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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: About 12 days after a mild upper respiratory infection, a 12-year-old boy complains of weakness in his lower extremities. Over several days, the weakness progresses to include his trunk. On physical examination, he has the weakness described and no lower extremity deep tendon reflexes, muscle atrophy, or pain. Spinal fluid studies are notable for elevated protein only. The most likely diagnosis in this patient is, with the following options: A: Bell palsy, B: Muscular dystrophy, C: Guillain-Barre syndrome, D: Charcot-Marie-Tooth disease ### Response:

The paralysis of Guillain- Barre occurs about 10 days after a nonspecific viral illness. Weakness is gradual over days or weeks, beginning in the lower extremities and progressing toward the trunk. Later, the upper limbs and the bulbar muscles can become involved. Involvement of the respiratory muscles is life threatening. The syndrome seems to be caused by a demyelination in the motor and, occasionally, the sensory erves. Measurement of spinal fluid protein is helpful in the diagnosis; protein levels are increased to more than twice normal, while glucose and cell counts are normal. Hospitalization for observation is indicated. Treatment can consist of intravenous immunoglobulin, steroids, or plasmapheresis. Recovery is not always complete. Bell palsy usually follows a mild upper respiratory infection, resulting in the rapid development of weakness of the entire side of the face. Muscular dystrophy encompasses a number of entities that include weakness over months. Charcot- Marie-Tooth disease has a clinical onset including perineal and intrinsic foot muscle atrophy, later extending to the intrinsic hand muscles and proximal legs.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: About 12 days after a mild upper respiratory infection, a 12-year-old boy complains of weakness in his lower extremities. Over several days, the weakness progresses to include his trunk. On physical examination, he has the weakness described and no lower extremity deep tendon reflexes, muscle atrophy, or pain. Spinal fluid studies are notable for elevated protein only. The most likely diagnosis in this patient is, with the following options: A: Bell palsy, B: Muscular dystrophy, C: Guillain-Barre syndrome, D: Charcot-Marie-Tooth disease ### Response: The paralysis of Guillain- Barre occurs about 10 days after a nonspecific viral illness. Weakness is gradual over days or weeks, beginning in the lower extremities and progressing toward the trunk. Later, the upper limbs and the bulbar muscles can become involved. Involvement of the respiratory muscles is life threatening. The syndrome seems to be caused by a demyelination in the motor and, occasionally, the sensory erves. Measurement of spinal fluid protein is helpful in the diagnosis; protein levels are increased to more than twice normal, while glucose and cell counts are normal. Hospitalization for observation is indicated. Treatment can consist of intravenous immunoglobulin, steroids, or plasmapheresis. Recovery is not always complete. Bell palsy usually follows a mild upper respiratory infection, resulting in the rapid development of weakness of the entire side of the face. Muscular dystrophy encompasses a number of entities that include weakness over months. Charcot- Marie-Tooth disease has a clinical onset including perineal and intrinsic foot muscle atrophy, later extending to the intrinsic hand muscles and proximal legs. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Rekha a 45-years-old woman has negative pap smear with +ve endocervical curretage. Next step in management will be:, with the following options: A: Colposcopy, B: Vaginal hysterectomy, C: Conisation, D: Wertheim's hysterectomy ### Response:

In the question, Rekha has negative pap smear along with positive endocervical curettage - it could mean endometrial cancer which has extended to cervix or adeno carcinoma of endocervix. To distinguish between the two - conization should be done. Colposcopy is of no use as it cannot usualize upper part of endocervix.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Rekha a 45-years-old woman has negative pap smear with +ve endocervical curretage. Next step in management will be:, with the following options: A: Colposcopy, B: Vaginal hysterectomy, C: Conisation, D: Wertheim's hysterectomy ### Response: In the question, Rekha has negative pap smear along with positive endocervical curettage - it could mean endometrial cancer which has extended to cervix or adeno carcinoma of endocervix. To distinguish between the two - conization should be done. Colposcopy is of no use as it cannot usualize upper part of endocervix. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In which of the following pervasive developmental disorder only one modality is impaired, others are normal -, with the following options: A: Autism, B: Asperger syndrome, C: Rett syndrome, D: All of the above ### Response:

Ans. is 'b' i.e., Asperger syndromeo Pervasive development disorders include several clinically similar conditions which are characterized by three symptom clustors:-i) Impairment of social interaction:- e.g., Lack of social smile or eye contact.ii) Impairment of communication (language and non-verbal):- Language problems, delayed or absent speech.iii) Restricted repititive and styerotyped behavior, interests and activities:- e.g., Sterotypy.iv) Another associated feature is mental retardation.o In Autism and Rett syndrome all three features are found. Where as:o In asperger syndrome -a) Only Social ineractiion is impaired, where asb) Intelligence is normal (The only pervasive development disorder in which intelligence is normal.)c) No language impairments.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In which of the following pervasive developmental disorder only one modality is impaired, others are normal -, with the following options: A: Autism, B: Asperger syndrome, C: Rett syndrome, D: All of the above ### Response: Ans. is 'b' i.e., Asperger syndromeo Pervasive development disorders include several clinically similar conditions which are characterized by three symptom clustors:-i) Impairment of social interaction:- e.g., Lack of social smile or eye contact.ii) Impairment of communication (language and non-verbal):- Language problems, delayed or absent speech.iii) Restricted repititive and styerotyped behavior, interests and activities:- e.g., Sterotypy.iv) Another associated feature is mental retardation.o In Autism and Rett syndrome all three features are found. Where as:o In asperger syndrome -a) Only Social ineractiion is impaired, where asb) Intelligence is normal (The only pervasive development disorder in which intelligence is normal.)c) No language impairments. ### 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 tests is not used in the diagnosis of insulinoma -, with the following options: A: Fasting blood glucose, B: Xylose test, C: C- peptide levels, D: Insulin/Glucose Ratio ### Response:

<img src=" /> Ref Harrison 20th edition pg 567

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 tests is not used in the diagnosis of insulinoma -, with the following options: A: Fasting blood glucose, B: Xylose test, C: C- peptide levels, D: Insulin/Glucose Ratio ### Response: <img src=" /> Ref Harrison 20th edition pg 567 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Agent causing malignant hypehermia, with the following options: A: Succinyl choline, B: Dantrolene, C: Gallamine, D: Ketamine ### Response:

Malignant hypehermia (MH) is a rare (1:15,000 in pediatric patients and 1:40,000 in adult patients) genetic hypermetabolic muscle disease, the characteristic phenotypical signs and symptoms of which most commonly appear with exposure to inhaled general anesthetics or succinylcholine (triggering agents). MH may occasionally present more than an hour after emergence from an anesthetic, and rarely may occur without exposure to known triggering agents. Most cases have been repoed in young males; almost none have been repoed in infants, and few have been repoed in the elderly. Neveheless, all ages and both sexes may be affected. The incidence of MH varies significantly from country to country and even among different geographic localities within the same country, reflecting varying gene pools. The upper Midwest appears to have the greatest incidence of MH in the United States. Anesthetic drugs that trigger MH include ether, halothane, enflurane, isoflurane, desflurane, sevoflurane, and depolarizing muscle relaxants, succinylcholine being the only anesthetic drug currently used. Desflurane and sevoflurane appear to be less potent triggers than halothane and produce a more gradual onset of MH. The onset may be explosive if succinylcholine is used. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Agent causing malignant hypehermia, with the following options: A: Succinyl choline, B: Dantrolene, C: Gallamine, D: Ketamine ### Response: Malignant hypehermia (MH) is a rare (1:15,000 in pediatric patients and 1:40,000 in adult patients) genetic hypermetabolic muscle disease, the characteristic phenotypical signs and symptoms of which most commonly appear with exposure to inhaled general anesthetics or succinylcholine (triggering agents). MH may occasionally present more than an hour after emergence from an anesthetic, and rarely may occur without exposure to known triggering agents. Most cases have been repoed in young males; almost none have been repoed in infants, and few have been repoed in the elderly. Neveheless, all ages and both sexes may be affected. The incidence of MH varies significantly from country to country and even among different geographic localities within the same country, reflecting varying gene pools. The upper Midwest appears to have the greatest incidence of MH in the United States. Anesthetic drugs that trigger MH include ether, halothane, enflurane, isoflurane, desflurane, sevoflurane, and depolarizing muscle relaxants, succinylcholine being the only anesthetic drug currently used. Desflurane and sevoflurane appear to be less potent triggers than halothane and produce a more gradual onset of MH. The onset may be explosive if succinylcholine is used. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: HMG Co A production in liver is inhibited by, with the following options: A: Insulin, B: Thyroxine, C: Glucagon, D: Cortisol ### Response:

Insulin

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: HMG Co A production in liver is inhibited by, with the following options: A: Insulin, B: Thyroxine, C: Glucagon, D: Cortisol ### Response: Insulin ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Bone with a bone appearance is seen in, with the following options: A: Osteogenesis imperfecta, B: Osteopetrosis, C: Scurvy, D: Rickets ### Response:

Bone within bone appearance is seen in : Osteopetrosis Acromegaly Bisphophonate therapy sickle cell anemia Healed phase of rickets and scurvy. Normal neonate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Bone with a bone appearance is seen in, with the following options: A: Osteogenesis imperfecta, B: Osteopetrosis, C: Scurvy, D: Rickets ### Response: Bone within bone appearance is seen in : Osteopetrosis Acromegaly Bisphophonate therapy sickle cell anemia Healed phase of rickets and scurvy. Normal neonate. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The antrochoanal polyp is?, with the following options: A: Single and grows posteriorly, B: Multiple, C: Bleeding, D: None ### Response:

Antrochoanal polyp is usually single and unilateral. More tendency to grow posteriorly and do not bleed. Unilateral nasal obstruction is the presenting symptom. Obstruction may become bilateral when polyp grows posteriorly into the nasopharynx and stas obstructing the opposite choana. (Ref - PL DHINGRA diseases of ear nose and throat, 7th edition, page no 193)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The antrochoanal polyp is?, with the following options: A: Single and grows posteriorly, B: Multiple, C: Bleeding, D: None ### Response: Antrochoanal polyp is usually single and unilateral. More tendency to grow posteriorly and do not bleed. Unilateral nasal obstruction is the presenting symptom. Obstruction may become bilateral when polyp grows posteriorly into the nasopharynx and stas obstructing the opposite choana. (Ref - PL DHINGRA diseases of ear nose and throat, 7th edition, page no 193) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Type1 Membranoproliferative glomerulonephritis is commonly associated with all except, with the following options: A: SLE, B: Persistent hepatitis C infection, C: Paial lipodystrophy, D: Neoplastic diseases ### Response:

Refer Robbins page no p922 Robbins 8th mentioned that paial lipodystrophy is adsoscated with C3 nephritic factor (C3NeF). It is associated with type 2 Membranoproliferative glomerulonephritis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Type1 Membranoproliferative glomerulonephritis is commonly associated with all except, with the following options: A: SLE, B: Persistent hepatitis C infection, C: Paial lipodystrophy, D: Neoplastic diseases ### Response: Refer Robbins page no p922 Robbins 8th mentioned that paial lipodystrophy is adsoscated with C3 nephritic factor (C3NeF). It is associated with type 2 Membranoproliferative glomerulonephritis ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Amyloid protein in human being is:, with the following options: A: A naturally present protein in normal individuals, B: Involves selectively blood vessels, C: Is visible by naked eyes as whitish cheesy material, D: A material which gets deposited in extracellular spaces ### Response:

Ans. D. A material which gets deposited in extracellular spaces(Ref. Robbins and Cotran Pathologic basis of Disease 9/e Chapter 6)Amyloid FibrilsPhysical nature of amyloidX-ray crystallography and infrared spectroscopy demonstrate a characteristic cross-b-pleated sheet conformation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Amyloid protein in human being is:, with the following options: A: A naturally present protein in normal individuals, B: Involves selectively blood vessels, C: Is visible by naked eyes as whitish cheesy material, D: A material which gets deposited in extracellular spaces ### Response: Ans. D. A material which gets deposited in extracellular spaces(Ref. Robbins and Cotran Pathologic basis of Disease 9/e Chapter 6)Amyloid FibrilsPhysical nature of amyloidX-ray crystallography and infrared spectroscopy demonstrate a characteristic cross-b-pleated sheet conformation. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Theirsch graft is:, with the following options: A: Full thickness, B: Partial thickness, C: Myocutaneous graft, D: Osesomyocutaneous graft ### Response:

Ref: Bailey & Love's Short Practice of Surgery 25th Edition Plastic And Reconstructive Surgery Chapter 29 I pg 396-7Explanation:Grafts are tissues that are transferred without their blood supply, which therefore have to revascularise once they are in a new site.They include the following:Split-thickness skin grafts (of varying thickness). These are sometimes called Thiersch grafts. Fine punctate bleeding from a split-thickness skin graft donor site.Full-thickness skin grafts (Wolfe grafts). Used for smaller areas of skin replacement where good elastic skin that will not contract is required (such as fingers, eyelids, facial parts).Composite skin grafts (usually skin and fat, or skin and cartilage). Often taken from the ear margin and useful for rebuilding missing elements of nose, eyelids and fingertips.Nerve grafts-Usually taken from the sural nerve but smaller cutaneous nerves may be used.Tendon grafts taken from the palmaris longus or plantaris tendon (runs just anteromedial to the Achilles tendon ) and used for injury loss or nerve damage correction.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Theirsch graft is:, with the following options: A: Full thickness, B: Partial thickness, C: Myocutaneous graft, D: Osesomyocutaneous graft ### Response: Ref: Bailey & Love's Short Practice of Surgery 25th Edition Plastic And Reconstructive Surgery Chapter 29 I pg 396-7Explanation:Grafts are tissues that are transferred without their blood supply, which therefore have to revascularise once they are in a new site.They include the following:Split-thickness skin grafts (of varying thickness). These are sometimes called Thiersch grafts. Fine punctate bleeding from a split-thickness skin graft donor site.Full-thickness skin grafts (Wolfe grafts). Used for smaller areas of skin replacement where good elastic skin that will not contract is required (such as fingers, eyelids, facial parts).Composite skin grafts (usually skin and fat, or skin and cartilage). Often taken from the ear margin and useful for rebuilding missing elements of nose, eyelids and fingertips.Nerve grafts-Usually taken from the sural nerve but smaller cutaneous nerves may be used.Tendon grafts taken from the palmaris longus or plantaris tendon (runs just anteromedial to the Achilles tendon ) and used for injury loss or nerve damage correction. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Beta 2 agonist used in rescue therapy in acute respiratory conditions are all except -, with the following options: A: Terbutaline, B: Salbutamol, C: Bambuterol, D: Ketotifen ### Response:

Ans. is 'd' i.e., Ketotifen BronchodilatorsDrugs reducing inflammationa) b2 SympathomimeticsLeukotriene antagonistsMast cell stabilizersCorticosteroidsAnti-IgE antibodyo Salbutamolo Terbutalineo Montelukasto Sodium cromoglycatea) Systemico Omalizumabo Bambuteralo Salmeterolo Zafirlukasto Ketotifeno Hydrocortisone o Formoterolo Ephedrine o Prednisolone b) Inhalation b) Methylxanthines o Beclomethasome o Theophyllineo Aminophylline o Budesonide o Doxophylline o Fluticasone c) Anticholinergics o Flunisolide o Ipratropiumo Tiopratropium o Ciclesonide

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Beta 2 agonist used in rescue therapy in acute respiratory conditions are all except -, with the following options: A: Terbutaline, B: Salbutamol, C: Bambuterol, D: Ketotifen ### Response: Ans. is 'd' i.e., Ketotifen BronchodilatorsDrugs reducing inflammationa) b2 SympathomimeticsLeukotriene antagonistsMast cell stabilizersCorticosteroidsAnti-IgE antibodyo Salbutamolo Terbutalineo Montelukasto Sodium cromoglycatea) Systemico Omalizumabo Bambuteralo Salmeterolo Zafirlukasto Ketotifeno Hydrocortisone o Formoterolo Ephedrine o Prednisolone b) Inhalation b) Methylxanthines o Beclomethasome o Theophyllineo Aminophylline o Budesonide o Doxophylline o Fluticasone c) Anticholinergics o Flunisolide o Ipratropiumo Tiopratropium o Ciclesonide ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Injury that comes under sec 320 IPC -, with the following options: A: Abrasion over face, B: Nasal bone fracture, C: Epistaxis, D: Lacerated wound over scalp ### Response:

Sec 320 IPC defines grievous hurt and among the given options, only b (fracture) is grievous injury.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Injury that comes under sec 320 IPC -, with the following options: A: Abrasion over face, B: Nasal bone fracture, C: Epistaxis, D: Lacerated wound over scalp ### Response: Sec 320 IPC defines grievous hurt and among the given options, only b (fracture) is grievous injury. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Postpartum lady after 48 hours of cesarean section, suffering from headache and signs of meningism. Headache gets relieved on lying down. Immediate treatment would be:, with the following options: A: Epidural blood patch, B: Do lumbar puncture, C: Foot end elevation, D: Sumatriptan ### Response:

Ans. A. Epidural blood patchExplanationAs patient has signs of meningism, the treatment would be epidural blood patch.The Lybecker classification of severity for PDPH:Mild PDPH (Score 1)Postural headache with slight restriction of daily activities.Not bedridden.No associated symptoms.Responds well to non-opiate analgesics (Paracetamol, NSAID, Caffeine).Moderate PDPH (Score 2)Postural headache with significant restriction of daily activities.Bedridden part of the day associated symptoms may or may not present.Requires the addition of opiate derivatives.Severe PDPH (Score 3)Postural headache with complete restriction of daily activities.Bedridden all day associated symptoms present (photophobia, diplopia, tinnitus, nausea, vomiting).Not responsive to the above conservative management.If the question was like this:

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Postpartum lady after 48 hours of cesarean section, suffering from headache and signs of meningism. Headache gets relieved on lying down. Immediate treatment would be:, with the following options: A: Epidural blood patch, B: Do lumbar puncture, C: Foot end elevation, D: Sumatriptan ### Response: Ans. A. Epidural blood patchExplanationAs patient has signs of meningism, the treatment would be epidural blood patch.The Lybecker classification of severity for PDPH:Mild PDPH (Score 1)Postural headache with slight restriction of daily activities.Not bedridden.No associated symptoms.Responds well to non-opiate analgesics (Paracetamol, NSAID, Caffeine).Moderate PDPH (Score 2)Postural headache with significant restriction of daily activities.Bedridden part of the day associated symptoms may or may not present.Requires the addition of opiate derivatives.Severe PDPH (Score 3)Postural headache with complete restriction of daily activities.Bedridden all day associated symptoms present (photophobia, diplopia, tinnitus, nausea, vomiting).Not responsive to the above conservative management.If the question was like this: ### 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 tarsometatarsal amputation?, with the following options: A: Sarmiento's Amputation, B: Lisfranc's Amputation, C: Chopart's Amputation, D: Syme's Amputation ### Response:

Ans. is 'b' i.e., Lisfranc's Amputation AmputationLevelSyme's Amputationthrough ankle joint (0.6 cm proximal)Sarmiento's Amputation1.3 cm proximal to ankle jointWagner Amputationtwo stage syme's amputationChopart's Amputationthrough midtarsal jointsLisfranc's Amputationthrough tarso-metatarsal jointsPirogoff's Amputationanterior part of calcaneum is removed

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 tarsometatarsal amputation?, with the following options: A: Sarmiento's Amputation, B: Lisfranc's Amputation, C: Chopart's Amputation, D: Syme's Amputation ### Response: Ans. is 'b' i.e., Lisfranc's Amputation AmputationLevelSyme's Amputationthrough ankle joint (0.6 cm proximal)Sarmiento's Amputation1.3 cm proximal to ankle jointWagner Amputationtwo stage syme's amputationChopart's Amputationthrough midtarsal jointsLisfranc's Amputationthrough tarso-metatarsal jointsPirogoff's Amputationanterior part of calcaneum is removed ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: FeCI3 test is used in diagnosis of -, with the following options: A: HCI, B: Acetic acid, C: Alcohol, D: Phenol ### Response:

Carbolic Acid Synonyms: Phenol, Hydroxy-Benzene Propeies * Colourless, prismatic, needle-like crystals that turns pink and liquefies when exposed to air * Has sweetish burning taste and phenol like smell * Concentrated phenol is a dark brown liquid and contains impurities like cresol * Lysol is 50% solution of cresol in saponified vegetable oil. However, phenol is 8 times more toxic than Lysol * Dettol is chlorinated phenol with turpineol * Household phenol (sold as phenyle) contains five percent phenol in water. * Derivatives of phenol 1. Cresol 2. Thymol 3. Creosate (coal tar) 4. Menthol 5. Tannic acid 6. Napthol 7. Resorcinol. Uses 1. Antiseptic and disinfectant 2. Manufacture of plastic Absorption, Metabolism and Excretion * Phenol is absorbed from skin, gastric mucosa, per rectum, per vagina and respiratory tract * Phenol is conveed into hydroquinone and pyrocatechol and excreted in urine. Traces are excreted by lungs, salivary glands, and skin. Fatal dose: * 2 gm crystals * 25 to 50 ml of household phenol Fatal period: 3 to 4 hours. Mechanism of Action * Phenol has local as well as systemic action * Locally it acts as corrosive agent and when absorbed, it causes CNS depression, metabolic acidosis and renal failure. * Carbolic acid has great penetrating power and it coagulates protein. * Phenols have a powerful antipyretic effect similar to that of salicylates. * Phenols and derivatives of phenols cause methemoglobinemia Clinical Features Local: When applied to skin or mucosa, it causes burning pain, numbness, tingling and anesthesia. It causes corrosion and produce white eschar (scar), which falls off in few days leaving brown stained area. Systemic: 1. GIT: Burning pain followed by tingling numbness and anesthesia. Nausea and vomiting. 2. RS: Respiration is slow and labored. 3. CNS: Headache, giddiness, unconsciousness, convulsions, coma. 4. Oliguria and hepatic failure. 5. Urine: May be colorless but on exposure to air turns green due to oxidation of phenol metabolites (hydroquinone and pyrocatechol). It is known as carboluria. 6. The hydroquinone and pyrocatechol may cause pigmentation in the cornea and various cailages, a condition known as oochronosis. Management * Skin: Wash with undiluted polyethylene glycol. * Oxygen/ventilatory suppo * Intravenous fluids and vasopressors to suppo blood pressure * Ingestion: Cautious stomach wash with sodium or magnesium sulfate solution * Lidocaine for ventricular arrhythmias * Benzodiazepines for seizures * Treat methemoglobinemia - if methemoglobinemia is > 30%, ingest Methylene blue (1-2 mg/kg). Exchange transfusion may be needed if methemoglobinemia is > 70%. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO300

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: FeCI3 test is used in diagnosis of -, with the following options: A: HCI, B: Acetic acid, C: Alcohol, D: Phenol ### Response: Carbolic Acid Synonyms: Phenol, Hydroxy-Benzene Propeies * Colourless, prismatic, needle-like crystals that turns pink and liquefies when exposed to air * Has sweetish burning taste and phenol like smell * Concentrated phenol is a dark brown liquid and contains impurities like cresol * Lysol is 50% solution of cresol in saponified vegetable oil. However, phenol is 8 times more toxic than Lysol * Dettol is chlorinated phenol with turpineol * Household phenol (sold as phenyle) contains five percent phenol in water. * Derivatives of phenol 1. Cresol 2. Thymol 3. Creosate (coal tar) 4. Menthol 5. Tannic acid 6. Napthol 7. Resorcinol. Uses 1. Antiseptic and disinfectant 2. Manufacture of plastic Absorption, Metabolism and Excretion * Phenol is absorbed from skin, gastric mucosa, per rectum, per vagina and respiratory tract * Phenol is conveed into hydroquinone and pyrocatechol and excreted in urine. Traces are excreted by lungs, salivary glands, and skin. Fatal dose: * 2 gm crystals * 25 to 50 ml of household phenol Fatal period: 3 to 4 hours. Mechanism of Action * Phenol has local as well as systemic action * Locally it acts as corrosive agent and when absorbed, it causes CNS depression, metabolic acidosis and renal failure. * Carbolic acid has great penetrating power and it coagulates protein. * Phenols have a powerful antipyretic effect similar to that of salicylates. * Phenols and derivatives of phenols cause methemoglobinemia Clinical Features Local: When applied to skin or mucosa, it causes burning pain, numbness, tingling and anesthesia. It causes corrosion and produce white eschar (scar), which falls off in few days leaving brown stained area. Systemic: 1. GIT: Burning pain followed by tingling numbness and anesthesia. Nausea and vomiting. 2. RS: Respiration is slow and labored. 3. CNS: Headache, giddiness, unconsciousness, convulsions, coma. 4. Oliguria and hepatic failure. 5. Urine: May be colorless but on exposure to air turns green due to oxidation of phenol metabolites (hydroquinone and pyrocatechol). It is known as carboluria. 6. The hydroquinone and pyrocatechol may cause pigmentation in the cornea and various cailages, a condition known as oochronosis. Management * Skin: Wash with undiluted polyethylene glycol. * Oxygen/ventilatory suppo * Intravenous fluids and vasopressors to suppo blood pressure * Ingestion: Cautious stomach wash with sodium or magnesium sulfate solution * Lidocaine for ventricular arrhythmias * Benzodiazepines for seizures * Treat methemoglobinemia - if methemoglobinemia is > 30%, ingest Methylene blue (1-2 mg/kg). Exchange transfusion may be needed if methemoglobinemia is > 70%. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO300 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are true about histo-immunological type of breast cancer EXCEPT:, with the following options: A: Molecular classification is based on gene expression profiling, B: Most common type is Luminal A, C: Best Prognosis is Luminal B, D: Worst prognosis is triple negative breast cancer ### Response:

Molecular classification of breast Ca is based on gene expression profiling. Molecular classification: Luminal A: ER & PR + ve, double positive HER - 2 - neu (-) ve Ki67 lowMost common type, best prognosis. Luminal B: two subtypes- 1. Luminal B HER(+) ER, PR - positive & Her - 2 - neu positive (triple positive) and Ki67 low/high 2. Luminal B HER(-) ER, PR - positive & Her - 2 - neu negative and Ki67 high Intermediate prognosis Basal cell type: triple negative ER, PR Her-2-neu (-)ve Ki67 high In BRCA 1 mutation most aggressive and Poorer prognosis because there are fewer targeted medicines available Her-2 type: Her-2-neu +veER, PR -ve aggressive and poor prognosis Normal like breast cancer- same like luminal A but prognosis poorer than luminal A Most common: luminal A Best prognosis: Luminal A Worst prognosis: Triple negative breast cancer

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are true about histo-immunological type of breast cancer EXCEPT:, with the following options: A: Molecular classification is based on gene expression profiling, B: Most common type is Luminal A, C: Best Prognosis is Luminal B, D: Worst prognosis is triple negative breast cancer ### Response: Molecular classification of breast Ca is based on gene expression profiling. Molecular classification: Luminal A: ER & PR + ve, double positive HER - 2 - neu (-) ve Ki67 lowMost common type, best prognosis. Luminal B: two subtypes- 1. Luminal B HER(+) ER, PR - positive & Her - 2 - neu positive (triple positive) and Ki67 low/high 2. Luminal B HER(-) ER, PR - positive & Her - 2 - neu negative and Ki67 high Intermediate prognosis Basal cell type: triple negative ER, PR Her-2-neu (-)ve Ki67 high In BRCA 1 mutation most aggressive and Poorer prognosis because there are fewer targeted medicines available Her-2 type: Her-2-neu +veER, PR -ve aggressive and poor prognosis Normal like breast cancer- same like luminal A but prognosis poorer than luminal A Most common: luminal A Best prognosis: Luminal A Worst prognosis: Triple negative breast cancer ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The corpus luteum of menstruation presents for:, with the following options: A: 5 days, B: 10 days, C: 14 days, D: 30 days ### Response:

14 days

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The corpus luteum of menstruation presents for:, with the following options: A: 5 days, B: 10 days, C: 14 days, D: 30 days ### Response: 14 days ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Anemia of chronic disease is characterized by, with the following options: A: Increased sideroblasts, B: Increased TIBC, C: Increased bone marrow iron, D: Increased protoporphyrin ### Response:

*Anemia of chronic disease- Impaired red cell production associated with any chronic diseases that would be infectious/inflammatory/neoplastic.*Chronic diseases produce a cytokine "IL-6" that increases the production of hepcidin from the liver. Hepcidin inhibits ferropoin function in macrophages and reduces the transfer of iron from the storage pool to developing erythroid precursors in bone marrow. *So the patient develops anemia irrespective of an increased amount of iron in macrophages.*Laboratory findings- Increased ferritin (storage iron), Low serum iron and reduced total iron binding capacity.-progenitors do not proliferate adequately because erythropoietin levels are inappropriately low for the degree of anemia.Whereas in iron deficiency anemia, the patient will have decreased ferritin, low serum iron, and high iron binding capacity. (Ref: Robbins 8/e p662)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Anemia of chronic disease is characterized by, with the following options: A: Increased sideroblasts, B: Increased TIBC, C: Increased bone marrow iron, D: Increased protoporphyrin ### Response: *Anemia of chronic disease- Impaired red cell production associated with any chronic diseases that would be infectious/inflammatory/neoplastic.*Chronic diseases produce a cytokine "IL-6" that increases the production of hepcidin from the liver. Hepcidin inhibits ferropoin function in macrophages and reduces the transfer of iron from the storage pool to developing erythroid precursors in bone marrow. *So the patient develops anemia irrespective of an increased amount of iron in macrophages.*Laboratory findings- Increased ferritin (storage iron), Low serum iron and reduced total iron binding capacity.-progenitors do not proliferate adequately because erythropoietin levels are inappropriately low for the degree of anemia.Whereas in iron deficiency anemia, the patient will have decreased ferritin, low serum iron, and high iron binding capacity. (Ref: Robbins 8/e p662) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The circumferential clasp when used with tooth supported partial dentures:, with the following options: A: Is usually the most logical clasp to use, B: Has good retentive and stabilizing ability, C: Both, D: None ### Response:

The circumferential clasp is usually the most logical clasp to use with all tooth-supported partial dentures, because of its retentive and stabilizing ability. Only when the retentive undercut may be approached better with a bar clasp arm or when esthetics will be enhanced, should the latter be used.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The circumferential clasp when used with tooth supported partial dentures:, with the following options: A: Is usually the most logical clasp to use, B: Has good retentive and stabilizing ability, C: Both, D: None ### Response: The circumferential clasp is usually the most logical clasp to use with all tooth-supported partial dentures, because of its retentive and stabilizing ability. Only when the retentive undercut may be approached better with a bar clasp arm or when esthetics will be enhanced, should the latter be used. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: 50 year old male with scrotal pain for 2 days, pain decreases with elevation of testis. Clinical diagnosis is:, with the following options: A: Torsion, B: Epididymoorchitis, C: Hernia, D: Hydrocele ### Response:

Ans. (b) EpididymoorchitisRef: Bailey 26th Edition, Page 1384* The sign demonstrated above is PREHN's SIGN* The sign is used to differentiate Orchitis and Torsion.* In Prehn's sign - Elevation of Testis reduces the pain in Orchitis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: 50 year old male with scrotal pain for 2 days, pain decreases with elevation of testis. Clinical diagnosis is:, with the following options: A: Torsion, B: Epididymoorchitis, C: Hernia, D: Hydrocele ### Response: Ans. (b) EpididymoorchitisRef: Bailey 26th Edition, Page 1384* The sign demonstrated above is PREHN's SIGN* The sign is used to differentiate Orchitis and Torsion.* In Prehn's sign - Elevation of Testis reduces the pain in Orchitis. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Euthanasia legalized in, with the following options: A: Netherlands, B: Belgium, C: Switzerland, D: All of the above ### Response:

(D) All of the above # Non-active euthanasia, or assisted suicide, is legal in three US states: 1. Oregon; 2. Washington; 3. Montana New Hampshire is currently considering a bill on assisted suicide Active euthanasia, commonly referred simply as euthanasia, is only legal in: 1. Netherlands 2. Belgium Euthenasia is legal in Switzerland. Assisted suicide is also legal in: 1. Albania 2. Luxembourg# Legal Aspects: Euthanasia is legal in the Netherlands, Belgium, and Luxembourg. It was legalized in the Northern Territory of Australia in 1995, but that legislation was repealed in 1997.> Euthanasia is not legal in any state in the United States. With certain conditions, in Switzerland, a layperson can legally assist suicide.> In the United States, physician-assisted suicide is legal in Oregon and Washington State if multiple criteria are met and then only after a process that includes a 15-day waiting period.> In 2009, the state supreme court of Montana ruled that state law permits physician-assisted suicide for terminally ill patients. In all other countries and all other states in the United States, physician-assisted suicide and euthanasia are illegal explicitly or by common law.DEFINITIONS OF ASSISTED SUICIDE AND EUTHANASIATermDefinitionLegal Status* Voluntary active euthanasiaIntentionally administering medications or other interventions to cause the patient's death with the patient's informed consentNetherlandsBelgium* Involuntary active euthanasiaIntentionally administering medications or other interventions to cause the patient's death when the patient was competent to consent but did not--e.g., the patient may not have been askedNowhere* Passive euthanasiaWithholding or withdrawing life-sustaining medical treatments from a patient to let him or her die (terminating life-sustaining treatments)Everywhere* Physician- assisted suicideA physician provides medications or other interventions to a patient with the understanding that the patient can use them to commit suicideOregonNetherlandsBelgium, Switzerland

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Euthanasia legalized in, with the following options: A: Netherlands, B: Belgium, C: Switzerland, D: All of the above ### Response: (D) All of the above # Non-active euthanasia, or assisted suicide, is legal in three US states: 1. Oregon; 2. Washington; 3. Montana New Hampshire is currently considering a bill on assisted suicide Active euthanasia, commonly referred simply as euthanasia, is only legal in: 1. Netherlands 2. Belgium Euthenasia is legal in Switzerland. Assisted suicide is also legal in: 1. Albania 2. Luxembourg# Legal Aspects: Euthanasia is legal in the Netherlands, Belgium, and Luxembourg. It was legalized in the Northern Territory of Australia in 1995, but that legislation was repealed in 1997.> Euthanasia is not legal in any state in the United States. With certain conditions, in Switzerland, a layperson can legally assist suicide.> In the United States, physician-assisted suicide is legal in Oregon and Washington State if multiple criteria are met and then only after a process that includes a 15-day waiting period.> In 2009, the state supreme court of Montana ruled that state law permits physician-assisted suicide for terminally ill patients. In all other countries and all other states in the United States, physician-assisted suicide and euthanasia are illegal explicitly or by common law.DEFINITIONS OF ASSISTED SUICIDE AND EUTHANASIATermDefinitionLegal Status* Voluntary active euthanasiaIntentionally administering medications or other interventions to cause the patient's death with the patient's informed consentNetherlandsBelgium* Involuntary active euthanasiaIntentionally administering medications or other interventions to cause the patient's death when the patient was competent to consent but did not--e.g., the patient may not have been askedNowhere* Passive euthanasiaWithholding or withdrawing life-sustaining medical treatments from a patient to let him or her die (terminating life-sustaining treatments)Everywhere* Physician- assisted suicideA physician provides medications or other interventions to a patient with the understanding that the patient can use them to commit suicideOregonNetherlandsBelgium, Switzerland ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Z track technique is used for, with the following options: A: Monitoring of lithium therapy, B: Monitoring of carbamazepine therapy, C: Administration of long acting depot antipsychotics, D: Administration of nicotine patches ### Response:

Ans. (C) Administration of long acting depot antipsychotics(Ref: Kaplan and Sadock's Concise Text book of Clinical Psychiatry 11th Ed; Page No- 873)Guidelines for Administration of Long Acting Antipsychotic Depot Injections (LAAI)LAAIs are given to patient with psychosis or mania who have poor compliance to oral treatment.A test dose is given for all drugs except olanzapine, risperidone, paliperidone and aripiprazole.Route of administration is by intramuscular route with maximum permissible volume as given below.Deltoid2 mlDorsogluteal4 mlVentrogluteal (Safest site)4 mlRectus femoris5 mlVastus lateralis5 mlZ track technique is used for injection into all sites, except deltoid. The skin is stretched laterally from the intended site of injection and then insert the needle at 90deg angle. After 10 seconds of injecting the drug, skin is released to allow the displaced tissue to cover the needle track. It is done to maximize absorption in to muscles by preventing the drug from moving back to subcutaneous tissue.Z track technique is also used to inject iron.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Z track technique is used for, with the following options: A: Monitoring of lithium therapy, B: Monitoring of carbamazepine therapy, C: Administration of long acting depot antipsychotics, D: Administration of nicotine patches ### Response: Ans. (C) Administration of long acting depot antipsychotics(Ref: Kaplan and Sadock's Concise Text book of Clinical Psychiatry 11th Ed; Page No- 873)Guidelines for Administration of Long Acting Antipsychotic Depot Injections (LAAI)LAAIs are given to patient with psychosis or mania who have poor compliance to oral treatment.A test dose is given for all drugs except olanzapine, risperidone, paliperidone and aripiprazole.Route of administration is by intramuscular route with maximum permissible volume as given below.Deltoid2 mlDorsogluteal4 mlVentrogluteal (Safest site)4 mlRectus femoris5 mlVastus lateralis5 mlZ track technique is used for injection into all sites, except deltoid. The skin is stretched laterally from the intended site of injection and then insert the needle at 90deg angle. After 10 seconds of injecting the drug, skin is released to allow the displaced tissue to cover the needle track. It is done to maximize absorption in to muscles by preventing the drug from moving back to subcutaneous tissue.Z track technique is also used to inject iron. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 60–year old male presented with discolouration, thickening and tunneling of 2 fingernails and one toe nail. Which of the following will clinch the diagnosis at the earliest?, with the following options: A: Wood's lamp examination, B: KOH mount, C: Slit smear (split skin smear), D: Gram stain ### Response:

Discolouring and tunneling of the fingernails suggests onychomycosis (Tinea unguium) Onychomycosis refers to nail infections caused by any fungus, including yeasts and nondermatophyte molds. KOH mount is used for fungal infections.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 60–year old male presented with discolouration, thickening and tunneling of 2 fingernails and one toe nail. Which of the following will clinch the diagnosis at the earliest?, with the following options: A: Wood's lamp examination, B: KOH mount, C: Slit smear (split skin smear), D: Gram stain ### Response: Discolouring and tunneling of the fingernails suggests onychomycosis (Tinea unguium) Onychomycosis refers to nail infections caused by any fungus, including yeasts and nondermatophyte molds. KOH mount is used for fungal infections. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: If a patient has bilirubin 20 mg/dl, AST=313,, ALT=103 & GGT=44 IU/L. Most probable diagnosis is:, with the following options: A: Viral hepatitis, B: Alcoholic hepatitis, C: Billiary atresia, D: Drugs ### Response:

Ans: B (Alcoholic...) Here, in Q AST > ALT(>3 times)- so most probable diagnosis is alcoholic hepatitisNormal value ofy-glutamyl transferase is 051IU/L L.D of Alcoholic Fatty Liver & Alcoholic HepatitisTestCommentASTincreased two-to-sevenfold,<400U/ L,greater than ALTALTIncreased two to sevenfold .less than 400U/ LAST/ALTUsually >1GGTPBilirubin5Not specific to alcohol, easily inducible .elevated in all forms of fatty liverMay be markedly increased in alcoholic hepatitis despite modest elevation in alkaline phosphatasePMNlf> 5500/uL predicts severe alcoholic hepatitis when discriminant function >32PMN- Polymorphonuclear cellsSERUM ENZ\ MES Harrison 18th/2527-30# The normal range for aminotransferases varies widely among laboratories, but generally ranges from 10-40 U/L.# Any type of liver cell injury can cause modest elevations in the serum aminotransferases. Levels of up to 300 U/L are nonspecific and may be found in any type of liver disorder. Minimal ALT elevations in asymptomatic blood donors rarely indicate severe liver disease; studies have shown that fatty liver disease is the most likely explanation. Striking elevations--i.e,, aminotransferases >1000 U/L--occur almost exclusively in disorders associated with extensive hepatocellular injury such as (1) viral hepatitis, (2) ischemic liver injury (prolonged hypotension or acute heart failure), or (3) toxin- or drug-induced liver injury.The pattern of the aminotransferase elevation can be helpful diagnostically. In most acute hepatocellular disorders, the ALT is higher than or equal to the AST. While the AST:ALT ratio is typically less than 1 in patients with chronic viral hepatitis and non-alcoholic fatty liver disease, a number of groups have noted that as cirrhosis develops this ratio rises to greater than 1.An AST.ALT ratio >2:1 is suggestive, while a ratio >3:1 is highly suggestive of alcoholic liver disease. The AST in alcoholic liver disease is rarely >300 U/L, and the ALT is often normal. A low level of ALT in the serum is due to an alcohol-induced deficiency of pyridoxa! phosphate.The aminotransferases are usually not greatly elevated in obstructive jaun dice.Enzymes that Reflect Cholestasis# The activities of three enzymes--alkaline phosphatase, 5'-nucleotidase, and g-glutamyi transpeptidase (GGT')--are usually elevated in cholestasis.Reflecting its more diffuse localization in the liver, GGT elevation in serum is less specific for cholestasis than are elevations of alkaline phosphatase or 5'-nucleotidase. Some have advocated the use of GGT to identify patients with occult alcohol use. Its lack of specificity makes its use in this setting questionable.Table (Harrison 18th/2530): Liver Test Patterns in Hepatobiliary DisordersType of DisorderBilirubinAminotrans ferasesAlkaline PhosphataseAlbuminProthrombin TimeHemolysis/Gilbert's syndromeNormal to 86 umol/L (5 mg/ dL) 85% due to indirect fractions No bilirubinuriaNormalNormalNormalNormalAcute hepatocellular necrosis (viral and drug hepatitis, hepatotoxins, acute heart failure)Both fractions may be elevated Peak usually follows aminotransferases BilirubinuriaElevated, often >500 1U ALT >ASTNorma] to <3 times normal elevationNormalUsually normal. If >5X above control and not corrected by parenteral vitamin K, suggests poor prognosisChronic hepatocellular disordersBoth fractions may be elevated BilirubinuriaElevated, but usually <300 IUNormal to <3 times normal elevationOften decreasedOften prolonged Fails to correct with parenteral vitamin KAlcoholic hepatitis CirrhosisBoth fractions may be elevatedBilirubinuriaAST:ALT > 2 suggests alcoholic hepatitis or cirrhosisNormal to <3 times normal elevationOften decreasedOften prolonged Fails to correct with parenteral vitamin KIntra- and extra-hepatic cholestasis(Obstructive jaundice)Both fractions may be elevated' BilirubinuriaNormal to moderate elevation Rarely >500IUElevated, often >4 times normal elevationNormal, unless chronicNormalIf prolonged, will correct with parenteral vitamin KInfiltrative diseases (tumor, granuloma- ta); partial bile duct obstructionUsually normalNormal to slight elevationElevated, often >4 times normal elevationFractionate, or confirm liver origin with 5' nucleotidase or g glutamyl transpep- tidaseNormalNormalTable (CMDT):Causes of serum aminotransferase elevations.Mild Elevations (<5x normal)Severe Elevations (> 15 x normal)Hepatic: ALT-predominantChronic hepatitis B, C, DAcute viral hepatitis (A-E, EBV, CMV)Steatosis/steatoh epatitisH emochromatosisMedications/toxinsAutoimmune hepatitis a 1 Antitrypsin deficiencyWilson diseaseCeliac diseaseHepatic: AST-predominantAlcohol-related liver injury (AST:ALT > 2:1)CirrhosisNonhepaticStrenuous exerciseHemolysisMyopathyThyroid diseaseMacro-ASTAcute viral hepatitis (A-E, herpes)Medications/toxinsIschemic hepatitisAutoimmune hepatitisWilson diseaseAcute bile duct obstructionAcute Budd-Chiari syndromeHepatic artery ligation

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: If a patient has bilirubin 20 mg/dl, AST=313,, ALT=103 & GGT=44 IU/L. Most probable diagnosis is:, with the following options: A: Viral hepatitis, B: Alcoholic hepatitis, C: Billiary atresia, D: Drugs ### Response: Ans: B (Alcoholic...) Here, in Q AST > ALT(>3 times)- so most probable diagnosis is alcoholic hepatitisNormal value ofy-glutamyl transferase is 051IU/L L.D of Alcoholic Fatty Liver & Alcoholic HepatitisTestCommentASTincreased two-to-sevenfold,<400U/ L,greater than ALTALTIncreased two to sevenfold .less than 400U/ LAST/ALTUsually >1GGTPBilirubin5Not specific to alcohol, easily inducible .elevated in all forms of fatty liverMay be markedly increased in alcoholic hepatitis despite modest elevation in alkaline phosphatasePMNlf> 5500/uL predicts severe alcoholic hepatitis when discriminant function >32PMN- Polymorphonuclear cellsSERUM ENZ\ MES Harrison 18th/2527-30# The normal range for aminotransferases varies widely among laboratories, but generally ranges from 10-40 U/L.# Any type of liver cell injury can cause modest elevations in the serum aminotransferases. Levels of up to 300 U/L are nonspecific and may be found in any type of liver disorder. Minimal ALT elevations in asymptomatic blood donors rarely indicate severe liver disease; studies have shown that fatty liver disease is the most likely explanation. Striking elevations--i.e,, aminotransferases >1000 U/L--occur almost exclusively in disorders associated with extensive hepatocellular injury such as (1) viral hepatitis, (2) ischemic liver injury (prolonged hypotension or acute heart failure), or (3) toxin- or drug-induced liver injury.The pattern of the aminotransferase elevation can be helpful diagnostically. In most acute hepatocellular disorders, the ALT is higher than or equal to the AST. While the AST:ALT ratio is typically less than 1 in patients with chronic viral hepatitis and non-alcoholic fatty liver disease, a number of groups have noted that as cirrhosis develops this ratio rises to greater than 1.An AST.ALT ratio >2:1 is suggestive, while a ratio >3:1 is highly suggestive of alcoholic liver disease. The AST in alcoholic liver disease is rarely >300 U/L, and the ALT is often normal. A low level of ALT in the serum is due to an alcohol-induced deficiency of pyridoxa! phosphate.The aminotransferases are usually not greatly elevated in obstructive jaun dice.Enzymes that Reflect Cholestasis# The activities of three enzymes--alkaline phosphatase, 5'-nucleotidase, and g-glutamyi transpeptidase (GGT')--are usually elevated in cholestasis.Reflecting its more diffuse localization in the liver, GGT elevation in serum is less specific for cholestasis than are elevations of alkaline phosphatase or 5'-nucleotidase. Some have advocated the use of GGT to identify patients with occult alcohol use. Its lack of specificity makes its use in this setting questionable.Table (Harrison 18th/2530): Liver Test Patterns in Hepatobiliary DisordersType of DisorderBilirubinAminotrans ferasesAlkaline PhosphataseAlbuminProthrombin TimeHemolysis/Gilbert's syndromeNormal to 86 umol/L (5 mg/ dL) 85% due to indirect fractions No bilirubinuriaNormalNormalNormalNormalAcute hepatocellular necrosis (viral and drug hepatitis, hepatotoxins, acute heart failure)Both fractions may be elevated Peak usually follows aminotransferases BilirubinuriaElevated, often >500 1U ALT >ASTNorma] to <3 times normal elevationNormalUsually normal. If >5X above control and not corrected by parenteral vitamin K, suggests poor prognosisChronic hepatocellular disordersBoth fractions may be elevated BilirubinuriaElevated, but usually <300 IUNormal to <3 times normal elevationOften decreasedOften prolonged Fails to correct with parenteral vitamin KAlcoholic hepatitis CirrhosisBoth fractions may be elevatedBilirubinuriaAST:ALT > 2 suggests alcoholic hepatitis or cirrhosisNormal to <3 times normal elevationOften decreasedOften prolonged Fails to correct with parenteral vitamin KIntra- and extra-hepatic cholestasis(Obstructive jaundice)Both fractions may be elevated' BilirubinuriaNormal to moderate elevation Rarely >500IUElevated, often >4 times normal elevationNormal, unless chronicNormalIf prolonged, will correct with parenteral vitamin KInfiltrative diseases (tumor, granuloma- ta); partial bile duct obstructionUsually normalNormal to slight elevationElevated, often >4 times normal elevationFractionate, or confirm liver origin with 5' nucleotidase or g glutamyl transpep- tidaseNormalNormalTable (CMDT):Causes of serum aminotransferase elevations.Mild Elevations (<5x normal)Severe Elevations (> 15 x normal)Hepatic: ALT-predominantChronic hepatitis B, C, DAcute viral hepatitis (A-E, EBV, CMV)Steatosis/steatoh epatitisH emochromatosisMedications/toxinsAutoimmune hepatitis a 1 Antitrypsin deficiencyWilson diseaseCeliac diseaseHepatic: AST-predominantAlcohol-related liver injury (AST:ALT > 2:1)CirrhosisNonhepaticStrenuous exerciseHemolysisMyopathyThyroid diseaseMacro-ASTAcute viral hepatitis (A-E, herpes)Medications/toxinsIschemic hepatitisAutoimmune hepatitisWilson diseaseAcute bile duct obstructionAcute Budd-Chiari syndromeHepatic artery ligation ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Each gram of fat supplies how many kcal of energy:, with the following options: A: 5, B: 9, C: 12, D: 13 ### Response:

The various nutrients provide energy as follows: Nutrient Energy in kcal/ gram Protein 4 Carbohydrate 4 Fat 9 Dietary Fibres 2 Ref: Park 21st Edition, Page 585.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Each gram of fat supplies how many kcal of energy:, with the following options: A: 5, B: 9, C: 12, D: 13 ### Response: The various nutrients provide energy as follows: Nutrient Energy in kcal/ gram Protein 4 Carbohydrate 4 Fat 9 Dietary Fibres 2 Ref: Park 21st Edition, Page 585. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Interpret the Statistical graph given below:-, with the following options: A: Positive correlation, B: Negative correlation, C: Absent correlation, D: Spurious correlation ### Response:

Scatter Diagram /Dot diagram - Used in depiction of correlation (Relation B/W two quantitative variable) Positive correlation : 0 > r > +1 (+1 is perfectly positive/ strong correlation) Negative correlation: -1 < r < 0 (-1 is perfectly negative correlation) No correlation r = 0 EXTRA EDGE: - Pearson product-moment correlation is used for ratio/interval scale data - Spearman rank-order correlation is used forordinal scale data

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Interpret the Statistical graph given below:-, with the following options: A: Positive correlation, B: Negative correlation, C: Absent correlation, D: Spurious correlation ### Response: Scatter Diagram /Dot diagram - Used in depiction of correlation (Relation B/W two quantitative variable) Positive correlation : 0 > r > +1 (+1 is perfectly positive/ strong correlation) Negative correlation: -1 < r < 0 (-1 is perfectly negative correlation) No correlation r = 0 EXTRA EDGE: - Pearson product-moment correlation is used for ratio/interval scale data - Spearman rank-order correlation is used forordinal scale data ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Peripheral flange is seen in which implant form?, with the following options: A: Subperiosteal implant, B: Extraoral implant, C: Disc shaped implant, D: Root form implant ### Response:

Extraoral implants has peripheral flange for increased surface area for better osseointegration and retention.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Peripheral flange is seen in which implant form?, with the following options: A: Subperiosteal implant, B: Extraoral implant, C: Disc shaped implant, D: Root form implant ### Response: Extraoral implants has peripheral flange for increased surface area for better osseointegration and retention. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are medically impoant streptococci except, with the following options: A: Streptococcus pyogenes, B: Streptococcus agalactiae, C: Streptococcus equisimilus, D: Streptococcus salivarius ### Response:

Streptococcus viridans is a miscellany of streptococci, normally resident in the mouth and upper respiratory tract. Based on sugar fermentation, cell wall composition and production of dextrans and levans, they have been classified into: S. mitis S. mutans S. salivarius S. sanguis Reference: Textbook of Microbiology; Anathanarayan and paniker&;s; 9th edition; Page no: 218

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are medically impoant streptococci except, with the following options: A: Streptococcus pyogenes, B: Streptococcus agalactiae, C: Streptococcus equisimilus, D: Streptococcus salivarius ### Response: Streptococcus viridans is a miscellany of streptococci, normally resident in the mouth and upper respiratory tract. Based on sugar fermentation, cell wall composition and production of dextrans and levans, they have been classified into: S. mitis S. mutans S. salivarius S. sanguis Reference: Textbook of Microbiology; Anathanarayan and paniker&;s; 9th edition; Page no: 218 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: One year old male child with cat\'s eye reflex and raised IOT –, with the following options: A: Toxplasma gondii infection, B: Toxcara canis, C: Retinoblastoma, D: Retinopathy of prematurity ### Response:

Leukocoria with raised IOT is characteristic of retinoblastoma.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: One year old male child with cat\'s eye reflex and raised IOT –, with the following options: A: Toxplasma gondii infection, B: Toxcara canis, C: Retinoblastoma, D: Retinopathy of prematurity ### Response: Leukocoria with raised IOT is characteristic of retinoblastoma. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All the following disorders are inherited except:, with the following options: A: Protein S deficiency, B: Antiphospholipid antibody syndrome, C: Protein C deficiency, D: Factor V Leiden mutation ### Response:

Ans: B (Anti phospholipid antibody syndrome) Ref: Robbins Pathologic Basis of Disease, 8th edition, Harrison's Online > Chapter 117. Arterial and Venous Thrombosis >Explanation:Heritable Causes of Arterial and Venous ThrombosisArterial ThrombosisPlatelet ReceptorsIntegrinsP1A2 polymorphismGPIVGPIbThrombin receptorRedox EnzymesPlasma glutathione peroxidaseEndothelial nitric oxide synthaseParaoxonaseHomocysteineCystathionine -synthase5.10-methylene tetrahydrofolate reductase (MTHFR) 'Venous ThrombosisProcoagulant Proteins* FibrinogenProthrombinProtein C Anticoagulant PathwayFactor V LeidenThrombomodulinFibrinolytic Proteins with Known PolymorphismsTissue plasminogen activator (tPa)Plasminogen activator inhibitor (PAI-1)HomocysteineCystathionine-synthase5,10-methylene tetrahydrofolate reductase (MTHFR)Acquired Causes of Venous ThrombosisSurgeryNeurosurgeryMajor abdominal surgeryMalignancyAntiphospholipid syndromeOtherTraumaPregnancyLong-haul travelObesityOral contraceptives/hormone replacementMyeloproliferative disordersPolycythemia vera

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All the following disorders are inherited except:, with the following options: A: Protein S deficiency, B: Antiphospholipid antibody syndrome, C: Protein C deficiency, D: Factor V Leiden mutation ### Response: Ans: B (Anti phospholipid antibody syndrome) Ref: Robbins Pathologic Basis of Disease, 8th edition, Harrison's Online > Chapter 117. Arterial and Venous Thrombosis >Explanation:Heritable Causes of Arterial and Venous ThrombosisArterial ThrombosisPlatelet ReceptorsIntegrinsP1A2 polymorphismGPIVGPIbThrombin receptorRedox EnzymesPlasma glutathione peroxidaseEndothelial nitric oxide synthaseParaoxonaseHomocysteineCystathionine -synthase5.10-methylene tetrahydrofolate reductase (MTHFR) 'Venous ThrombosisProcoagulant Proteins* FibrinogenProthrombinProtein C Anticoagulant PathwayFactor V LeidenThrombomodulinFibrinolytic Proteins with Known PolymorphismsTissue plasminogen activator (tPa)Plasminogen activator inhibitor (PAI-1)HomocysteineCystathionine-synthase5,10-methylene tetrahydrofolate reductase (MTHFR)Acquired Causes of Venous ThrombosisSurgeryNeurosurgeryMajor abdominal surgeryMalignancyAntiphospholipid syndromeOtherTraumaPregnancyLong-haul travelObesityOral contraceptives/hormone replacementMyeloproliferative disordersPolycythemia vera ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Regarding cutaneous amoebiasis which is not true -, with the following options: A: It is a spreading necrotizing inflammation of the skin and cutaneous tissue, B: Rapid improvement with anti-amoebic treatment occurs, C: Can occur in the perianal region, D: The infection reaches the skin through the blood stream ### Response:

Option 1, 2, 3, 4 1. Cutaneous amoebiasis or Amoebiasis cutis- it is usually seen over the region adjoining a visceral lesion e.g. area of drainage of liver abscess or colostomy wound or from the rectum perianally. It may also be seen following anal intercourse. 2. Perianal skin ulcers: by direct extension of ulcers to perianal skin. 3. Amoeboma (Amoebic granuloma): a diffuse pseudotumor like mass of granulomatous tissue found in rectosigmoid region and sometimes growing sufficiently large to block the lumen 4.Rapid improvement with anti-amoebic treatment occurs. D.O.C:- metronidazole

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Regarding cutaneous amoebiasis which is not true -, with the following options: A: It is a spreading necrotizing inflammation of the skin and cutaneous tissue, B: Rapid improvement with anti-amoebic treatment occurs, C: Can occur in the perianal region, D: The infection reaches the skin through the blood stream ### Response: Option 1, 2, 3, 4 1. Cutaneous amoebiasis or Amoebiasis cutis- it is usually seen over the region adjoining a visceral lesion e.g. area of drainage of liver abscess or colostomy wound or from the rectum perianally. It may also be seen following anal intercourse. 2. Perianal skin ulcers: by direct extension of ulcers to perianal skin. 3. Amoeboma (Amoebic granuloma): a diffuse pseudotumor like mass of granulomatous tissue found in rectosigmoid region and sometimes growing sufficiently large to block the lumen 4.Rapid improvement with anti-amoebic treatment occurs. D.O.C:- metronidazole ### 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 female with history of painless breast lump measuring 6.2x4.5 cm. Trucut biopsy showed carcinoma breast. She underwent surgical removal of and post operative biopsy showed with carcinoma breast with high grade necrosis with margin 4 mm. Which of the following is needed?, with the following options: A: Adjuvant chemotherapy, B: Adjuvant radiotherapy, C: Adjuvant chemoradiotherapy, D: No additional treatment ### Response:

Ans. (c) Adjuvant Chemo RT(Ref Page 854/Sabiston 20th Edition)* Indications of RT:# Extracapsular nodal extension# Lymphovascular invasion# Close surgical margins# High grade necrosis# Age < 40 years

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 female with history of painless breast lump measuring 6.2x4.5 cm. Trucut biopsy showed carcinoma breast. She underwent surgical removal of and post operative biopsy showed with carcinoma breast with high grade necrosis with margin 4 mm. Which of the following is needed?, with the following options: A: Adjuvant chemotherapy, B: Adjuvant radiotherapy, C: Adjuvant chemoradiotherapy, D: No additional treatment ### Response: Ans. (c) Adjuvant Chemo RT(Ref Page 854/Sabiston 20th Edition)* Indications of RT:# Extracapsular nodal extension# Lymphovascular invasion# Close surgical margins# High grade necrosis# Age < 40 years ### 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 receives a toxic dose of lignocaine i.v., the patient is likely to exhibit:, with the following options: A: Excessive salivation, B: Mydriasis and diarrhea, C: Respiratory paralysis, D: Seizures and coma ### Response:

(Ref: KDT 6/e p356) lf LA reaches the blood stream, most prominent adverse effects are related to CNS and CVS. ln CNS, stimulation (convulsions) followed by depression (coma) is seen. Initial stimulation is due to inhibition of the inhibitory neurons.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A patient receives a toxic dose of lignocaine i.v., the patient is likely to exhibit:, with the following options: A: Excessive salivation, B: Mydriasis and diarrhea, C: Respiratory paralysis, D: Seizures and coma ### Response: (Ref: KDT 6/e p356) lf LA reaches the blood stream, most prominent adverse effects are related to CNS and CVS. ln CNS, stimulation (convulsions) followed by depression (coma) is seen. Initial stimulation is due to inhibition of the inhibitory neurons. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Atavistic epiphysis is seen in:, with the following options: A: Trochanters of femur, B: Lower end of radius, C: Tubercles of humerus, D: Coracoid process of scapula ### Response:

Epiphysis: Bones end or tip, that ossifies from secondary centres are called epiphysis. There are four types of epiphysis. Pressure epiphysis, traction epiphysis aberrant epiphysis and atavistic epiphysis. Atavistic epiphysis is an independant bone which in man becomes fused to another bone. This type of epiphysis is seen in coracoid process of scapula and os trigonum.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Atavistic epiphysis is seen in:, with the following options: A: Trochanters of femur, B: Lower end of radius, C: Tubercles of humerus, D: Coracoid process of scapula ### Response: Epiphysis: Bones end or tip, that ossifies from secondary centres are called epiphysis. There are four types of epiphysis. Pressure epiphysis, traction epiphysis aberrant epiphysis and atavistic epiphysis. Atavistic epiphysis is an independant bone which in man becomes fused to another bone. This type of epiphysis is seen in coracoid process of scapula and os trigonum. ### 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 cystic hygroma is -, with the following options: A: Non transilluminant, B: Lined by columnar epithelium epithelium, C: Develops from jugular lymphatic sequestration, D: All ### Response:

Cystic hygroma Cystic hygroma is a swelling usually occuring in the lower third of the neck It is most commonly seen in posterior triangle of the neck, but may also occur in axilla, groin & mediastinum It results due to sequestration of a poion of the jugular lymph sac from the lymphatic system. It usually manifests in the neonate or in early infancy (occasionally present at bih) The swelling is soft and paially compressible and invariably increases in size when the child coughs or cries. The characteristic that distinguishes it from all other neck swellings is that it is brilliantly translucent. The cysts are filled with clear lymph and are lined by endothelium. Ref : Bailey and love surgery text book 27th Ed.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: True regarding cystic hygroma is -, with the following options: A: Non transilluminant, B: Lined by columnar epithelium epithelium, C: Develops from jugular lymphatic sequestration, D: All ### Response: Cystic hygroma Cystic hygroma is a swelling usually occuring in the lower third of the neck It is most commonly seen in posterior triangle of the neck, but may also occur in axilla, groin & mediastinum It results due to sequestration of a poion of the jugular lymph sac from the lymphatic system. It usually manifests in the neonate or in early infancy (occasionally present at bih) The swelling is soft and paially compressible and invariably increases in size when the child coughs or cries. The characteristic that distinguishes it from all other neck swellings is that it is brilliantly translucent. The cysts are filled with clear lymph and are lined by endothelium. Ref : Bailey and love surgery text book 27th Ed. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Schizophrenia is characterised by A/E, with the following options: A: Formal thought disorder, B: Delusion of reference, C: Waxy flexibility, D: Altered sensorium ### Response:

D i.e. Altered Sensorium

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Schizophrenia is characterised by A/E, with the following options: A: Formal thought disorder, B: Delusion of reference, C: Waxy flexibility, D: Altered sensorium ### Response: D i.e. Altered Sensorium ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: If a biochemical test gives the same reading for a sample on repeated testing, it is inferred that the measurement is:, with the following options: A: Precise, B: Accurate, C: Specific, D: Sensitive ### Response:

Criteria of screening test Acceptability – The test should be acceptable to population to which it is going to be applied. Repeatability  (reliability, precision, reproducibility)  –  The test must give consistent results when repeated more than once on the same individual or material under the same condition. Validity (accuracy) – It refers to what extent the test accurately measures which it purports to measure. (it means it expresses the ability of a test to separate or distinguish those who have the disease from those who do not). Accuracy refers to closeness with which measured values agree with “true” value. It has two components: i. Sensitivity – Ability of test of identify correctly all those who have disease. ii. Specificity – Ability to test to identify correctly all those who do not have disease.  So, if test gives the same reading for a sample on repeated testing means test is precise (i.e., reliable, reproducible, repeatable).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: If a biochemical test gives the same reading for a sample on repeated testing, it is inferred that the measurement is:, with the following options: A: Precise, B: Accurate, C: Specific, D: Sensitive ### Response: Criteria of screening test Acceptability – The test should be acceptable to population to which it is going to be applied. Repeatability  (reliability, precision, reproducibility)  –  The test must give consistent results when repeated more than once on the same individual or material under the same condition. Validity (accuracy) – It refers to what extent the test accurately measures which it purports to measure. (it means it expresses the ability of a test to separate or distinguish those who have the disease from those who do not). Accuracy refers to closeness with which measured values agree with “true” value. It has two components: i. Sensitivity – Ability of test of identify correctly all those who have disease. ii. Specificity – Ability to test to identify correctly all those who do not have disease.  So, if test gives the same reading for a sample on repeated testing means test is precise (i.e., reliable, reproducible, repeatable). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The HIV virus binds directly to the surface receptors of CD4 lymphocytes with _____., with the following options: A: Reverse transcriptase, B: Integrase, C: Hemagglutinin, D: Glycoprotein 120 ### Response:

