurane, B: Isoflurane, C: Ether, D: Alothane ### Response:

Some inhalational agent sensitize the hea to adrenaline -Arrhythmias can occur -therefore these agents are contraindicated in Pheochromocytoma and along with adrenalinHalothane has maximum propensityOther agents sensitizing the hea to adrenaline are Trilene, Cyclopropane, Chloroform, Enflurane(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 167 - 169)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following inhalational agent sensitizes myocardium to catecholamine, with the following options: A: Sevoflurane, B: Isoflurane, C: Ether, D: Alothane ### Response: Some inhalational agent sensitize the hea to adrenaline -Arrhythmias can occur -therefore these agents are contraindicated in Pheochromocytoma and along with adrenalinHalothane has maximum propensityOther agents sensitizing the hea to adrenaline are Trilene, Cyclopropane, Chloroform, Enflurane(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 167 - 169) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A patient is known to have calcium nephrocalcinosis for the post 10 years. All of the following dietary recommendations should be suggested, Except:, with the following options: A: Protein Restriction, B: Calcium Restriction, C: Calcium Restriction, D: All of the above ### Response:

Answer is B (Calcium Restriction): Low protein, Low sodium and Normal Calcium diet is recommended for patients with calcium nephrolithiasis Dietry Intervention in patients with Calcium Nephrolithiasis Dietary intervention plays a cardinal role in the preventive treatment of calcium nephrolithiasis. Studies have shown that a low protein, low salt diet significantly reduces nephrolithiasis recurrence rates in patients with idiopathic hypercalciuria. Long term dietary compliance with a low protein, low salt diet has been shown to be superior to a low calcium diet in prevention of nephrolithiasis. A low calcium diet may increase the intestinal absorption of oxalate reducing the effectiveness of this therapy. Therefore low calcium diets are not recommended. Diets containing 700 to 800 mg of calcium are adequate for patients with idiopathic hypercalciuria. Low protein diets reduce purine intake, resulting in reduced systemic acid and uric acid loads. Low sodium diets reduce the amount of calcium in urine' - The Washington Manual Nephrology Subspecialty Consult' 2nd/245

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A patient is known to have calcium nephrocalcinosis for the post 10 years. All of the following dietary recommendations should be suggested, Except:, with the following options: A: Protein Restriction, B: Calcium Restriction, C: Calcium Restriction, D: All of the above ### Response: Answer is B (Calcium Restriction): Low protein, Low sodium and Normal Calcium diet is recommended for patients with calcium nephrolithiasis Dietry Intervention in patients with Calcium Nephrolithiasis Dietary intervention plays a cardinal role in the preventive treatment of calcium nephrolithiasis. Studies have shown that a low protein, low salt diet significantly reduces nephrolithiasis recurrence rates in patients with idiopathic hypercalciuria. Long term dietary compliance with a low protein, low salt diet has been shown to be superior to a low calcium diet in prevention of nephrolithiasis. A low calcium diet may increase the intestinal absorption of oxalate reducing the effectiveness of this therapy. Therefore low calcium diets are not recommended. Diets containing 700 to 800 mg of calcium are adequate for patients with idiopathic hypercalciuria. Low protein diets reduce purine intake, resulting in reduced systemic acid and uric acid loads. Low sodium diets reduce the amount of calcium in urine' - The Washington Manual Nephrology Subspecialty Consult' 2nd/245 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Supports of uterus are all except, with the following options: A: Uterosacral ligaments, B: Mackenrodt's ligament, C: Broad ligament, D: Levatorani ### Response:

Ans. C. Broad ligamentCLASSIFICATIONPrimary supportsa. Muscular or activei. Pelvic diaphragmii. Perineal bodyiii. Urogenital diaphragmb. Fibromuscular or mechanicali. Uterine axisii. Pub cervical ligamentiii. Transverse cervical ligamentiv. Uterosacral ligamentv. Round ligament of uterusSecondary supportsi. Broad ligamentsii. Uterovesical fold of peritoneumiii. Rectovaginal fold of peritoneum Broad Ligaments:These are folds of peritoneum which attach the uterus to the lateral pelvic wall, it has anterior and posterior surfaces and upper, lower, medial and lateral borders. It contains the following structures:Uterine tubei. Round lig. of uterusii. Lig. of ovaryiii. Uterine and ovarian plexus and nerve plexusiv. Epoophoron and paroophoronv. Lymphaticsvi. Connective tissue.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Supports of uterus are all except, with the following options: A: Uterosacral ligaments, B: Mackenrodt's ligament, C: Broad ligament, D: Levatorani ### Response: Ans. C. Broad ligamentCLASSIFICATIONPrimary supportsa. Muscular or activei. Pelvic diaphragmii. Perineal bodyiii. Urogenital diaphragmb. Fibromuscular or mechanicali. Uterine axisii. Pub cervical ligamentiii. Transverse cervical ligamentiv. Uterosacral ligamentv. Round ligament of uterusSecondary supportsi. Broad ligamentsii. Uterovesical fold of peritoneumiii. Rectovaginal fold of peritoneum Broad Ligaments:These are folds of peritoneum which attach the uterus to the lateral pelvic wall, it has anterior and posterior surfaces and upper, lower, medial and lateral borders. It contains the following structures:Uterine tubei. Round lig. of uterusii. Lig. of ovaryiii. Uterine and ovarian plexus and nerve plexusiv. Epoophoron and paroophoronv. Lymphaticsvi. Connective tissue. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: AFP is elevated in, with the following options: A: HCC, B: Infant hemangioendothelioma, C: Amoebic liver abscess, D: Embryonic sarcoma ### Response:

.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: AFP is elevated in, with the following options: A: HCC, B: Infant hemangioendothelioma, C: Amoebic liver abscess, D: Embryonic sarcoma ### Response: . ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The most common complication of intracapsular fracture neck of femur is, with the following options: A: Mal union, B: Osteoahritis, C: Non-Union, D: Shoening ### Response:

C i.e. Nonunion

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The most common complication of intracapsular fracture neck of femur is, with the following options: A: Mal union, B: Osteoahritis, C: Non-Union, D: Shoening ### Response: C i.e. Nonunion ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following gas is commonly used in laparoscopic procedures?, with the following options: A: Air, B: Pure 02, C: N20, D: C02 ### Response:

CO2 is used for insufflation during endoscopic procedures (e.g., laparoscopic surgery) because it is highly soluble and does not suppo combustion. Inadveent gas emboli thus are dissolved and eliminated more easily by the respiratory system. Ref: Patel P.M., Patel H.H., Roth D.M. (2011). Chapter 19. General Anesthetics and Therapeutic Gases. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following gas is commonly used in laparoscopic procedures?, with the following options: A: Air, B: Pure 02, C: N20, D: C02 ### Response: CO2 is used for insufflation during endoscopic procedures (e.g., laparoscopic surgery) because it is highly soluble and does not suppo combustion. Inadveent gas emboli thus are dissolved and eliminated more easily by the respiratory system. Ref: Patel P.M., Patel H.H., Roth D.M. (2011). Chapter 19. General Anesthetics and Therapeutic Gases. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Rapid fluid resuscitation of the hypovolemic patient after abdominal trauma is significantly enhanced by which of the following?, with the following options: A: Placement of long 18-gauge subclavian vein catheters, B: Placement of percutaneous femoral vein catheters, C: Bilateral saphenous vein cutdowns, D: Placement of short, large-bore percutaneous peripheral intravenous catheters ### Response:

Rapid fluid administration is often the key to successful trauma resuscitation. Some of the important factors affecting the rate of fluid resuscitation include the diameter of the intravenous tubing, the size and length of the venous cannulae, the fluid viscosity, and the site of administration. According to Poiseuille's law, flow is proportional to the fourth power of the radius of a catheter and inversely proportional to its length. Therefore, the shorter a catheter and the larger its diameter, the faster one can infuse a solution through it. Central venous placement alone does not assure rapid flow. Importantly, the diameter of the intravenous tubing employed may be the rate-determining factor in fluid delivery: blood-infusion tubing allows twice the flow of standard intravenous tubing and should be used when rapid fluid resuscitation is needed. Any patient who is suspected of having a major abdominal injury should immediately have at least two short, large-bore (16-gauge or larger) intravenous cannulae placed in peripheral veins. Longer, smaller catheters, such as standard 18-gauge central venous catheters, may take more time to place and will have lower flow rates. Once fluid resuscitation is under way, one may elect to place an 8- or 9-French pulmonary artery catheter-introducer via a central venous approach for further volume administration, as well as for measurement of central venous pressure or for Swan-Ganz catheter insertion. Lower-extremity venous cannulae, placed by saphenous vein cutdown or percutaneously into the femoral veins, are no longer advised as primary access for patients with abdominal trauma, since possible disruption of iliac veins or the inferior vena cava will render volume infusion ineffective. Studies have demonstrated that the flow rate of cold whole blood is roughly two-thirds that of whole blood at room temperature. Diluting and warming the blood by "piggybacking" it into infusion lines that are delivering crystalloid will decrease the blood's viscosity, enhance flow, and minimize hypothermia.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Rapid fluid resuscitation of the hypovolemic patient after abdominal trauma is significantly enhanced by which of the following?, with the following options: A: Placement of long 18-gauge subclavian vein catheters, B: Placement of percutaneous femoral vein catheters, C: Bilateral saphenous vein cutdowns, D: Placement of short, large-bore percutaneous peripheral intravenous catheters ### Response: Rapid fluid administration is often the key to successful trauma resuscitation. Some of the important factors affecting the rate of fluid resuscitation include the diameter of the intravenous tubing, the size and length of the venous cannulae, the fluid viscosity, and the site of administration. According to Poiseuille's law, flow is proportional to the fourth power of the radius of a catheter and inversely proportional to its length. Therefore, the shorter a catheter and the larger its diameter, the faster one can infuse a solution through it. Central venous placement alone does not assure rapid flow. Importantly, the diameter of the intravenous tubing employed may be the rate-determining factor in fluid delivery: blood-infusion tubing allows twice the flow of standard intravenous tubing and should be used when rapid fluid resuscitation is needed. Any patient who is suspected of having a major abdominal injury should immediately have at least two short, large-bore (16-gauge or larger) intravenous cannulae placed in peripheral veins. Longer, smaller catheters, such as standard 18-gauge central venous catheters, may take more time to place and will have lower flow rates. Once fluid resuscitation is under way, one may elect to place an 8- or 9-French pulmonary artery catheter-introducer via a central venous approach for further volume administration, as well as for measurement of central venous pressure or for Swan-Ganz catheter insertion. Lower-extremity venous cannulae, placed by saphenous vein cutdown or percutaneously into the femoral veins, are no longer advised as primary access for patients with abdominal trauma, since possible disruption of iliac veins or the inferior vena cava will render volume infusion ineffective. Studies have demonstrated that the flow rate of cold whole blood is roughly two-thirds that of whole blood at room temperature. Diluting and warming the blood by "piggybacking" it into infusion lines that are delivering crystalloid will decrease the blood's viscosity, enhance flow, and minimize hypothermia. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The most common site of brain metastasis is, with the following options: A: Cerebrum, B: Cerebellum, C: Medulla oblongata, D: Pons ### Response:

MC site of brain metastases (85%) CEREBRUM2nd MC site of brain metastases- CEREBELLUM LUNG, BREAST, MELANOMA (SKIN CANCER), COLON AND KIDNEY cancers commonly spread to the brain.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2460)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The most common site of brain metastasis is, with the following options: A: Cerebrum, B: Cerebellum, C: Medulla oblongata, D: Pons ### Response: MC site of brain metastases (85%) CEREBRUM2nd MC site of brain metastases- CEREBELLUM LUNG, BREAST, MELANOMA (SKIN CANCER), COLON AND KIDNEY cancers commonly spread to the brain.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2460) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Gastrojejernostomy surgery belongs to, with the following options: A: Clean surgery, B: Contaminated surgery, C: Clean contaminated surgery, D: Dirty surgery ### Response:

Clean contaminated surgery : Wound is exposed to not only skin but also GI tract / Respiratory tract / Urinary tract organism in controlled enviroment. Hence Gastrojejunostomy surjery belongs to this category.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Gastrojejernostomy surgery belongs to, with the following options: A: Clean surgery, B: Contaminated surgery, C: Clean contaminated surgery, D: Dirty surgery ### Response: Clean contaminated surgery : Wound is exposed to not only skin but also GI tract / Respiratory tract / Urinary tract organism in controlled enviroment. Hence Gastrojejunostomy surjery belongs to this category. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not related to epidemiology ?, with the following options: A: Promotion of health, B: Identification of etiology of disease, C: To collect data of magnitude of health problem, D: To teach a medical student how to conduct safe delivery ### Response:

Ans. is 'd' i.e., To teach a medical student how to conduct safe delivery According to the International Epidemiological Association (IEA), epidemiology has three main aims : a) To describe the distribution and magnitude of health and disease problems in human populations. b) To identify aetiological factors (risk factors) in the pathogenesis of disease; and c) To provide the data essential to the planning, implementation and evaluation of services for the prevention, control and treatment of disease and to the setting up of priorities among those services. In order to fulfil these aims, three rather different classes of epidemiological studies may be mentioned : descriptive studies, analytical studies, and experimental or intervention studies. The ultimate aim of epidemiology is to lead to effective action : a) To eliminate or reduce the health problem or its consequences; and b) To promote the health and well-being of society as a whole.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not related to epidemiology ?, with the following options: A: Promotion of health, B: Identification of etiology of disease, C: To collect data of magnitude of health problem, D: To teach a medical student how to conduct safe delivery ### Response: Ans. is 'd' i.e., To teach a medical student how to conduct safe delivery According to the International Epidemiological Association (IEA), epidemiology has three main aims : a) To describe the distribution and magnitude of health and disease problems in human populations. b) To identify aetiological factors (risk factors) in the pathogenesis of disease; and c) To provide the data essential to the planning, implementation and evaluation of services for the prevention, control and treatment of disease and to the setting up of priorities among those services. In order to fulfil these aims, three rather different classes of epidemiological studies may be mentioned : descriptive studies, analytical studies, and experimental or intervention studies. The ultimate aim of epidemiology is to lead to effective action : a) To eliminate or reduce the health problem or its consequences; and b) To promote the health and well-being of society as a whole. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following actions of aspirin is manifested at the lowest dose?, with the following options: A: Analgesic, B: Antipyretic, C: Anti-inflammatory, D: Antiplatelet aggregatory ### Response:

Aspirin can produce dose dependent effects. Antiplatelet action is seen at lowest doses (40-325 mg). Anti-inflammatory action require the highest doses.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following actions of aspirin is manifested at the lowest dose?, with the following options: A: Analgesic, B: Antipyretic, C: Anti-inflammatory, D: Antiplatelet aggregatory ### Response: Aspirin can produce dose dependent effects. Antiplatelet action is seen at lowest doses (40-325 mg). Anti-inflammatory action require the highest doses. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Shoest acting local anaesthetic, with the following options: A: Procaine, B: Xylocaine, C: Bupivacaine, D: Chloroprocaine ### Response:

.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Shoest acting local anaesthetic, with the following options: A: Procaine, B: Xylocaine, C: Bupivacaine, D: Chloroprocaine ### Response: . ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: During USG, fetal abdominal circumference is measured at the level of:, with the following options: A: Stomach and umbilical vein, perpendicular to spine, B: Kidneys, C: Stomach parallel to spine, D: Liver and spleen ### Response:

Ans. is a, i.e Stomach and umbilical vein, perpendicular to the spineRef. Williams 24/e, p 198The abdominal circumference is measured at a transverse plane (i.e. plane perpendicular to fetal spine) at the level of stomach and conference of the umbilical vein with the portal sinus.It is an indicator of fetal growth, hence is an indicator of IUGR/macrosomia in fetus.Note: Biparietal diameter: is measured in transthalamic view at the level of thalamic and cavut septum pellucidum (CSP), from the outer edge of the skull to inner edge of the distal skull.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: During USG, fetal abdominal circumference is measured at the level of:, with the following options: A: Stomach and umbilical vein, perpendicular to spine, B: Kidneys, C: Stomach parallel to spine, D: Liver and spleen ### Response: Ans. is a, i.e Stomach and umbilical vein, perpendicular to the spineRef. Williams 24/e, p 198The abdominal circumference is measured at a transverse plane (i.e. plane perpendicular to fetal spine) at the level of stomach and conference of the umbilical vein with the portal sinus.It is an indicator of fetal growth, hence is an indicator of IUGR/macrosomia in fetus.Note: Biparietal diameter: is measured in transthalamic view at the level of thalamic and cavut septum pellucidum (CSP), from the outer edge of the skull to inner edge of the distal skull. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common cause of rubeosis iridis, with the following options: A: Tumor, B: CRAO, C: Radiation retinopathy, D: Diabetic retinopathy ### Response:

it develops following retinal ischemia which is a common feature of: ●proliferative diabetic retinopathy ●central retinal vein occlusion ●sickle cell retinopathy ●Eale's disease

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common cause of rubeosis iridis, with the following options: A: Tumor, B: CRAO, C: Radiation retinopathy, D: Diabetic retinopathy ### Response: it develops following retinal ischemia which is a common feature of: ●proliferative diabetic retinopathy ●central retinal vein occlusion ●sickle cell retinopathy ●Eale's disease ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: 26 year old female underwent hysterosalpingogram for the investigation of infeility. She has a previous history of tuberculosis. If she had developed genital tuberculosis, which genital organ will be affected commonly?, with the following options: A: Cervix, B: Ovary, C: Fallopian tube, D: Vagina ### Response:

The primary focus of genital tuberculosis is the fallopian tubes (90% of the times), which are almost always affected bilaterally but not symmetrically. The tubes are thickened and show a rough external surface with adhesions. As tuberculosis heals, the entire tube becomes encased in heavy connective scar tissue and the lumen develops a beaded, rigid pipe stem appearance. The obstruction of the tube most frequently occurs in the region of transition between the isthmus and the ampulla.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: 26 year old female underwent hysterosalpingogram for the investigation of infeility. She has a previous history of tuberculosis. If she had developed genital tuberculosis, which genital organ will be affected commonly?, with the following options: A: Cervix, B: Ovary, C: Fallopian tube, D: Vagina ### Response: The primary focus of genital tuberculosis is the fallopian tubes (90% of the times), which are almost always affected bilaterally but not symmetrically. The tubes are thickened and show a rough external surface with adhesions. As tuberculosis heals, the entire tube becomes encased in heavy connective scar tissue and the lumen develops a beaded, rigid pipe stem appearance. The obstruction of the tube most frequently occurs in the region of transition between the isthmus and the ampulla. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Arrange following structures as pierced by spinal needle during spinal block (from outside to inside) i) Interspinous ligaments ii) Ligamentum flavum iii) Supra spinous ligament iv) Epidural space, with the following options: A: (i), (ii), (iii), (iv), B: (ii), (iv), (i), (iii), C: (iii), (i), (ii), (iv), D: (ii), (iii), (i), (iv) ### Response:

Structures as pierced by spinal needle during spinal block (from outside to inside): iii)Supra spinous ligament i) Interspinous ligaments ii) Ligamentum flavum iv) Epidural space

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Arrange following structures as pierced by spinal needle during spinal block (from outside to inside) i) Interspinous ligaments ii) Ligamentum flavum iii) Supra spinous ligament iv) Epidural space, with the following options: A: (i), (ii), (iii), (iv), B: (ii), (iv), (i), (iii), C: (iii), (i), (ii), (iv), D: (ii), (iii), (i), (iv) ### Response: Structures as pierced by spinal needle during spinal block (from outside to inside): iii)Supra spinous ligament i) Interspinous ligaments ii) Ligamentum flavum iv) Epidural space ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following represents the clinical presentation of a patient with critical lower limb ischemia?, with the following options: A: Intermittent Claudication, B: Intermittent Claudication and gangrene, C: Rest pain and ischemic ulcers, D: Intermittent claudication and ischemic ulcers ### Response:

Patient with critical limb ischemia has insufficient perfusion to sustain limb at rest, if left untreated such patients require amputation in 6 months. They experience pain at rest, ulcers and ischemic gangrene. Rest pain is exacerbated when lying supine and is improved by dangling the feet. Narcotics can also relieve the pain. Ref: Noninvasive Cardiovascular Imaging: A Multimodality Approach By Mario J. Garcia, Page 123; Schwaz's Principles of Surgery, 9th Edition, Chapter 23

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following represents the clinical presentation of a patient with critical lower limb ischemia?, with the following options: A: Intermittent Claudication, B: Intermittent Claudication and gangrene, C: Rest pain and ischemic ulcers, D: Intermittent claudication and ischemic ulcers ### Response: Patient with critical limb ischemia has insufficient perfusion to sustain limb at rest, if left untreated such patients require amputation in 6 months. They experience pain at rest, ulcers and ischemic gangrene. Rest pain is exacerbated when lying supine and is improved by dangling the feet. Narcotics can also relieve the pain. Ref: Noninvasive Cardiovascular Imaging: A Multimodality Approach By Mario J. Garcia, Page 123; Schwaz's Principles of Surgery, 9th Edition, Chapter 23 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: An investigator finds out that 5 independent factors influence the occurrence of a disease. Comparison of multiple factors that are responsible for the disease can be assessed by, with the following options: A: Multiple logistic regression, B: Multiple linear regression, C: Chi-square test, D: ANOVA ### Response:

• ANOVA: Analysis of Variance is a parametric test used for polyotomous independent variable • Chi-square test: Is non-parametric test used for testing association between 2 or more qualitative variables • Multiple linear regression: Is used if the target variables are dimensional having multiple possible values (e.g. blood pressure, serum cholesterol, body temperature) • Multiple logistic regression: Is used if the target variables are binary having only two possible values (e.g. hypertension, smoking, geriatric age group)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: An investigator finds out that 5 independent factors influence the occurrence of a disease. Comparison of multiple factors that are responsible for the disease can be assessed by, with the following options: A: Multiple logistic regression, B: Multiple linear regression, C: Chi-square test, D: ANOVA ### Response: • ANOVA: Analysis of Variance is a parametric test used for polyotomous independent variable • Chi-square test: Is non-parametric test used for testing association between 2 or more qualitative variables • Multiple linear regression: Is used if the target variables are dimensional having multiple possible values (e.g. blood pressure, serum cholesterol, body temperature) • Multiple logistic regression: Is used if the target variables are binary having only two possible values (e.g. hypertension, smoking, geriatric age group) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following are true about diffuse axonal injuries except:, with the following options: A: Injuries to axons by shearing force, B: Most common location is lobar white matter at the junction of grey and white matter, C: Associated with raised ICT in all the cases, D: MRI is investigation of choice ### Response:

DIFFUSE AXONAL INJURIES (DAI) - DAI represents the presence of widespread axonal damage (white matter)in both hemispheres secondary to serve head injury. - Results from application of severe acceleration/ deceleration or angular strain to the brain (injuries to axons by shering force) - MC location: Lobar white matter at the junction of grey and white matter>Corpus callosum> Brain stem - Loss of conscciousness is a common finding - DAI: MC cause of post-traumatic vegetative state - Raised ICT may or may not be associated - MRI is IOC for DAI(better than CT scan).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following are true about diffuse axonal injuries except:, with the following options: A: Injuries to axons by shearing force, B: Most common location is lobar white matter at the junction of grey and white matter, C: Associated with raised ICT in all the cases, D: MRI is investigation of choice ### Response: DIFFUSE AXONAL INJURIES (DAI) - DAI represents the presence of widespread axonal damage (white matter)in both hemispheres secondary to serve head injury. - Results from application of severe acceleration/ deceleration or angular strain to the brain (injuries to axons by shering force) - MC location: Lobar white matter at the junction of grey and white matter>Corpus callosum> Brain stem - Loss of conscciousness is a common finding - DAI: MC cause of post-traumatic vegetative state - Raised ICT may or may not be associated - MRI is IOC for DAI(better than CT scan). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 40 year old male presented with sudden onset of severe chest pain radiating to the left upper arm. ECG was suggestive of myocardial infarction. Investigations revealed poor blood supply to the anterior 2/3rd of the interventricular septuum. Which of the following blood vessels is most likely to be blocked, with the following options: A: Right coronary aery, B: Left coronary aery, C: Posterior interventricular aery, D: Marginal aery ### Response:

The anterior 2/3rd of the interventricular septum is supplied by the left coronary aery. The right coronary aery distribution supplies Right atrium Right Ventricle ( except a small region to the right of the anterior interventricular groove ) A variable paof the diaphragmatic aspect of the left ventricle. Posteroinferior 1/3rd of the interventricular septum. Pa of the left atrium. The conduction system as far as the proximal pas of the right and left crura. The left coronary aery distribution supplies Left atrium Left ventricle A narrow strip of the right ventricle. The anterior 2/3rd of the interventricular septum Ref: Gray&;s Anatomy 41st edition Pgno: 1019

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 40 year old male presented with sudden onset of severe chest pain radiating to the left upper arm. ECG was suggestive of myocardial infarction. Investigations revealed poor blood supply to the anterior 2/3rd of the interventricular septuum. Which of the following blood vessels is most likely to be blocked, with the following options: A: Right coronary aery, B: Left coronary aery, C: Posterior interventricular aery, D: Marginal aery ### Response: The anterior 2/3rd of the interventricular septum is supplied by the left coronary aery. The right coronary aery distribution supplies Right atrium Right Ventricle ( except a small region to the right of the anterior interventricular groove ) A variable paof the diaphragmatic aspect of the left ventricle. Posteroinferior 1/3rd of the interventricular septum. Pa of the left atrium. The conduction system as far as the proximal pas of the right and left crura. The left coronary aery distribution supplies Left atrium Left ventricle A narrow strip of the right ventricle. The anterior 2/3rd of the interventricular septum Ref: Gray&;s Anatomy 41st edition Pgno: 1019 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Feature(s) of Taenia capitis is/are all except:, with the following options: A: May presents as a boggy swelling, B: Most commonly occurs in elderly, C: May present as black dot, D: Caused by trichophyton & microsporum but not by epidermophyton ### Response:

Ans: B (Most...) "ScutuluirrThe characteristic lesion of favus, appearing as a yellow saucershaped crust made up ofhyphae and spores."- dictionary.thefreedictionary.comTINEA CAPITIS AND TINEA BARBAE iVeena khanna3rd/244T.capitis - caused by microsporum any species & Trichophyton most species- Ananthanarayan 8^/606Tinea capitis is dermatophytosis or ringworm of the scalp and hair.Age: invariably a child3 Pattern are recognized: Non-inflammatory( broken hair present zls gray/black dot), inf]ammatory(kerion-pnesenf as a boggy swelling with multiple discharging sinus) & Favi/s(cause cicatrical alopecia)As the hair grows out of the follicle, the hyphae of microsporum species produce a chain of spores that form a sheath around the hair shaft (ectothrix). These spores impart a greenish to silvery fluorescence when the hairs are examined under Wood's light (365 nm).In contrast, T tonsurans, the chief cause of *black dot" tinea capitis, produces spores within the hair shaft (endothrix). These hairs do not fluoresce; they are weakened and typically break easily at the follicular opening. In prepubescent children, epidemic tinea capitis is usually self-limiting.Zoophilic species may induce a severe combined inflammatory and hypersensitivity reaction called a kerion.Another manifestation of tinea capitis is favus, an acute inflammatory infection of the hair follicle caused by T schoenleinii, which leads to the formation of scutula (crusts) around the follicle. In favic hairs, the hyphae do not form spores but can be found within the hair shaft.Table :Some Clinical Features of Dermatophyte InfectionSkin DiseaseLocation of LesionsClinicalFungiTinea corporis (ringworm)Nonhairy, smooth skin.Circular patches with advancing red, vesiculated border and central scaling. Pruritic.T rubrum, E floccosumTinea pedis1 (athlete's foot)Interdigital spaces on feet of persons wearing shoes.Acute: itching, red vesicular. Chronic: itching, scaling, fissures.T rubrum, T mentagrophytes, E floccosumTinea cruris (jock itch)Groin.Erythematous scaling lesion in intertriginous area. PruriticT rubrum, T mentagrophytes, E floccosumTinea capitisScalp hair. Endothrix: fungus inside hair shaft. Ectothrix: fungus on surface of hair.Circular bald patches with short hair stubs or broken hair within hair follicles. Kerion rare. Microsporum- infected hairs fluoresce.Tmentagrophytes, M canisTinea barbaeBeard hair.Edematous, erythematous lesion.T mentagrophytesTinea unguium (onychomycosis)Nail.Nails thickened or crumbling distally; discolored; lusterless.Usually associated with tinea pedis.T rubrum, T mentagrophytes, E floccosumDermatophytid (id reaction)Usually sides and flexor aspects of fingers. Palm. Any site on body.Pruritic vesicular to bullous lesions. Most commonly associated with tinea pedis.No fungi present in lesion.May become secondarily infected with bacteria.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Feature(s) of Taenia capitis is/are all except:, with the following options: A: May presents as a boggy swelling, B: Most commonly occurs in elderly, C: May present as black dot, D: Caused by trichophyton & microsporum but not by epidermophyton ### Response: Ans: B (Most...) "ScutuluirrThe characteristic lesion of favus, appearing as a yellow saucershaped crust made up ofhyphae and spores."- dictionary.thefreedictionary.comTINEA CAPITIS AND TINEA BARBAE iVeena khanna3rd/244T.capitis - caused by microsporum any species & Trichophyton most species- Ananthanarayan 8^/606Tinea capitis is dermatophytosis or ringworm of the scalp and hair.Age: invariably a child3 Pattern are recognized: Non-inflammatory( broken hair present zls gray/black dot), inf]ammatory(kerion-pnesenf as a boggy swelling with multiple discharging sinus) & Favi/s(cause cicatrical alopecia)As the hair grows out of the follicle, the hyphae of microsporum species produce a chain of spores that form a sheath around the hair shaft (ectothrix). These spores impart a greenish to silvery fluorescence when the hairs are examined under Wood's light (365 nm).In contrast, T tonsurans, the chief cause of *black dot" tinea capitis, produces spores within the hair shaft (endothrix). These hairs do not fluoresce; they are weakened and typically break easily at the follicular opening. In prepubescent children, epidemic tinea capitis is usually self-limiting.Zoophilic species may induce a severe combined inflammatory and hypersensitivity reaction called a kerion.Another manifestation of tinea capitis is favus, an acute inflammatory infection of the hair follicle caused by T schoenleinii, which leads to the formation of scutula (crusts) around the follicle. In favic hairs, the hyphae do not form spores but can be found within the hair shaft.Table :Some Clinical Features of Dermatophyte InfectionSkin DiseaseLocation of LesionsClinicalFungiTinea corporis (ringworm)Nonhairy, smooth skin.Circular patches with advancing red, vesiculated border and central scaling. Pruritic.T rubrum, E floccosumTinea pedis1 (athlete's foot)Interdigital spaces on feet of persons wearing shoes.Acute: itching, red vesicular. Chronic: itching, scaling, fissures.T rubrum, T mentagrophytes, E floccosumTinea cruris (jock itch)Groin.Erythematous scaling lesion in intertriginous area. PruriticT rubrum, T mentagrophytes, E floccosumTinea capitisScalp hair. Endothrix: fungus inside hair shaft. Ectothrix: fungus on surface of hair.Circular bald patches with short hair stubs or broken hair within hair follicles. Kerion rare. Microsporum- infected hairs fluoresce.Tmentagrophytes, M canisTinea barbaeBeard hair.Edematous, erythematous lesion.T mentagrophytesTinea unguium (onychomycosis)Nail.Nails thickened or crumbling distally; discolored; lusterless.Usually associated with tinea pedis.T rubrum, T mentagrophytes, E floccosumDermatophytid (id reaction)Usually sides and flexor aspects of fingers. Palm. Any site on body.Pruritic vesicular to bullous lesions. Most commonly associated with tinea pedis.No fungi present in lesion.May become secondarily infected with bacteria. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 64-year-old man develops increasing dysphagia over many months. A barium swallow is performed. What is the most likely cause of his clinical presentation?, with the following options: A: Carcinoma of the esophagus, B: Achalasia, C: Sliding hiatal hernia, D: Paraoesophageal hernia ### Response:

The appearance of unexplained dysphagia in adults requires urgent evaluation. Esophageal carcinoma is particularly prevalent in certain parts of Africa and Asia, but the incidence is increasing in Western countries. In achalasia there is initially a greater tolerance for solids over liquids. In carcinoma, dysphagia for solids is noted initially, and later there is difficulty in swallowing liquids as well. Esophagoscopy is required in the workup of dysphagia. It is imperative to rule out an underlying carcinoma.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 64-year-old man develops increasing dysphagia over many months. A barium swallow is performed. What is the most likely cause of his clinical presentation?, with the following options: A: Carcinoma of the esophagus, B: Achalasia, C: Sliding hiatal hernia, D: Paraoesophageal hernia ### Response: The appearance of unexplained dysphagia in adults requires urgent evaluation. Esophageal carcinoma is particularly prevalent in certain parts of Africa and Asia, but the incidence is increasing in Western countries. In achalasia there is initially a greater tolerance for solids over liquids. In carcinoma, dysphagia for solids is noted initially, and later there is difficulty in swallowing liquids as well. Esophagoscopy is required in the workup of dysphagia. It is imperative to rule out an underlying carcinoma. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Specific gravity of CSF is?, with the following options: A: 1.003 - 1.008, B: 1.006 - 1.009, C: 1.001 - 1.003, D: 1.010 - 1.013 ### Response:

1.006 -- 1.009 REF: Ganong's 22" ed p. 613 Specific gravity of CSF is 1.006 -- 1.009

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Specific gravity of CSF is?, with the following options: A: 1.003 - 1.008, B: 1.006 - 1.009, C: 1.001 - 1.003, D: 1.010 - 1.013 ### Response: 1.006 -- 1.009 REF: Ganong's 22" ed p. 613 Specific gravity of CSF is 1.006 -- 1.009 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 40 yr. old male patient presented with chronic history of breathlessness and intermittent jaundice. He denies any smoking and alcohol abuse. Lung and liver specimens revealed the following findings respectively Which of the following pooled plasma human concentrates have been approved for the above condition: -, with the following options: A: Prolastin, B: Aralast, C: Zamaira, D: All of the above ### Response:

The lung specimen reveals diffusive panacinar emphysema. The liver biopsy shows PAS positive diastase resistant deposits. Both the above clues point towards option C. Human plasma concentrates approved are: - A. Prolastin B. Aralast C. Zamaira

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 40 yr. old male patient presented with chronic history of breathlessness and intermittent jaundice. He denies any smoking and alcohol abuse. Lung and liver specimens revealed the following findings respectively Which of the following pooled plasma human concentrates have been approved for the above condition: -, with the following options: A: Prolastin, B: Aralast, C: Zamaira, D: All of the above ### Response: The lung specimen reveals diffusive panacinar emphysema. The liver biopsy shows PAS positive diastase resistant deposits. Both the above clues point towards option C. Human plasma concentrates approved are: - A. Prolastin B. Aralast C. Zamaira ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Drug of choice for Mycoplasma pneumoniae is :, with the following options: A: Penicillin, B: Tetracycline, C: Cefuroxime, D: Erythromycin ### Response:

Answer is D (Erythromycin):

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Drug of choice for Mycoplasma pneumoniae is :, with the following options: A: Penicillin, B: Tetracycline, C: Cefuroxime, D: Erythromycin ### Response: Answer is D (Erythromycin): ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Effective leprosy control programme may be indicated bn all of the following except ?, with the following options: A: Increasing number of children affected, B: Decreased grade 2 disability, C: Low MDR resistant, multibacillary cases, D: High new case detection rate ### Response:

Ans. is 'a' i.e. Increasing number of children affected' FNaluation of programme: here are two main types of indicators in leprosy control a) Operational indicators These are related to case-finding, treatment, relapses & disabilities for e.g. o Relapse rate - One of the best indicators of the efficacy of drug regimen o Case detection ratio - No. of cases registered / no. of cases estimated. o Propoion of children among newly detected cases. o Propoion of multibacillary cases on regular treatment during the year. o Propoion of female cases among newly detected cases. o Treatment completion/cure rate. o Propoion of new cases presenting with grade 2 disability/impairment at the time of diagnosis. o Propoion of treatment defaulters. o Propoion of patients who develop new/additional disability during MDT. b) Epidemiological indicators: To assess the impact of the actions taken with regard to the problem reduction. o Incidence rate - most sensitive index of transmission of disease. Only index for measuring the effectiveness of the measure taken i.e. reduction of transmission. o Prevalence - This provides a measure of case load & is useful in planning of the treatment services. High new case detection rate comes under operational indicators which shows that the Leprosy Control Programme is effective in detecting new cases from the already pool of leprosy cases. Thus these new cases could be treated to reduce fuher transmission of disease.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Effective leprosy control programme may be indicated bn all of the following except ?, with the following options: A: Increasing number of children affected, B: Decreased grade 2 disability, C: Low MDR resistant, multibacillary cases, D: High new case detection rate ### Response: Ans. is 'a' i.e. Increasing number of children affected' FNaluation of programme: here are two main types of indicators in leprosy control a) Operational indicators These are related to case-finding, treatment, relapses & disabilities for e.g. o Relapse rate - One of the best indicators of the efficacy of drug regimen o Case detection ratio - No. of cases registered / no. of cases estimated. o Propoion of children among newly detected cases. o Propoion of multibacillary cases on regular treatment during the year. o Propoion of female cases among newly detected cases. o Treatment completion/cure rate. o Propoion of new cases presenting with grade 2 disability/impairment at the time of diagnosis. o Propoion of treatment defaulters. o Propoion of patients who develop new/additional disability during MDT. b) Epidemiological indicators: To assess the impact of the actions taken with regard to the problem reduction. o Incidence rate - most sensitive index of transmission of disease. Only index for measuring the effectiveness of the measure taken i.e. reduction of transmission. o Prevalence - This provides a measure of case load & is useful in planning of the treatment services. High new case detection rate comes under operational indicators which shows that the Leprosy Control Programme is effective in detecting new cases from the already pool of leprosy cases. Thus these new cases could be treated to reduce fuher transmission of disease. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Ascaris lumbricoides is:, with the following options: A: Ascaris lumbricoides is:, B: Cestode, C: Protozoa, D: Trematode ### Response:

Nematode

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Ascaris lumbricoides is:, with the following options: A: Ascaris lumbricoides is:, B: Cestode, C: Protozoa, D: Trematode ### Response: Nematode ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following testicular carcinoma is not germ cell tumor -, with the following options: A: Embryonal cell carcinoma, B: Teratoma, C: Choriocarcinoma, D: Gonadoblastoma ### Response:

Ans. is 'd' i.e., Gonadoblastoma

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following testicular carcinoma is not germ cell tumor -, with the following options: A: Embryonal cell carcinoma, B: Teratoma, C: Choriocarcinoma, D: Gonadoblastoma ### Response: Ans. is 'd' i.e., Gonadoblastoma ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: any behaviour that is assosiated with aversive response is not repeated in future, what is the line of therapy, with the following options: A: mentalization therapy, B: behavioural therapy, C: activity sheduling, D: interpersonal therapy ### Response:

Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: any behaviour that is assosiated with aversive response is not repeated in future, what is the line of therapy, with the following options: A: mentalization therapy, B: behavioural therapy, C: activity sheduling, D: interpersonal therapy ### Response: Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Infection with colitis is caused by -, with the following options: A: Enterobius vermicularis, B: Trichuris trichura, C: Strongyliodes, D: Clonorchis ### Response:

STRONGYLOIDES The clinical disease may be classified as cutaneous, pulmonary and intestinal. The overwhelming severe disease seen in the immunocompromised is known as hyperinfection. Cutaneous There may be a dermatitis, with erythema and itching at the site of penetration of the filariform larvae, paicularly when large numbers of larvae enter the skin. In those sensitised by prior infection, there may be an allergic response. This may prevent circulation in the blood of the larvae, which may instead migrate in skin, leading to a form of creeping eruption or larva migrans. Pulmonary During escape of the larvae from the pulmonary capillaries into the alveoli, small haemorrhages occur, along with cellular infiltration into alveoli and bronchioles. Larvae may be found in the sputum. Intestinal The symptoms may resemble those of peptic ulcer or of malabsorption syndrome. Mucus diarrhoea is often present. In heavy infection, the mucosa may be honeycombed with the worm and there may be extensive sloughing, causing dysenteric stools. Hyperinfection In debilitated individuals, and paicularly in those with cellular immune defects, extensive internal reinfection takes place, leading to enormous numbers of adult worms in the intestines and lungs, and larvae in various tissues and organs. This is known as hyperinfection. Severe malnutrition, lepromatous leprosy, lymphoreticular malignancies, AIDS, immunosuppressive drugs and other situations in which cellmediated immunity is defective, predispose to this condition. Hyperinfection is an impoant hazard of steroid therapy and other instances of prolonged immunosuppression as in tansplant patients. Manifestations depend on the sites affected. Brain abscess, meningitis and peritonitis are major fatal complications. TEXTBOOK OF MEDICAL PARASITOLOGY;CKJ PANIKER;6TH EDITION;PAGE NO 173

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Infection with colitis is caused by -, with the following options: A: Enterobius vermicularis, B: Trichuris trichura, C: Strongyliodes, D: Clonorchis ### Response: STRONGYLOIDES The clinical disease may be classified as cutaneous, pulmonary and intestinal. The overwhelming severe disease seen in the immunocompromised is known as hyperinfection. Cutaneous There may be a dermatitis, with erythema and itching at the site of penetration of the filariform larvae, paicularly when large numbers of larvae enter the skin. In those sensitised by prior infection, there may be an allergic response. This may prevent circulation in the blood of the larvae, which may instead migrate in skin, leading to a form of creeping eruption or larva migrans. Pulmonary During escape of the larvae from the pulmonary capillaries into the alveoli, small haemorrhages occur, along with cellular infiltration into alveoli and bronchioles. Larvae may be found in the sputum. Intestinal The symptoms may resemble those of peptic ulcer or of malabsorption syndrome. Mucus diarrhoea is often present. In heavy infection, the mucosa may be honeycombed with the worm and there may be extensive sloughing, causing dysenteric stools. Hyperinfection In debilitated individuals, and paicularly in those with cellular immune defects, extensive internal reinfection takes place, leading to enormous numbers of adult worms in the intestines and lungs, and larvae in various tissues and organs. This is known as hyperinfection. Severe malnutrition, lepromatous leprosy, lymphoreticular malignancies, AIDS, immunosuppressive drugs and other situations in which cellmediated immunity is defective, predispose to this condition. Hyperinfection is an impoant hazard of steroid therapy and other instances of prolonged immunosuppression as in tansplant patients. Manifestations depend on the sites affected. Brain abscess, meningitis and peritonitis are major fatal complications. TEXTBOOK OF MEDICAL PARASITOLOGY;CKJ PANIKER;6TH EDITION;PAGE NO 173 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Neuroparalytic keratitis is associated with paralysis of which cranial nerve?, with the following options: A: 3rd, B: 4th, C: 6th, D: 7th ### Response:

Ans. d (Seventh cranial nerve palsy). (Ref. Parson, Diseases of eye, 18th ed., 154; Basak, Ophthalmology, 2nd/298)Herpes simplex keratitis (HSV 1)Neuro- ophthalmological keratitisNeuroparalytic KeratitisMarginal keratitisPhlecty-nular keratitisInterstitial keratitisMooren's ulcer- Primary herpetic kertitis- Dendritic geographical (inadvertent use of steroids)- Disciform (treatment is steroids)- Punctate- numular- Optic neuritis- Cranial nerve palsy (3, 4 and 6th nerves)- Affects cornea, but 3rd cranial nerve palsy is most common cause.Due to paralysis of motor nerve that closes eyelids and is usually a sequel to facial palsy.Catarrhal ulcerCaused by Staph.- Endogenous toxin induced keratitis- TB protein, staph, strepto, intestinal parasites- Fascicular ulcer- Ring ulcer- Pannus- Treatment: topical steroids'Groundglass' appearance- Salmon patch of Hutchinson- KP nodules- Etiology: Congenital syphilis, TB (Hutchison triad) and Cogan's syndrome.Chronic serpiginous ulcer.Treated with steroids

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Neuroparalytic keratitis is associated with paralysis of which cranial nerve?, with the following options: A: 3rd, B: 4th, C: 6th, D: 7th ### Response: Ans. d (Seventh cranial nerve palsy). (Ref. Parson, Diseases of eye, 18th ed., 154; Basak, Ophthalmology, 2nd/298)Herpes simplex keratitis (HSV 1)Neuro- ophthalmological keratitisNeuroparalytic KeratitisMarginal keratitisPhlecty-nular keratitisInterstitial keratitisMooren's ulcer- Primary herpetic kertitis- Dendritic geographical (inadvertent use of steroids)- Disciform (treatment is steroids)- Punctate- numular- Optic neuritis- Cranial nerve palsy (3, 4 and 6th nerves)- Affects cornea, but 3rd cranial nerve palsy is most common cause.Due to paralysis of motor nerve that closes eyelids and is usually a sequel to facial palsy.Catarrhal ulcerCaused by Staph.- Endogenous toxin induced keratitis- TB protein, staph, strepto, intestinal parasites- Fascicular ulcer- Ring ulcer- Pannus- Treatment: topical steroids'Groundglass' appearance- Salmon patch of Hutchinson- KP nodules- Etiology: Congenital syphilis, TB (Hutchison triad) and Cogan's syndrome.Chronic serpiginous ulcer.Treated with steroids ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Hutchinson's rule is related to ?, with the following options: A: Herpes simplex keratitis, B: Mycotic keratitis, C: Herpes zoster ophthalmicus, D: None ### Response:

Ans. is 'c' i.e., Herpes zoster ophthalmicus Hutchinson's rule : - In herpes zoster ophthalmicus, involvement of the tip of nose, supplied by external nasal nerve (a terminal branch of nasociliary nerve), signifies increase risk of ocular involvement (uveitis).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Hutchinson's rule is related to ?, with the following options: A: Herpes simplex keratitis, B: Mycotic keratitis, C: Herpes zoster ophthalmicus, D: None ### Response: Ans. is 'c' i.e., Herpes zoster ophthalmicus Hutchinson's rule : - In herpes zoster ophthalmicus, involvement of the tip of nose, supplied by external nasal nerve (a terminal branch of nasociliary nerve), signifies increase risk of ocular involvement (uveitis). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Radiofrequency ablation is done for :, with the following options: A: Ventricular tachycardia, B: PSVT, C: WPW, D: Atrial tachycardia ### Response:

Answer is C (WPW) `Ablation of bypass tract offers a permanent cure of supraventricular tachycardias. The advent of radiofrequency catheter ablation has viually eliminated the need for surgery.'

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Radiofrequency ablation is done for :, with the following options: A: Ventricular tachycardia, B: PSVT, C: WPW, D: Atrial tachycardia ### Response: Answer is C (WPW) `Ablation of bypass tract offers a permanent cure of supraventricular tachycardias. The advent of radiofrequency catheter ablation has viually eliminated the need for surgery.' ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Podophyllum resin is indicated in the treatment of –, with the following options: A: Psoriasis, B: Pemphigus, C: Condyloma acuminata, D: Condylomata lata ### Response:

Podophylin is used in anogenital wart (condyloma accuminata).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Podophyllum resin is indicated in the treatment of –, with the following options: A: Psoriasis, B: Pemphigus, C: Condyloma acuminata, D: Condylomata lata ### Response: Podophylin is used in anogenital wart (condyloma accuminata). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The cycle of malaria parasite is in sequence of ? 1) Exoerythrocytic stage 2) Gametocytic stage 3) Erythrocytic stage 4) Sporogony, with the following options: A: 1,2,3,4, B: 1,3,2,4, C: 1,4,2,3, D: 4, 3, 2 ### Response:

Ans. is 'b' i.e., 1, 3, 2, 4

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The cycle of malaria parasite is in sequence of ? 1) Exoerythrocytic stage 2) Gametocytic stage 3) Erythrocytic stage 4) Sporogony, with the following options: A: 1,2,3,4, B: 1,3,2,4, C: 1,4,2,3, D: 4, 3, 2 ### Response: Ans. is 'b' i.e., 1, 3, 2, 4 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The professional antigen presenting cells are, with the following options: A: Endothelial cells, B: Dendritic cells, C: T cells, D: B cells ### Response:

Professional APC Express MHC class II molecules Dendritic cells Immature dendritic cells (Langerhans cells) Macrophages B cells Non - professional APC Do not express MHC class II molecules Stimulated by cytokines like IFN Fibroblasts Thymic epithelial cells Thyroid epithelial cells Glial cells Pancreatic beta cells Endothelial cells

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The professional antigen presenting cells are, with the following options: A: Endothelial cells, B: Dendritic cells, C: T cells, D: B cells ### Response: Professional APC Express MHC class II molecules Dendritic cells Immature dendritic cells (Langerhans cells) Macrophages B cells Non - professional APC Do not express MHC class II molecules Stimulated by cytokines like IFN Fibroblasts Thymic epithelial cells Thyroid epithelial cells Glial cells Pancreatic beta cells Endothelial cells ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: DNA transfer in bacteria via phage is:, with the following options: A: Conjugation, B: Transduction, C: Transformation, D: Translation ### Response:

Ref: Textbook of Microbiology by Surinder Kumar, P 93 Microbiology by Ananthanarayan and Paniker, 8th ed., pg. 60Some bacteria also transfer genetic material between cells via following ways:* Transduction: Transfer of genetic material from one bacterium to another by a bacteriophage is known as transduction# Most widespread mechanism of gene transfer among prokaryotes* Transformation: Transfer of genetic material through the agency of free DNA* Conjugation: DNA is transferred through direct cell contact. Gram negative anerobes like E. Coli, Bacteroides, Porphyromonas, and Fusobacterium use this method of gene transfer* Bacteriophages are viruses that parasitize bacteria* Most bacteriophages carry their genetic information (the phage genome) as a length of double-stranded DNA coiled up inside a protein coat.* Lysogenic conversion: Phage DNA integrated in bacterial chromosome as prophase - replicated stably as part of host cell chromosome - transferred to daughter cell.# In other words: "This process by which the prophage DNA confers genetic information to a bacterium is called lysogenic or phage conversion."# NOTE: In transduction, phage acts only as a vehicle carrying bacterial genes from one cell to another but in lysogenic conversion the phage DNA itself is the new genetic element.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: DNA transfer in bacteria via phage is:, with the following options: A: Conjugation, B: Transduction, C: Transformation, D: Translation ### Response: Ref: Textbook of Microbiology by Surinder Kumar, P 93 Microbiology by Ananthanarayan and Paniker, 8th ed., pg. 60Some bacteria also transfer genetic material between cells via following ways:* Transduction: Transfer of genetic material from one bacterium to another by a bacteriophage is known as transduction# Most widespread mechanism of gene transfer among prokaryotes* Transformation: Transfer of genetic material through the agency of free DNA* Conjugation: DNA is transferred through direct cell contact. Gram negative anerobes like E. Coli, Bacteroides, Porphyromonas, and Fusobacterium use this method of gene transfer* Bacteriophages are viruses that parasitize bacteria* Most bacteriophages carry their genetic information (the phage genome) as a length of double-stranded DNA coiled up inside a protein coat.* Lysogenic conversion: Phage DNA integrated in bacterial chromosome as prophase - replicated stably as part of host cell chromosome - transferred to daughter cell.# In other words: "This process by which the prophage DNA confers genetic information to a bacterium is called lysogenic or phage conversion."# NOTE: In transduction, phage acts only as a vehicle carrying bacterial genes from one cell to another but in lysogenic conversion the phage DNA itself is the new genetic element. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which is not used in pasteurization ?, with the following options: A: Phosphatase test, B: Methylene blue test, C: Coliform count, D: Standard plate count ### Response:

Ans. is 'b' i.e., Methylene blue test

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which is not used in pasteurization ?, with the following options: A: Phosphatase test, B: Methylene blue test, C: Coliform count, D: Standard plate count ### Response: Ans. is 'b' i.e., Methylene blue test ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common nephrotic syndrome in elderly patients, with the following options: A: Minimal change GN, B: Membranous GN, C: IgA nephropathy, D: None of the above ### Response:

Ans. b (Membranous GN) (Ref H-17th/1791)# MEMBRANOUS GN accounts for approx 30% of cases of nephrotic syndrome in adults with peak incidence between 30-50 yrs age.# It is rare in childhood and by far the most common cause of nephrotic syndrome in the elderly# In 25-30% of cases, MGN is secondary to malignancy (solid tumors of the breast, lung, colon), infection (hepatitis B, malaria, schistosomiasis), or rheumatologic disorders like lupus or rarely rheumatoid arthritis.# Male to female ratio of 2:1.MEMBRANOUS GLOMERULONEPHRITISA. Primary/idiopathic membranous glomerulonephritisB. Secondary membranous glomerulonephritis1. Infection: Hepatitis B and C, syphilis, malaria, schistosomiasis, leprosy, filariasis2. Cancer: Breast, colon, lung, stomach, kidney, esophagus, neuroblastoma3. Drugs: gold, mercury, penicillamine, nonsteroidal anti-inflammatory agents, probenecid4. Autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis, primary biliary cirrhosis, dermatitis herpetiformis, bullous pemphigoid, myasthenia gravis, Sjogren's syndrome, Hashimoto's thyroiditis5. Other systemic diseases: Fanconi's syndrome, sickle cell anemia, diabetes, Crohn's disease, sarcoidosis, Guillain- Barre syndrome, Weber-Christian disease, angiofollicular lymph node hyperplasia# Uniform thickening of the BM along the peripheral capillary loops is seen by light microscopy on renal biopsy.# Immunofluorescence demonstrates diffuse granular deposits of IgG and C3, and electron microscopy typically reveals electron-dense subepithelial deposits.# Eighty percent of patients with MGN present with nephrotic syndrome and nonselective proteinuria. Microscopic hematuria is seen in up to 50% of patients. Spontaneous remissions occur in 20-33% of patients and often occur late in the course after years of nephrotic syndrome. One-third of patients continue to have relapsing nephrotic syndrome.# Although thrombotic complications are a feature of all nephrotic syndromes, MGN has the highest reported incidences of renal vein thrombosis, pulmonary embolism, and deep vein thrombosis.# Rx: In addition to the Rx of edema, dyslipidemia, and hypertension, inhibition of the renin-angiotensin system is recommended.Recommendations based on small clinical studies are to treat with steroids and cyclophosphamide, chlorambucil, or cyclosporine.Additional Educational Points# The renal lesions most commonly seen, in order of decreasing frequency, are cryoglobulinemic glomerulonephritis, MGN, and Type I MPGN.# All cases with borderline lepromatous and lepromatous types of leprosy have various forms of glomerulonephritis. Most common is focal glomerulonephritis followed by mesangioproliferative glomerulonephritis or renal amyloidosis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common nephrotic syndrome in elderly patients, with the following options: A: Minimal change GN, B: Membranous GN, C: IgA nephropathy, D: None of the above ### Response: Ans. b (Membranous GN) (Ref H-17th/1791)# MEMBRANOUS GN accounts for approx 30% of cases of nephrotic syndrome in adults with peak incidence between 30-50 yrs age.# It is rare in childhood and by far the most common cause of nephrotic syndrome in the elderly# In 25-30% of cases, MGN is secondary to malignancy (solid tumors of the breast, lung, colon), infection (hepatitis B, malaria, schistosomiasis), or rheumatologic disorders like lupus or rarely rheumatoid arthritis.# Male to female ratio of 2:1.MEMBRANOUS GLOMERULONEPHRITISA. Primary/idiopathic membranous glomerulonephritisB. Secondary membranous glomerulonephritis1. Infection: Hepatitis B and C, syphilis, malaria, schistosomiasis, leprosy, filariasis2. Cancer: Breast, colon, lung, stomach, kidney, esophagus, neuroblastoma3. Drugs: gold, mercury, penicillamine, nonsteroidal anti-inflammatory agents, probenecid4. Autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis, primary biliary cirrhosis, dermatitis herpetiformis, bullous pemphigoid, myasthenia gravis, Sjogren's syndrome, Hashimoto's thyroiditis5. Other systemic diseases: Fanconi's syndrome, sickle cell anemia, diabetes, Crohn's disease, sarcoidosis, Guillain- Barre syndrome, Weber-Christian disease, angiofollicular lymph node hyperplasia# Uniform thickening of the BM along the peripheral capillary loops is seen by light microscopy on renal biopsy.# Immunofluorescence demonstrates diffuse granular deposits of IgG and C3, and electron microscopy typically reveals electron-dense subepithelial deposits.# Eighty percent of patients with MGN present with nephrotic syndrome and nonselective proteinuria. Microscopic hematuria is seen in up to 50% of patients. Spontaneous remissions occur in 20-33% of patients and often occur late in the course after years of nephrotic syndrome. One-third of patients continue to have relapsing nephrotic syndrome.# Although thrombotic complications are a feature of all nephrotic syndromes, MGN has the highest reported incidences of renal vein thrombosis, pulmonary embolism, and deep vein thrombosis.# Rx: In addition to the Rx of edema, dyslipidemia, and hypertension, inhibition of the renin-angiotensin system is recommended.Recommendations based on small clinical studies are to treat with steroids and cyclophosphamide, chlorambucil, or cyclosporine.Additional Educational Points# The renal lesions most commonly seen, in order of decreasing frequency, are cryoglobulinemic glomerulonephritis, MGN, and Type I MPGN.# All cases with borderline lepromatous and lepromatous types of leprosy have various forms of glomerulonephritis. Most common is focal glomerulonephritis followed by mesangioproliferative glomerulonephritis or renal amyloidosis. ### End