HIV’s envelope contains two glycoproteins, gp120 and gp41. gp120 binds specifically with CD4 surface receptors.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The HIV virus binds directly to the surface receptors of CD4 lymphocytes with _____., with the following options: A: Reverse transcriptase, B: Integrase, C: Hemagglutinin, D: Glycoprotein 120 ### Response: HIV’s envelope contains two glycoproteins, gp120 and gp41. gp120 binds specifically with CD4 surface receptors. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Chocolate agar is an example of?, with the following options: A: Enriched medium, B: Enrichment medium, C: Selective medium, D: Transport medium ### Response:

Ans. (a) Enriched mediumRef: Appendix-82 for "Categories of artificial media

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Chocolate agar is an example of?, with the following options: A: Enriched medium, B: Enrichment medium, C: Selective medium, D: Transport medium ### Response: Ans. (a) Enriched mediumRef: Appendix-82 for "Categories of artificial media ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Cherry red spot at macula is seen in :, with the following options: A: Macular infarction, B: Neimen picks disease, C: Commotio retinae, D: CRVO ### Response:

D i.e. CRVO CRAO (not CRVO) presents with cherry red spot at macula Q

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Cherry red spot at macula is seen in :, with the following options: A: Macular infarction, B: Neimen picks disease, C: Commotio retinae, D: CRVO ### Response: D i.e. CRVO CRAO (not CRVO) presents with cherry red spot at macula Q ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In putrifaction greenish discolouration is first seen in:, with the following options: A: Lion, B: Epigastrium, C: Right iliac fossa, D: Lower limb ### Response:

C i.e. Right iliac fossa

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In putrifaction greenish discolouration is first seen in:, with the following options: A: Lion, B: Epigastrium, C: Right iliac fossa, D: Lower limb ### Response: C i.e. Right iliac fossa ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Gillette's space is, with the following options: A: Retropharyngeal space, B: Peritonsillar space, C: Parapharyngeal space, D: None ### Response:

Retropharyngeal space, situated behind the pharynx and extending from the base of the skull to the bifurcation of the trachea. Space is divided into two lateral compaments (spaces of Gillette) by a fibrous raphe. Each lateral space contains retropharyngeal nodes which usually disappear at 3-4 years of age. Parapharyngeal space communicates with the retropharyngeal space. Infection of retropharyngeal space can pass down behind the oesophagus into the mediastinum. (Ref: Diseases of ear, nose and throat, PL Dhingra, 7thh edition, page no. 299)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Gillette's space is, with the following options: A: Retropharyngeal space, B: Peritonsillar space, C: Parapharyngeal space, D: None ### Response: Retropharyngeal space, situated behind the pharynx and extending from the base of the skull to the bifurcation of the trachea. Space is divided into two lateral compaments (spaces of Gillette) by a fibrous raphe. Each lateral space contains retropharyngeal nodes which usually disappear at 3-4 years of age. Parapharyngeal space communicates with the retropharyngeal space. Infection of retropharyngeal space can pass down behind the oesophagus into the mediastinum. (Ref: Diseases of ear, nose and throat, PL Dhingra, 7thh edition, page no. 299) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Precursor of all steroid hormones -, with the following options: A: Pregnenolone, B: Deoxycortisol, C: Androstenedione, D: Dehydroepiandrosterone ### Response:

Ans. is 'a' i.e., Pregnenolone o All steroid hormones originate from cholesterol.o Steps involved in biosynthesis of various steroid hormones are as follows :-Cholesterol is first acted upon by desmolase to form a 21-carbon product pregnenolone, which is the biosynthetic precursor of all steroid hormones.Pregnenolone is converted to progesterone by dehydrogenase.Progesterone is further converted to glucocorticoids and mineralcorticoids by hydroxy lotions. These reactions are affected by monooxygenases w'hich require cytochrome P-450 as an intermediate electrone carrier. These monooxygenases are -17-hydroxylase and 21-hydroxylase - Microsomal11-hydroxyalse - Mitochondrial

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Precursor of all steroid hormones -, with the following options: A: Pregnenolone, B: Deoxycortisol, C: Androstenedione, D: Dehydroepiandrosterone ### Response: Ans. is 'a' i.e., Pregnenolone o All steroid hormones originate from cholesterol.o Steps involved in biosynthesis of various steroid hormones are as follows :-Cholesterol is first acted upon by desmolase to form a 21-carbon product pregnenolone, which is the biosynthetic precursor of all steroid hormones.Pregnenolone is converted to progesterone by dehydrogenase.Progesterone is further converted to glucocorticoids and mineralcorticoids by hydroxy lotions. These reactions are affected by monooxygenases w'hich require cytochrome P-450 as an intermediate electrone carrier. These monooxygenases are -17-hydroxylase and 21-hydroxylase - Microsomal11-hydroxyalse - Mitochondrial ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In a person who is acclimatized to high altitude for a long time, which of the following changes is seen?, with the following options: A: Increased MCHC, B: Irregular respiration, C: Pulmonary arterial hypertension, D: Increased airway resistance ### Response:

Ans: C (Pulmonary arterial hypertension) Ref: Ganong's Review of Medical Physiology, 21st ed, and Medical Physiology: Principles for Clinical Medicine by Rhoades RA 4th edition, pg 396 Explanation: "Although the body undergoes many beneficial changes that allow acclimatization to high altitude, there are some undesirable effects. One of these is pulmonary hypertension (abnormally high pulmonary arterial blood pressure). Alveolar hypoxia causes pulmonary vasoconstriction. Remember that regional hypoxia redirects blood away from poorly ventilated regions in the lung without any change in pulmonary pressure. However, with generalized hypoxia, pulmonary pressure rises because all the preafveolar vessels constrict. In addition, prolonged hypoxia causes vascular remodeling in which pulmonary arterial smooth muscle cells undergo hypertrophy and hyperplasia. The vascular remodeling results in narrowing of the small pulmonary arteries and increases pulmonary vascular resistance, leading to a further significant increase in pulmonary vascular hypertension.'' Ref: Medical Physiology: Principles for Clinical Medicine by Rhoades RA, 4th edition, pg 396 Changes Seen in High Altitude Acclimatization Respiratory alkalosis produced by the hyperventilation shifts the oxygen-hemoglobin dissociation curve to the left, but there is a concomitant. Increase in red blood cell 2, 3-DPG, which tends to decrease the O2 affinity of hemoglobin. The net effect is a small increase in P50. Erythropoietin secretion increases promptly on ascent to high altitude and then falls somewhat over the following 4 days as the ventilatory response increases and the arterial PO2 rises. The increase in circulating RBCs triggered by the erythropoietin begins in 2-3 days and is sustained. | Alveolar PO2 | Hematocrit (Polycythemia) - | MCV and | MCHC. | RBC mass. | Concentration of capillaries in skeletal muscle tissue. | Myoglobin (Facilitates movement of O2 in tissues) | Mitochondria (the site of oxidative reactions). | Tissue cytochrome oxidase. | Aerobic enzyme concentration. | 2,3-BPG. Hypoxic pulmonary vasoconstriction leading to pulmonary arterial hypertension, Right ventricular hypertrophy. Also Note: Hypoxic hypoxia is a problem in normal individuals at high altitudes In high altitudes, the composition of air stays the same, but the total barometric pressure falls with increasing altitude. Therefore, the PO2 also falls. At 3000 m (approximately 10,000 ft) above sea level, the alveolar PO2 is about 60 mmHg and there is enough hypoxic stimulation of the chemoreceptors to definitely increase ventilation. As one ascends higher, the alveolar PO2 falls less rapidly and the alveolar PCO2 declines somewhat because of the hyperventilation. The resulting fall in arterial PCO2 produces respiratory alkalosis. Manifestations in unacclimatized subjects: o c At 3700 m - Mental symptoms o At 5500 m - Hypoxic symptoms o At above 6100 m (20,000 ft) - Unconsciousness and death. Acute "Transient" Mountain Sickness Occurs when unacclimatized persons first arrive at a high altitude. This syndrome develops 8-24 hours after arrival and lasts 4-8 days. It is characterized by headache, irritability, insomnia, breathlessness, and nausea and vomiting. Associated with cerebral edema. The low PO2 at high altitude causes arteriolar dilation, and if cerebral auto regulation does not compensate, there is an increase in capillary pressure that favors increased transudetion of fluid into brain tissue. Decreased urine output (Normally diuresis is seen at high altitude). High-altitude cerebral edema The capillary leakage in mountain sickness progresses to frank brain swelling, with ataxia, disorientation, and in some cases coma and death due to herniation of the brain through the tentorium. High-altitude pulmonary edema. It is a patchy edema of the lungs that is related to the marked pulmonary hypertension that develops at high altitude. Treatment of High Altitude illness All forms of high-altitude illness are benefited by: Descent to a lower altitude. Diuretic acetazolamide - This drug inhibits carbonic anhydrase. producing increased HCO3- excretion in the urine, stimulating respiration, increasing PaCO2. and reducing CSF formation. Oxygen supplementation / Hyperbaric chamber (Pulmonary edema). Glucocorticoids (Cerebral edema). Nifedipine can lower pulmonary artery pressure. Chronic Mountain Sickness (Monge's Disease) Due to aberration of normal physiological response to high altitude. Extremely increased hemoglobin levels. Pulmonary hypertension. Right ventricular failure. Treatment: Return to lower altitudes.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In a person who is acclimatized to high altitude for a long time, which of the following changes is seen?, with the following options: A: Increased MCHC, B: Irregular respiration, C: Pulmonary arterial hypertension, D: Increased airway resistance ### Response: Ans: C (Pulmonary arterial hypertension) Ref: Ganong's Review of Medical Physiology, 21st ed, and Medical Physiology: Principles for Clinical Medicine by Rhoades RA 4th edition, pg 396 Explanation: "Although the body undergoes many beneficial changes that allow acclimatization to high altitude, there are some undesirable effects. One of these is pulmonary hypertension (abnormally high pulmonary arterial blood pressure). Alveolar hypoxia causes pulmonary vasoconstriction. Remember that regional hypoxia redirects blood away from poorly ventilated regions in the lung without any change in pulmonary pressure. However, with generalized hypoxia, pulmonary pressure rises because all the preafveolar vessels constrict. In addition, prolonged hypoxia causes vascular remodeling in which pulmonary arterial smooth muscle cells undergo hypertrophy and hyperplasia. The vascular remodeling results in narrowing of the small pulmonary arteries and increases pulmonary vascular resistance, leading to a further significant increase in pulmonary vascular hypertension.'' Ref: Medical Physiology: Principles for Clinical Medicine by Rhoades RA, 4th edition, pg 396 Changes Seen in High Altitude Acclimatization Respiratory alkalosis produced by the hyperventilation shifts the oxygen-hemoglobin dissociation curve to the left, but there is a concomitant. Increase in red blood cell 2, 3-DPG, which tends to decrease the O2 affinity of hemoglobin. The net effect is a small increase in P50. Erythropoietin secretion increases promptly on ascent to high altitude and then falls somewhat over the following 4 days as the ventilatory response increases and the arterial PO2 rises. The increase in circulating RBCs triggered by the erythropoietin begins in 2-3 days and is sustained. | Alveolar PO2 | Hematocrit (Polycythemia) - | MCV and | MCHC. | RBC mass. | Concentration of capillaries in skeletal muscle tissue. | Myoglobin (Facilitates movement of O2 in tissues) | Mitochondria (the site of oxidative reactions). | Tissue cytochrome oxidase. | Aerobic enzyme concentration. | 2,3-BPG. Hypoxic pulmonary vasoconstriction leading to pulmonary arterial hypertension, Right ventricular hypertrophy. Also Note: Hypoxic hypoxia is a problem in normal individuals at high altitudes In high altitudes, the composition of air stays the same, but the total barometric pressure falls with increasing altitude. Therefore, the PO2 also falls. At 3000 m (approximately 10,000 ft) above sea level, the alveolar PO2 is about 60 mmHg and there is enough hypoxic stimulation of the chemoreceptors to definitely increase ventilation. As one ascends higher, the alveolar PO2 falls less rapidly and the alveolar PCO2 declines somewhat because of the hyperventilation. The resulting fall in arterial PCO2 produces respiratory alkalosis. Manifestations in unacclimatized subjects: o c At 3700 m - Mental symptoms o At 5500 m - Hypoxic symptoms o At above 6100 m (20,000 ft) - Unconsciousness and death. Acute "Transient" Mountain Sickness Occurs when unacclimatized persons first arrive at a high altitude. This syndrome develops 8-24 hours after arrival and lasts 4-8 days. It is characterized by headache, irritability, insomnia, breathlessness, and nausea and vomiting. Associated with cerebral edema. The low PO2 at high altitude causes arteriolar dilation, and if cerebral auto regulation does not compensate, there is an increase in capillary pressure that favors increased transudetion of fluid into brain tissue. Decreased urine output (Normally diuresis is seen at high altitude). High-altitude cerebral edema The capillary leakage in mountain sickness progresses to frank brain swelling, with ataxia, disorientation, and in some cases coma and death due to herniation of the brain through the tentorium. High-altitude pulmonary edema. It is a patchy edema of the lungs that is related to the marked pulmonary hypertension that develops at high altitude. Treatment of High Altitude illness All forms of high-altitude illness are benefited by: Descent to a lower altitude. Diuretic acetazolamide - This drug inhibits carbonic anhydrase. producing increased HCO3- excretion in the urine, stimulating respiration, increasing PaCO2. and reducing CSF formation. Oxygen supplementation / Hyperbaric chamber (Pulmonary edema). Glucocorticoids (Cerebral edema). Nifedipine can lower pulmonary artery pressure. Chronic Mountain Sickness (Monge's Disease) Due to aberration of normal physiological response to high altitude. Extremely increased hemoglobin levels. Pulmonary hypertension. Right ventricular failure. Treatment: Return to lower altitudes. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Not true regarding fresh frozen plasma, with the following options: A: Supplies major coagulation factors, B: ABO match not required, C: Should be used in replacement of factors in DIC / trauma, D: To be used within 30 minutes of having trauma ### Response:

Shelf Life Packed RBCs plulcletz Fresh frozen plasma Cryoprecipitate 42 days 5 days 1 year 1 year

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Not true regarding fresh frozen plasma, with the following options: A: Supplies major coagulation factors, B: ABO match not required, C: Should be used in replacement of factors in DIC / trauma, D: To be used within 30 minutes of having trauma ### Response: Shelf Life Packed RBCs plulcletz Fresh frozen plasma Cryoprecipitate 42 days 5 days 1 year 1 year ### 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 drug is contraindicated in variant angina?, with the following options: A: Diltiazem, B: Nitrates, C: Propranolol, D: Verapamil ### Response:

Variant angina is caused by coronary vasospasm DOC:Sublingual Nitroglycerine Prophylaxis : Calcium channel blockers (like verapamil and Diltiazem) and nitrates Beta blockers are avoided as they may precipitate coronary vasospasm by counteracting beta 2 mediated coronary vasodilation. Therefore they are avoided in variant angina.

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 drug is contraindicated in variant angina?, with the following options: A: Diltiazem, B: Nitrates, C: Propranolol, D: Verapamil ### Response: Variant angina is caused by coronary vasospasm DOC:Sublingual Nitroglycerine Prophylaxis : Calcium channel blockers (like verapamil and Diltiazem) and nitrates Beta blockers are avoided as they may precipitate coronary vasospasm by counteracting beta 2 mediated coronary vasodilation. Therefore they are avoided in variant angina. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 10-year old child is undergoing squint surgery. He suddenly developed increased hea rate, arrhythmia, high fever, metabolic and respiratory acidosis on aerial blood gases and elevation of end tidal CO2. Which of the following would be the first agent of choice in the management of this condition?, with the following options: A: Dantrolene, B: Paracetamol, C: Procainamide, D: Sodium bicarbonate ### Response:

Ans. a. Dantrolene Sudden development of increased hea rate, arrhythmia, high fever, metabolic and respiratory acidosis on aerial blood gases and elevation of end tidal CO, in a child undergoing squint surgery is highly suggestive of malignant hypehermia. Dantrolene would be the first agent of choice in the management of malignant hypehermia. "Malignant Hypehermia: Dantrolene is the only drug effective in reversing the symptoms and preventing the episode.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 10-year old child is undergoing squint surgery. He suddenly developed increased hea rate, arrhythmia, high fever, metabolic and respiratory acidosis on aerial blood gases and elevation of end tidal CO2. Which of the following would be the first agent of choice in the management of this condition?, with the following options: A: Dantrolene, B: Paracetamol, C: Procainamide, D: Sodium bicarbonate ### Response: Ans. a. Dantrolene Sudden development of increased hea rate, arrhythmia, high fever, metabolic and respiratory acidosis on aerial blood gases and elevation of end tidal CO, in a child undergoing squint surgery is highly suggestive of malignant hypehermia. Dantrolene would be the first agent of choice in the management of malignant hypehermia. "Malignant Hypehermia: Dantrolene is the only drug effective in reversing the symptoms and preventing the episode. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Toxic megacolon is seen in, with the following options: A: Chronic non specific ulcerative colities, B: Crohn's disease, C: Colonic diveiculosis, D: Hamaomatous polyp ### Response:

.Toxic megacolon * 1.5% incidence * Common in transverse colon * Colon is more than 6 cm in diameter * Colon is like wet blotting paper * Commonly seen in ulcerative colitis * Can occur in bacterial colitis, pseudomembranous colitis, fulminant amoebic colitis * May be precipitated by antidiarrhoeal drugs * Emergency surgery, colectomy, colostomy/ileostomy may be required * IV fluids, blood transfusion, antibiotics, steroids are also needed * Can be life threatening* Plain X-ray is very useful. ref:SRB's manual of surgery,ed 5,pg no 895

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Toxic megacolon is seen in, with the following options: A: Chronic non specific ulcerative colities, B: Crohn's disease, C: Colonic diveiculosis, D: Hamaomatous polyp ### Response: .Toxic megacolon * 1.5% incidence * Common in transverse colon * Colon is more than 6 cm in diameter * Colon is like wet blotting paper * Commonly seen in ulcerative colitis * Can occur in bacterial colitis, pseudomembranous colitis, fulminant amoebic colitis * May be precipitated by antidiarrhoeal drugs * Emergency surgery, colectomy, colostomy/ileostomy may be required * IV fluids, blood transfusion, antibiotics, steroids are also needed * Can be life threatening* Plain X-ray is very useful. ref:SRB's manual of surgery,ed 5,pg no 895 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Implants used in orthodontics are, with the following options: A: Endo-osseous implants, B: Trans-osseous implants, C: Micro implants, D: Bioresorbable implants ### Response:

Anchorage is the most critical aspect of orthodontics. The anchorage savers do offer extra assistance to anchorage, most recent armamentarium in orthodontics was the introduction of mini screw implants (MSI) and skeletal anchorage system (SAS). Their small size has led to them being called- "mini-implants, micro-implants, mini-screws or mini-pins". Textbook of Orthodontics, Gurkeerat Singh 2nd ed page 299

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Implants used in orthodontics are, with the following options: A: Endo-osseous implants, B: Trans-osseous implants, C: Micro implants, D: Bioresorbable implants ### Response: Anchorage is the most critical aspect of orthodontics. The anchorage savers do offer extra assistance to anchorage, most recent armamentarium in orthodontics was the introduction of mini screw implants (MSI) and skeletal anchorage system (SAS). Their small size has led to them being called- "mini-implants, micro-implants, mini-screws or mini-pins". Textbook of Orthodontics, Gurkeerat Singh 2nd ed page 299 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are relations of left ureter EXCEPT:, with the following options: A: Sigmoid mesentery, B: Bifurcation of common iliac aery, C: Quadratus lumborum, D: Gonadal vessels ### Response:

Left ureter is related posteriorly to psoas major muscle (not quadratus lumborum). Posterior relations:- Both the ureters run anterior to psoas major muscle and bifurcation of common iliac aery. Anterior relation:- Gonadal vessels cross the ureters anteriorly (medial to lateral) and descend down along with them. Medially the right ureter is related to inferior vena cava and left ureter is related to inferior mesenteric vein.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are relations of left ureter EXCEPT:, with the following options: A: Sigmoid mesentery, B: Bifurcation of common iliac aery, C: Quadratus lumborum, D: Gonadal vessels ### Response: Left ureter is related posteriorly to psoas major muscle (not quadratus lumborum). Posterior relations:- Both the ureters run anterior to psoas major muscle and bifurcation of common iliac aery. Anterior relation:- Gonadal vessels cross the ureters anteriorly (medial to lateral) and descend down along with them. Medially the right ureter is related to inferior vena cava and left ureter is related to inferior mesenteric vein. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All is true about Brown - sequard syndrome except, with the following options: A: Hemisection of spinal cord, B: Ipsilateral loss of vibration sensations, C: Ipsilateral loss of crude touch sensations, D: Ipsilateral paralysis below the level of lesion ### Response:

The patient present with contralateral loss of crude touch sensations, since anterior spinothalamic tract carrying these sensations, crosses the midline and runs on the opposite half of spinal cord.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All is true about Brown - sequard syndrome except, with the following options: A: Hemisection of spinal cord, B: Ipsilateral loss of vibration sensations, C: Ipsilateral loss of crude touch sensations, D: Ipsilateral paralysis below the level of lesion ### Response: The patient present with contralateral loss of crude touch sensations, since anterior spinothalamic tract carrying these sensations, crosses the midline and runs on the opposite half of spinal cord. ### 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 odds ratio for the following?Screening test resultsDiagnosis Total DiseasedNot diseasedPositiveabNegativecdTotala+bb+d, with the following options: A: ad/bc, B: ab/cd, C: ac/bd, D: bc/ad ### Response:

Ans. a (ad/bc). (Ref: Park PSM 22nd/pg. 70, 75, 86)1. Relative riskRR =Incidence of disease (or death) among exposed-----------------------------Incidence of disease (or death) among non-exposed2. Odds Ratio (Cross-product ratio)Odds ratio = ad/bc# The odds ratio is a measure of effect size particularly important in Bayesian statistics and logistic regression.# It is defined as the ratio of the odds of an event occurring in one group to the odds of it occurring in another group, or to a data-based estimate of that ratio. These groups might be men and women, an experimental group and a control group, or any other dichotomous classification.# An odds ratio of 1 indicates that the condition or event under study is equally likely in both groups. An odds ratio greater than 1 indicates that the condition or event is more likely in the first group. And an odds ratio less than 1 indicates that the condition or event is less likely in the first group. The odds ratio must be zero or greater than zero. As the odds of the first group approaches zero, the odds ratio approaches zero. As the odds of the second group approaches zero, the odds ratio approaches positive infinity.3. Attributable RiskAR =Incidence of disease rate among exposed - incidence of disease rate among non-exposed--------------------------------------------------Incidence rate among exposedx 100 Screening test resultsDiagnosisTotal DiseasedNot diseased Positivea(true positive)b(faIse positive)a + bNegativec(False negative)d(True negative)C+dTotala + bb+da+b+c+d Sensitivity = TP/(TP+FN)Specificity= TN/(TN+FP)Positive predictive value=TP/(TP+FP)Negative predictive value = TN/(TN+FN)Accuracy=(TP+TN)/(TP+TN+FP+FN) Specificity = a---a + c Specificity = d---b + d Positive predictive value PPV = a---a + b Negative predictive value NPV = d---c + d Relative riskRR =Attributable riskAR =-Hardy-weinberg equilibriump2+2pq+q2=lp+q=l

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 odds ratio for the following?Screening test resultsDiagnosis Total DiseasedNot diseasedPositiveabNegativecdTotala+bb+d, with the following options: A: ad/bc, B: ab/cd, C: ac/bd, D: bc/ad ### Response: Ans. a (ad/bc). (Ref: Park PSM 22nd/pg. 70, 75, 86)1. Relative riskRR =Incidence of disease (or death) among exposed-----------------------------Incidence of disease (or death) among non-exposed2. Odds Ratio (Cross-product ratio)Odds ratio = ad/bc# The odds ratio is a measure of effect size particularly important in Bayesian statistics and logistic regression.# It is defined as the ratio of the odds of an event occurring in one group to the odds of it occurring in another group, or to a data-based estimate of that ratio. These groups might be men and women, an experimental group and a control group, or any other dichotomous classification.# An odds ratio of 1 indicates that the condition or event under study is equally likely in both groups. An odds ratio greater than 1 indicates that the condition or event is more likely in the first group. And an odds ratio less than 1 indicates that the condition or event is less likely in the first group. The odds ratio must be zero or greater than zero. As the odds of the first group approaches zero, the odds ratio approaches zero. As the odds of the second group approaches zero, the odds ratio approaches positive infinity.3. Attributable RiskAR =Incidence of disease rate among exposed - incidence of disease rate among non-exposed--------------------------------------------------Incidence rate among exposedx 100 Screening test resultsDiagnosisTotal DiseasedNot diseased Positivea(true positive)b(faIse positive)a + bNegativec(False negative)d(True negative)C+dTotala + bb+da+b+c+d Sensitivity = TP/(TP+FN)Specificity= TN/(TN+FP)Positive predictive value=TP/(TP+FP)Negative predictive value = TN/(TN+FN)Accuracy=(TP+TN)/(TP+TN+FP+FN) Specificity = a---a + c Specificity = d---b + d Positive predictive value PPV = a---a + b Negative predictive value NPV = d---c + d Relative riskRR =Attributable riskAR =-Hardy-weinberg equilibriump2+2pq+q2=lp+q=l ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Population explosion is defined as population growth rate of more than_______ per year., with the following options: A: 2, B: 1.75, C: 1.8, D: 1.5 ### Response:

Ans. a (2.0) (Ref. Park PSM 22nd/pg. 443)Relation between growth rate and population:RatingAnnual rate of growth %Number of years required for the population to double in sizeStationary populationNo growth Slow growthLess than 0.5More than 139Moderate growth0.5 to 1.0139-70Rapid growth1.0 to 1.570-47Very rapid growth1.5 to 2.047-35"Explosive" growth2.0 to 2.535-28"Explosive" growth2.5 to 3.028-23

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Population explosion is defined as population growth rate of more than_______ per year., with the following options: A: 2, B: 1.75, C: 1.8, D: 1.5 ### Response: Ans. a (2.0) (Ref. Park PSM 22nd/pg. 443)Relation between growth rate and population:RatingAnnual rate of growth %Number of years required for the population to double in sizeStationary populationNo growth Slow growthLess than 0.5More than 139Moderate growth0.5 to 1.0139-70Rapid growth1.0 to 1.570-47Very rapid growth1.5 to 2.047-35"Explosive" growth2.0 to 2.535-28"Explosive" growth2.5 to 3.028-23 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Topical antifungal in fusarium infections is:, with the following options: A: Silver sulfadiazine, B: Natamycin, C: Ketoconazole, D: Flucytosine ### Response:

Natamycin

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Topical antifungal in fusarium infections is:, with the following options: A: Silver sulfadiazine, B: Natamycin, C: Ketoconazole, D: Flucytosine ### Response: Natamycin ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At what period, Frequency is present in pregnancy:, with the following options: A: Before 16 weeks, B: After 18 weeks, C: After 20 weeks, D: After 24 weeks ### Response:

Before 16 weeks

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At what period, Frequency is present in pregnancy:, with the following options: A: Before 16 weeks, B: After 18 weeks, C: After 20 weeks, D: After 24 weeks ### Response: Before 16 weeks ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A young patient presents with enlargement of the costochondral junction and with the white line of Fraenkel at the metaphysis. The diagnosis is -, with the following options: A: Scruvy, B: Rickets, C: Hyperparathyroidism, D: Osteomalacia ### Response:

Enlargement of the costochondral junction (rosary) and white line of Frankel are seen both in scurvy and rickets. However, the best answer here is scurvy as white line Fraenkel is seen in healing rickets, not in active rickets. And rickets (if not specified as healing rickets) refers to active disease.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A young patient presents with enlargement of the costochondral junction and with the white line of Fraenkel at the metaphysis. The diagnosis is -, with the following options: A: Scruvy, B: Rickets, C: Hyperparathyroidism, D: Osteomalacia ### Response: Enlargement of the costochondral junction (rosary) and white line of Frankel are seen both in scurvy and rickets. However, the best answer here is scurvy as white line Fraenkel is seen in healing rickets, not in active rickets. And rickets (if not specified as healing rickets) refers to active disease. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In minimal change disease, which of the following is seen?, with the following options: A: Immunodeposits in glomerulus, B: Immunodeposits in mesangium, C: Immunodeposits in blood vessels, D: No immunodeposits ### Response:

d. No immunodeposits(Ref: Nelson's 20/e p 2521-2528, Ghai 8/e p 477-482)In minimal change disease:Light microscopy: Glomeruli appear normal: No Ig/complement deposits, GBM: normalImmunofluorescence microscopy: No electron-dense depositsElectron microscopy: Diffuse effacement of foot processes of podocytes ("podocytopathy").

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In minimal change disease, which of the following is seen?, with the following options: A: Immunodeposits in glomerulus, B: Immunodeposits in mesangium, C: Immunodeposits in blood vessels, D: No immunodeposits ### Response: d. No immunodeposits(Ref: Nelson's 20/e p 2521-2528, Ghai 8/e p 477-482)In minimal change disease:Light microscopy: Glomeruli appear normal: No Ig/complement deposits, GBM: normalImmunofluorescence microscopy: No electron-dense depositsElectron microscopy: Diffuse effacement of foot processes of podocytes ("podocytopathy"). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: HHV-8 causes ?, with the following options: A: Burkitt's lymphoma, B: Nasopharyngeal carcinoma, C: Kaposi sarcoma, D: Hepatic carcinoma ### Response:

Ans. is 'c' i.e., Kaposi sarcoma

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: HHV-8 causes ?, with the following options: A: Burkitt's lymphoma, B: Nasopharyngeal carcinoma, C: Kaposi sarcoma, D: Hepatic carcinoma ### Response: Ans. is 'c' i.e., Kaposi sarcoma ### 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 used for myoclonic seizures except:, with the following options: A: Sodium valproate, B: Zonisamide, C: Carbamazepine, D: Topiramate ### Response:

*'Carbamazepine and phenytoin can aggravate juvenile myoclonic epilepsy' Drugs useful for myoclonic seizures are: *Valproic acid (Drug of choice) *Benzodiazepines *Zonisamide *Levetiracetam *Topiramate *Lamotrigine REF : KATZUNG 14TH 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 are used for myoclonic seizures except:, with the following options: A: Sodium valproate, B: Zonisamide, C: Carbamazepine, D: Topiramate ### Response: *'Carbamazepine and phenytoin can aggravate juvenile myoclonic epilepsy' Drugs useful for myoclonic seizures are: *Valproic acid (Drug of choice) *Benzodiazepines *Zonisamide *Levetiracetam *Topiramate *Lamotrigine REF : KATZUNG 14TH ED. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Active moiety of CoA is, with the following options: A: Acetyl group, B: Pantothenic acid, C: Thiol of beta alanine, D: Thiol of pantothenic acid ### Response:

- Synthesis of coenzyme A from pantothenate occurs in a series of  reactions. Pantothenate is  first phosphorylated to  which  cysteine is  added. Decarboxylation, followed by addition of AMP moiety and a phosphate (each from ATP) results in  coenzyme A. -Coenzyme A serves as a carrier of activated acetyl or acyl groups (as thiol esters).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Active moiety of CoA is, with the following options: A: Acetyl group, B: Pantothenic acid, C: Thiol of beta alanine, D: Thiol of pantothenic acid ### Response: - Synthesis of coenzyme A from pantothenate occurs in a series of  reactions. Pantothenate is  first phosphorylated to  which  cysteine is  added. Decarboxylation, followed by addition of AMP moiety and a phosphate (each from ATP) results in  coenzyme A. -Coenzyme A serves as a carrier of activated acetyl or acyl groups (as thiol esters). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are true about Hypothyroidism except:, with the following options: A: Delayed dentition, B: Widened fontanelle, C: Distended abdomen, D: All are true ### Response:

d. All are true(Ref: Nelson's 20/e p 2669-2773, Ghai 8/e p 516-521)If left untreated, a child with Hypothyroidism develops the following features:Growth will be stunted, the extremities are shortFace: Depressed bridge of nose, swollen eyelids, thick, broad, protruding tongueDelayed Dentition, hoarse voice; Broad hands with short fingers; Dry and scaly skin with little perspiration

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are true about Hypothyroidism except:, with the following options: A: Delayed dentition, B: Widened fontanelle, C: Distended abdomen, D: All are true ### Response: d. All are true(Ref: Nelson's 20/e p 2669-2773, Ghai 8/e p 516-521)If left untreated, a child with Hypothyroidism develops the following features:Growth will be stunted, the extremities are shortFace: Depressed bridge of nose, swollen eyelids, thick, broad, protruding tongueDelayed Dentition, hoarse voice; Broad hands with short fingers; Dry and scaly skin with little perspiration ### 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 vocal cord palsy is, with the following options: A: Surgical, B: Inflammatory, C: Trauma, D: Malignancy ### Response:

Neuritis or surgical trauma (thyroidectomy) is the most impoant cause. Thyroid surgery is the most common cause when both recurrent and external laryngeal nerves of one side may be involved. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 6, page - 300

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 vocal cord palsy is, with the following options: A: Surgical, B: Inflammatory, C: Trauma, D: Malignancy ### Response: Neuritis or surgical trauma (thyroidectomy) is the most impoant cause. Thyroid surgery is the most common cause when both recurrent and external laryngeal nerves of one side may be involved. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 6, page - 300 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are associated with pituitary apoplexy except:, with the following options: A: Hyperthyroidism, B: Diabetes mellitus, C: Sickle cell anemia, D: Hypertension ### Response:

Ans. is 'a' i.e. Hyperthyroidism Pituitary apoplexy * Acute intrapituitary hemorrhagic vascular event causing substantial damage to pituitary.Symptoms of pituitary apoplexy * Endocrinal emergencySevere hypoglycemiaHypotensionCentral nervous system hemorrhage and death.Acute symptomsSevere headache with signs of meningeal irritationB/L visual changesOphthalmoplegiaCardiovascular collapse and loss of consciousness (in severe cases)Causes of pituitary apoplexyPreexisting adenoma (spontaneously)Postpartum (Sheehan's syndrome)Diabetes mellitusHypertensionSickle cell anemiaAcute shockDiagnosisCT or MRI reveal signs of intratumoral or sellar hemorrhage with deviation of pituitary stalk and compression of pituitary tissue.TreatmentPatient with no evidence of visual loss or impaired consciousnessManaged conservatively with high dose glucocorticoidPatient with significant visual loss and loss of consciousnessRequire urgent surgical decompressionVisual recovery is inversely correlated with the length of the time after the acute event

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are associated with pituitary apoplexy except:, with the following options: A: Hyperthyroidism, B: Diabetes mellitus, C: Sickle cell anemia, D: Hypertension ### Response: Ans. is 'a' i.e. Hyperthyroidism Pituitary apoplexy * Acute intrapituitary hemorrhagic vascular event causing substantial damage to pituitary.Symptoms of pituitary apoplexy * Endocrinal emergencySevere hypoglycemiaHypotensionCentral nervous system hemorrhage and death.Acute symptomsSevere headache with signs of meningeal irritationB/L visual changesOphthalmoplegiaCardiovascular collapse and loss of consciousness (in severe cases)Causes of pituitary apoplexyPreexisting adenoma (spontaneously)Postpartum (Sheehan's syndrome)Diabetes mellitusHypertensionSickle cell anemiaAcute shockDiagnosisCT or MRI reveal signs of intratumoral or sellar hemorrhage with deviation of pituitary stalk and compression of pituitary tissue.TreatmentPatient with no evidence of visual loss or impaired consciousnessManaged conservatively with high dose glucocorticoidPatient with significant visual loss and loss of consciousnessRequire urgent surgical decompressionVisual recovery is inversely correlated with the length of the time after the acute event ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: McEwen's triangle is a landmark for, with the following options: A: Antral drain, B: Mastoid surgery, C: Submucous resection, D: Uncinectomies ### Response:

Mac Ewen's (Suprameatal) Triangle: Boundaries of the triangle are: a. Anteriorly: posterosuperior border of the bony external auditory canal along with the spine of Henle. b. Posteriorly: a veical line drawn tangential to the posterior margin of the external, canal. c. Superiorly: the supramastoid crest. It is land mark for exposure of lateral surface of mastoid.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: McEwen's triangle is a landmark for, with the following options: A: Antral drain, B: Mastoid surgery, C: Submucous resection, D: Uncinectomies ### Response: Mac Ewen's (Suprameatal) Triangle: Boundaries of the triangle are: a. Anteriorly: posterosuperior border of the bony external auditory canal along with the spine of Henle. b. Posteriorly: a veical line drawn tangential to the posterior margin of the external, canal. c. Superiorly: the supramastoid crest. It is land mark for exposure of lateral surface of mastoid. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Defects in Enterohepatic Circulation of Bile Acids due to the altered canalicular function is seen in:, with the following options: A: Cirrhosis, B: Primary biliary cirrhosis, C: Gilbe's syndrome, D: Dubin johnson syndrome ### Response:

Defects in Enterohepatic Circulation of Bile Acids Decreased Bile acid synthesis is affected in Cirrhosis decreased Biliary secretion due to Altered canalicular function Primary biliary cirrhosis Ref: Harrison, E-18, P-2462.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Defects in Enterohepatic Circulation of Bile Acids due to the altered canalicular function is seen in:, with the following options: A: Cirrhosis, B: Primary biliary cirrhosis, C: Gilbe's syndrome, D: Dubin johnson syndrome ### Response: Defects in Enterohepatic Circulation of Bile Acids Decreased Bile acid synthesis is affected in Cirrhosis decreased Biliary secretion due to Altered canalicular function Primary biliary cirrhosis Ref: Harrison, E-18, P-2462. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vitriolage is punished under, with the following options: A: Sec 294 IPC, B: 326 A IPC, C: 354 A IPC, D: 326 B IPC ### Response:

Refer the byte "Legal sections".

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vitriolage is punished under, with the following options: A: Sec 294 IPC, B: 326 A IPC, C: 354 A IPC, D: 326 B IPC ### Response: Refer the byte "Legal sections". ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Bile is concentrated in the gallbladder to _______ times, with the following options: A: 5, B: 10, C: 20, D: 50 ### Response:

Functions of Gallbladder Reservoir of bile Concentration of bile 5-10 times Secretion of mucus, 20ml/day by tubuloalveolar glands Acidification of bile Ref: Sabiston 20th edition Pgno :1482

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Bile is concentrated in the gallbladder to _______ times, with the following options: A: 5, B: 10, C: 20, D: 50 ### Response: Functions of Gallbladder Reservoir of bile Concentration of bile 5-10 times Secretion of mucus, 20ml/day by tubuloalveolar glands Acidification of bile Ref: Sabiston 20th edition Pgno :1482 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Antenatal mother with epilepsy on phenytoin therapy must be given:, with the following options: A: Folic acid supplementation, B: Vitamin B12 supplementation, C: Vitamin B6 supplementation, D: Vitamin A supplementation ### Response:

Ans. (a) Folic acid supplementationRef: D. C Dutta 8th ed./ 585* Use of anti- epileptic drugs like phenytoin, valproate and even phenobarbitone has been shown in pregnancy to contribute to acquire folic acid deficiency.* If a lady is deficient in folic acid at the time of her pregnancy, then the baby most likely will born with neural tube defect.* Traditionally we study that folic acid should be taken peri-conceptionally 2 months before and 3 months later to pregnant status at dose of 400 micrograms.* However with the use of anti-epileptics drugs like phenytoin, valproate etc. the dose of folic acid needs to be supplemented at a dose of 4mg once per day.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Antenatal mother with epilepsy on phenytoin therapy must be given:, with the following options: A: Folic acid supplementation, B: Vitamin B12 supplementation, C: Vitamin B6 supplementation, D: Vitamin A supplementation ### Response: Ans. (a) Folic acid supplementationRef: D. C Dutta 8th ed./ 585* Use of anti- epileptic drugs like phenytoin, valproate and even phenobarbitone has been shown in pregnancy to contribute to acquire folic acid deficiency.* If a lady is deficient in folic acid at the time of her pregnancy, then the baby most likely will born with neural tube defect.* Traditionally we study that folic acid should be taken peri-conceptionally 2 months before and 3 months later to pregnant status at dose of 400 micrograms.* However with the use of anti-epileptics drugs like phenytoin, valproate etc. the dose of folic acid needs to be supplemented at a dose of 4mg once per day. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A veterinary doctor had fever for 15 days. His blood culture in special laboratory media was positive for Gram-negative sho bacilli which were oxidase positive. Which one of the following is the likely organism grown in culture?, with the following options: A: Pasteurella spp., B: Francisella spp., C: Baonella spp., D: Brucella spp. ### Response:

Pasteurella sp-Gram --ve bacilli oxidase +ve causes cellulitis but no fever Francisella sp-Gram --ve sho bacillus, oxidase +ve, causes Tularemia ahrosis but no PUO(Pyrexia of unknown origin) Baonella -- Gram --ve red, oxidase +ve Brucella, Gram --ve, sho bacillus causes PUO Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 339

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A veterinary doctor had fever for 15 days. His blood culture in special laboratory media was positive for Gram-negative sho bacilli which were oxidase positive. Which one of the following is the likely organism grown in culture?, with the following options: A: Pasteurella spp., B: Francisella spp., C: Baonella spp., D: Brucella spp. ### Response: Pasteurella sp-Gram --ve bacilli oxidase +ve causes cellulitis but no fever Francisella sp-Gram --ve sho bacillus, oxidase +ve, causes Tularemia ahrosis but no PUO(Pyrexia of unknown origin) Baonella -- Gram --ve red, oxidase +ve Brucella, Gram --ve, sho bacillus causes PUO Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 339 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A young man finds that every time he eats dairy products he feels very uncomfoable. His stomach becomes distended. He develops gas and diarrhoea frequently. These symptoms do not appear when he eats food other than dairy products. Which of the following is most likely enzyme in which this young man is deficient:, with the following options: A: Alpha amylase, B: Beta galactosidase, C: Alpha glucosidase, D: Sucrase ### Response:

The patient has abdominal discomfo & diarrhoea after taking milk. Diagnosis is Lactose Intolerance. Enzyme deficient in this patient is b-Galactosidase which is also known as Lactase. It breaks down milk sugar lactose into glucose and galactose which can be easily absorbed. a-Amylase digests Starch (Option a) a- Glucosidase or Acid Maltase is minor pathway of Glycogen breakdown in lysosomes (Option c) If abdominal discomfo & diarrhea appear after taking sugar or sugarcane juice, then enzyme deficient is Sucrase (Option d)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A young man finds that every time he eats dairy products he feels very uncomfoable. His stomach becomes distended. He develops gas and diarrhoea frequently. These symptoms do not appear when he eats food other than dairy products. Which of the following is most likely enzyme in which this young man is deficient:, with the following options: A: Alpha amylase, B: Beta galactosidase, C: Alpha glucosidase, D: Sucrase ### Response: The patient has abdominal discomfo & diarrhoea after taking milk. Diagnosis is Lactose Intolerance. Enzyme deficient in this patient is b-Galactosidase which is also known as Lactase. It breaks down milk sugar lactose into glucose and galactose which can be easily absorbed. a-Amylase digests Starch (Option a) a- Glucosidase or Acid Maltase is minor pathway of Glycogen breakdown in lysosomes (Option c) If abdominal discomfo & diarrhea appear after taking sugar or sugarcane juice, then enzyme deficient is Sucrase (Option d) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: P.N.H is associated with all of the following conditions,except:, with the following options: A: Aplastic anemia, B: Increased LAP scores, C: Venous thrombosis, D: Iron deficiency anemia ### Response:

PNH is not associated with increased LAP scores. In PNH, there is loss of hemoglobin and iron in urine - the negative iron deficit leading to iron deficiency anemia. The hypercoagulable state in PNH leads to Budd Chiari syndrome and this disorder, being an acquired stem cell defect can lead to aplastic anemia. The clinical syndrome can present with 3 types of symptoms including: (1) an acquired intracorpuscular hemolytic anemia due to the abnormal susceptibility of the RBC membrane to the hemolytic activity of complement; (2) thrombosis in large vessels, such as hepatic, abdominal, cerebral, and subdermal veins; and (3) a deficiency in hematopoiesis that may be mild or severe, such as pancytopenia in an aplastic anemia state. Flow cytometry is used to detect CD59 (MIRL), a glycoprotein, and CD55 (DAF) in regulation of complement action. Absence or reduced expression of both CD59 and CD55 on PNH RBCs is diagnostic. The Ham test (acidified serum lysis) establishes the diagnosis of paroxysmal nocturnal hemoglobinuria (PNH), demonstrating a characteristic abnormality of PNH red blood cells by acidified fresh normal serum. Heated serum at 56degC inactivates complement and prevents hemolysis in PNH cells.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: P.N.H is associated with all of the following conditions,except:, with the following options: A: Aplastic anemia, B: Increased LAP scores, C: Venous thrombosis, D: Iron deficiency anemia ### Response: PNH is not associated with increased LAP scores. In PNH, there is loss of hemoglobin and iron in urine - the negative iron deficit leading to iron deficiency anemia. The hypercoagulable state in PNH leads to Budd Chiari syndrome and this disorder, being an acquired stem cell defect can lead to aplastic anemia. The clinical syndrome can present with 3 types of symptoms including: (1) an acquired intracorpuscular hemolytic anemia due to the abnormal susceptibility of the RBC membrane to the hemolytic activity of complement; (2) thrombosis in large vessels, such as hepatic, abdominal, cerebral, and subdermal veins; and (3) a deficiency in hematopoiesis that may be mild or severe, such as pancytopenia in an aplastic anemia state. Flow cytometry is used to detect CD59 (MIRL), a glycoprotein, and CD55 (DAF) in regulation of complement action. Absence or reduced expression of both CD59 and CD55 on PNH RBCs is diagnostic. The Ham test (acidified serum lysis) establishes the diagnosis of paroxysmal nocturnal hemoglobinuria (PNH), demonstrating a characteristic abnormality of PNH red blood cells by acidified fresh normal serum. Heated serum at 56degC inactivates complement and prevents hemolysis in PNH cells. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: This has increased risk of, with the following options: A: Squamous cell carcinoma, B: Basal cell carcinoma, C: Melanoma, D: Liposarcoma ### Response:

This is a cutaneous horn. Actinic (solar) keratoses (AK), i.e. cutaneous horns and keratoacanthomas, were considered to be premalignant lesions leading to SCC. Ref: Bailey and Love, 27e, page: 606

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: This has increased risk of, with the following options: A: Squamous cell carcinoma, B: Basal cell carcinoma, C: Melanoma, D: Liposarcoma ### Response: This is a cutaneous horn. Actinic (solar) keratoses (AK), i.e. cutaneous horns and keratoacanthomas, were considered to be premalignant lesions leading to SCC. Ref: Bailey and Love, 27e, page: 606 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Highest amount of saturated fatty acid is seen in ?, with the following options: A: Soyabean oil, B: Groundnut oil, C: Palm oil, D: Sunflower oil ### Response:

Ans. is 'c' i.e., Palm oil Fatty- acids On the basis of presence or absence of double bond fatty acids are divided into :- 1.Saturated fatty acids Have no double bond. Examples --* Palmitie acid, lauric acid, stearic acid 2. Unsaturated fatty acids Have one or more double bonds i) Monounsaturated (Have single double bond) Oleic acid ii) Polyunsaturated (Have more than one double bonds) --) Linoleic acid. Linolenic acid,,4rachidonic acid, Eicosapentaenoic acid, Docosahexaenoic acid. Coming to question o Polyunsaturated are mostly found in Vegetal* oils and the saturated fatty acids mainly in animal fats. Q However, there are exceptions, as jOr example, coconut and palm oils, although vegetable oils, have on extremly high percentage of saturated acids on the other hand, fish oils, although they are not vegetable oils, contain poly and mono-unsaturated fatty acids.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Highest amount of saturated fatty acid is seen in ?, with the following options: A: Soyabean oil, B: Groundnut oil, C: Palm oil, D: Sunflower oil ### Response: Ans. is 'c' i.e., Palm oil Fatty- acids On the basis of presence or absence of double bond fatty acids are divided into :- 1.Saturated fatty acids Have no double bond. Examples --* Palmitie acid, lauric acid, stearic acid 2. Unsaturated fatty acids Have one or more double bonds i) Monounsaturated (Have single double bond) Oleic acid ii) Polyunsaturated (Have more than one double bonds) --) Linoleic acid. Linolenic acid,,4rachidonic acid, Eicosapentaenoic acid, Docosahexaenoic acid. Coming to question o Polyunsaturated are mostly found in Vegetal* oils and the saturated fatty acids mainly in animal fats. Q However, there are exceptions, as jOr example, coconut and palm oils, although vegetable oils, have on extremly high percentage of saturated acids on the other hand, fish oils, although they are not vegetable oils, contain poly and mono-unsaturated fatty acids. ### 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 persistent hypeension in child with Intrinsic Renal disease is, with the following options: A: CGN, B: Chronic pyelonephritis, C: Obstructive uropathy, D: Renal tumor ### Response:

ACEIs or ARBs, appropriate diuretic therapy, and dietary salt restriction make up the foundation for the treatment of HTN in CKD. Bedtime dosing of at least one antihypeensive medication improves BP control in patients with CKD. Reference: GHAI Essential pediatrics, 8th edition

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 persistent hypeension in child with Intrinsic Renal disease is, with the following options: A: CGN, B: Chronic pyelonephritis, C: Obstructive uropathy, D: Renal tumor ### Response: ACEIs or ARBs, appropriate diuretic therapy, and dietary salt restriction make up the foundation for the treatment of HTN in CKD. Bedtime dosing of at least one antihypeensive medication improves BP control in patients with CKD. Reference: GHAI Essential pediatrics, 8th edition ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Compared to breast milk colostrum is rich with :, with the following options: A: Protein, B: Fat, C: Lactose, D: Water ### Response:

Colostrum Colostrum is the first stage of breast milk that occurs during pregnancy and lasts for several days after the birth of the baby. It is either yellowish or creamy in color. It is also much thicker than the milk that is produced later in breastfeeding. Colostrums is high in protein, fat-soluble vitamins, minerals, and immunoglobulins. Immunoglobulins are antibodies that pass from the mother to the baby and provide passive immunity for the baby. . Passive immunity protects the baby from a wide variety of bacterial and viral illnesses. 2-4 days after birth, colostrums will be replaced by transitional milk.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Compared to breast milk colostrum is rich with :, with the following options: A: Protein, B: Fat, C: Lactose, D: Water ### Response: Colostrum Colostrum is the first stage of breast milk that occurs during pregnancy and lasts for several days after the birth of the baby. It is either yellowish or creamy in color. It is also much thicker than the milk that is produced later in breastfeeding. Colostrums is high in protein, fat-soluble vitamins, minerals, and immunoglobulins. Immunoglobulins are antibodies that pass from the mother to the baby and provide passive immunity for the baby. . Passive immunity protects the baby from a wide variety of bacterial and viral illnesses. 2-4 days after birth, colostrums will be replaced by transitional milk. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wh,he follow morphogenic as well as mitogenic?, with the following options: A: Fibroblast growth factor, B: Platelet derived growth factor, C: Bone morphogenetic protein, D: Insulin-like growth factor ### Response:

Ans. c. Bone morphogenetic protein

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wh,he follow morphogenic as well as mitogenic?, with the following options: A: Fibroblast growth factor, B: Platelet derived growth factor, C: Bone morphogenetic protein, D: Insulin-like growth factor ### Response: Ans. c. Bone morphogenetic protein ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which muscle of extensor Compament flexes the elbow ?, with the following options: A: ECRL, B: ECU, C: Anconeus, D: Brachioradialis ### Response:

Ans. is `d' i.e., Brachioradialis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which muscle of extensor Compament flexes the elbow ?, with the following options: A: ECRL, B: ECU, C: Anconeus, D: Brachioradialis ### Response: Ans. is `d' i.e., Brachioradialis ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Action potential is generated in excitable cells. These cells are:, with the following options: A: Nerves, B: Muscle, C: Glands, D: All ### Response:

All of them. Ie., A Nerves; B i.e. Muscle; C i.e. Glands Action potential develops in excitable cells such as nerves (neurons), muscle (skeletal, smooth and cardiac), and other contractile tissues such as few glandsQ. Glial cells such as neuroglial cells do not generate action potential.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Action potential is generated in excitable cells. These cells are:, with the following options: A: Nerves, B: Muscle, C: Glands, D: All ### Response: All of them. Ie., A Nerves; B i.e. Muscle; C i.e. Glands Action potential develops in excitable cells such as nerves (neurons), muscle (skeletal, smooth and cardiac), and other contractile tissues such as few glandsQ. Glial cells such as neuroglial cells do not generate action potential. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Beams can be used for cancer treatment are, with the following options: A: g-rays, B: a-rays, C: Neutrons, D: All ### Response:

A i.e. Gamma rays; B i.e. a-rays; C i.e. Neutron

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Beams can be used for cancer treatment are, with the following options: A: g-rays, B: a-rays, C: Neutrons, D: All ### Response: A i.e. Gamma rays; B i.e. a-rays; C i.e. Neutron ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: To create a poo-caval shunt in a patient with poal hypeension, which of the following venous anastomosis should be performed?, with the following options: A: Superior mesenteric vein to inferior mesenteric vein, B: Right gastric vein to left gastric vein, C: Right gastric vein to right gastric vein, D: Left splenic vein to left renal vein ### Response:

Poacaval shunting is major surgery. It involves a large cut (incision) in the belly area (abdomen). The surgeon then makes a connection between the poal vein (which supplies most of the liver's blood) and the inferior vena cava (the vein that drains blood from most of the lower pa of the body.)The new connection dives blood flow way from the liver. This reduces blood pressure in the poal vein and decreases the risk of a tear (rupture) and bleeding from the veins in the esophagus and stomach. Ref - Researchgate.net

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: To create a poo-caval shunt in a patient with poal hypeension, which of the following venous anastomosis should be performed?, with the following options: A: Superior mesenteric vein to inferior mesenteric vein, B: Right gastric vein to left gastric vein, C: Right gastric vein to right gastric vein, D: Left splenic vein to left renal vein ### Response: Poacaval shunting is major surgery. It involves a large cut (incision) in the belly area (abdomen). The surgeon then makes a connection between the poal vein (which supplies most of the liver's blood) and the inferior vena cava (the vein that drains blood from most of the lower pa of the body.)The new connection dives blood flow way from the liver. This reduces blood pressure in the poal vein and decreases the risk of a tear (rupture) and bleeding from the veins in the esophagus and stomach. Ref - Researchgate.net ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A false belief unexplained by reality, shared by a number of people is:, with the following options: A: Superstition, B: Illusion, C: Delusion, D: Obsession ### Response:

A. i.e. SuperstitionNormal thinking is characterized by smooth & continuous flow or fluency (continuity), reasonable speed, clear goal directed logical organization (clarity & organization), with a logic, sequence, intent and control. Whereas, constant/firm belief held on inadequate grounds is delusion.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A false belief unexplained by reality, shared by a number of people is:, with the following options: A: Superstition, B: Illusion, C: Delusion, D: Obsession ### Response: A. i.e. SuperstitionNormal thinking is characterized by smooth & continuous flow or fluency (continuity), reasonable speed, clear goal directed logical organization (clarity & organization), with a logic, sequence, intent and control. Whereas, constant/firm belief held on inadequate grounds is delusion. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Struma ovaril is composed entirely of ?, with the following options: A: Mature thyroid tissue, B: Immature thyroid tissue, C: Pimary ovarian carcinoid tissue, D: None of the above ### Response:

Ans. is 'a' i.e., Mature thyroid tissue

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Struma ovaril is composed entirely of ?, with the following options: A: Mature thyroid tissue, B: Immature thyroid tissue, C: Pimary ovarian carcinoid tissue, D: None of the above ### Response: Ans. is 'a' i.e., Mature thyroid tissue ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Trichology is the study of:, with the following options: A: Hair, B: Nail, C: Skin, D: Bones ### Response:

Ans: a (Hair) Ref: Reddy, 27th ed, p. 84Trichology is the study of hair.NoteThanatology: Study of death in all aspects.Cheiloscopy: Study of lip markings for identification.Poroscopy: Study of microscopic pores present in the ridges of fingers.Dactylography: Study of finger prints.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Trichology is the study of:, with the following options: A: Hair, B: Nail, C: Skin, D: Bones ### Response: Ans: a (Hair) Ref: Reddy, 27th ed, p. 84Trichology is the study of hair.NoteThanatology: Study of death in all aspects.Cheiloscopy: Study of lip markings for identification.Poroscopy: Study of microscopic pores present in the ridges of fingers.Dactylography: Study of finger prints. ### 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 has complaint of seeing coloured holoes in the evening and blurring of vision for last few days with normal 10P ?, with the following options: A: Prodromal phase of acute angle closure glaucoma, B: Acute angle closure glaucoma, C: Chronic glaucoma, D: Epidemic dropsy ### Response:

Ans. is 'a' i.e., Prodromal phase of acute angle closure glaucoma Features of latent PACG (Prodromal stage) are :? Shallow anterior chamber Occasionally complain of halos around light Sometimes slight-haziness or blurring of vision Normal 10P It is the only phase of glaucoma, where IOP pressure is normal at all the time. Whereas in incipient stage, there is recurrent elevation of IOP by predisposing factors like dim light.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A patient has complaint of seeing coloured holoes in the evening and blurring of vision for last few days with normal 10P ?, with the following options: A: Prodromal phase of acute angle closure glaucoma, B: Acute angle closure glaucoma, C: Chronic glaucoma, D: Epidemic dropsy ### Response: Ans. is 'a' i.e., Prodromal phase of acute angle closure glaucoma Features of latent PACG (Prodromal stage) are :? Shallow anterior chamber Occasionally complain of halos around light Sometimes slight-haziness or blurring of vision Normal 10P It is the only phase of glaucoma, where IOP pressure is normal at all the time. Whereas in incipient stage, there is recurrent elevation of IOP by predisposing factors like dim light. ### 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 true about Peroneus longus?, with the following options: A: Inveor of foot, B: Supplied by deep peroneal nerve, C: Maintains arches of foot, D: Arises from tibia ### Response:

PERONEUS LONGUS origin: head of fibula Lateral surface of shaft of fibula.Inseion: lateral side of base of first metacarpal and adjoining medial cuneiform bone.Nerve supply: superficial peroneal nerve. Action: eveor of foot when the foot is off the ground.Maintain lateral longitudinal arch and transverse arch of the foot.Peroneus longus and Tibialis anterior are inseed into the same two bones, the two together forming a stirrup beneath the middle of sole. The presence of the sling keeps the middle of foot pulled up and prevent flattening of its arches. <img src=" /> {Reference: BDC 6E pg no.100}

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 true about Peroneus longus?, with the following options: A: Inveor of foot, B: Supplied by deep peroneal nerve, C: Maintains arches of foot, D: Arises from tibia ### Response: PERONEUS LONGUS origin: head of fibula Lateral surface of shaft of fibula.Inseion: lateral side of base of first metacarpal and adjoining medial cuneiform bone.Nerve supply: superficial peroneal nerve. Action: eveor of foot when the foot is off the ground.Maintain lateral longitudinal arch and transverse arch of the foot.Peroneus longus and Tibialis anterior are inseed into the same two bones, the two together forming a stirrup beneath the middle of sole. The presence of the sling keeps the middle of foot pulled up and prevent flattening of its arches. <img src=" /> {Reference: BDC 6E pg no.100} ### 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 2 way communication-, with the following options: A: Lectures, B: Group discussion, C: Panel discussion, D: Symposium ### Response:

The flow of communication is one way from the communicator to the audience.The familiar example is the lecture method in class rooms.This is known as Didactic method (refer pgno:855 park 23 rd edition)

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 2 way communication-, with the following options: A: Lectures, B: Group discussion, C: Panel discussion, D: Symposium ### Response: The flow of communication is one way from the communicator to the audience.The familiar example is the lecture method in class rooms.This is known as Didactic method (refer pgno:855 park 23 rd edition) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 6-year-old boy is often teased at school because he has stooled in his underwear almost daily for the last 3 months. He was toilet trained at 2 years of age without difficulty, but over the last 2 years he has developed ongoing constipation. His family is frustrated because they cannot believe him when he says, "I didn't know I had to go." He is otherwise normal; school is going well, and his home life is stable. His only significant finding on examination is stool in the rectal vault. The plain radiograph of his abdomen is shown. Initial management of this problem should include which of the following?, with the following options: A: Barium enema and rectal biopsy, B: Family counseling, C: Time-out when he stools in his underwear, D: Clear fecal impaction and short-term stool softener use ### Response:

(d) Source: (Hay et al, pp 84-85. Kliegman et al, pp 73-75. McMillan et al, pp 672-674, 1920-1923. Rudolph et al, pp 1386-1389.) Encopresis is defined as the passage of feces in inappropriate locations after bowel control would be expected (usually older than 4 years). Encopresis is seen both with chronic constipation and overflow incontinence (retentive encopresis), and without constipation (nonretentive encopresis). Retentive encopresis is more common, and is the source of this child's problem. There is leakage of liquid stool around a large fecal impaction, resulting in fecal soiling. The radiograph demonstrates a dilated, stool-filled colon consistent with retentive encopresis. Treatment involves clearing the fecal mass, maintaining soft stools for a short period of time with mineral oil or stool softeners (3-6 months), and behavioral modification. Most children will grow out of this condition. Timeout would be ineffective, because these children usually have dysfunctional anal sphincters and little control over the problem; they do not know they are soiling their clothes until it is too late. Daily enemas could potentially be harmful. A rectal biopsy would help diagnose Hirschsprung disease, but the story presented is not consistent with that diagnosis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 6-year-old boy is often teased at school because he has stooled in his underwear almost daily for the last 3 months. He was toilet trained at 2 years of age without difficulty, but over the last 2 years he has developed ongoing constipation. His family is frustrated because they cannot believe him when he says, "I didn't know I had to go." He is otherwise normal; school is going well, and his home life is stable. His only significant finding on examination is stool in the rectal vault. The plain radiograph of his abdomen is shown. Initial management of this problem should include which of the following?, with the following options: A: Barium enema and rectal biopsy, B: Family counseling, C: Time-out when he stools in his underwear, D: Clear fecal impaction and short-term stool softener use ### Response: (d) Source: (Hay et al, pp 84-85. Kliegman et al, pp 73-75. McMillan et al, pp 672-674, 1920-1923. Rudolph et al, pp 1386-1389.) Encopresis is defined as the passage of feces in inappropriate locations after bowel control would be expected (usually older than 4 years). Encopresis is seen both with chronic constipation and overflow incontinence (retentive encopresis), and without constipation (nonretentive encopresis). Retentive encopresis is more common, and is the source of this child's problem. There is leakage of liquid stool around a large fecal impaction, resulting in fecal soiling. The radiograph demonstrates a dilated, stool-filled colon consistent with retentive encopresis. Treatment involves clearing the fecal mass, maintaining soft stools for a short period of time with mineral oil or stool softeners (3-6 months), and behavioral modification. Most children will grow out of this condition. Timeout would be ineffective, because these children usually have dysfunctional anal sphincters and little control over the problem; they do not know they are soiling their clothes until it is too late. Daily enemas could potentially be harmful. A rectal biopsy would help diagnose Hirschsprung disease, but the story presented is not consistent with that diagnosis. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 52-year-old man complains of impotence. On physical examination, he has an elevated jugular venous pressure, S3 gallop, and hepatomegaly. He also appears tanned, with pigmentation along skin folds. He has joint pain and bony overgrowth primarily affecting the second and third metacarpophalangeal joints bilaterally. The plasma glucose is 250 mg/dL, and liver enzymes are elevated. Which of the following studies will help establish the diagnosis?, with the following options: A: Detection of nocturnal penile tumescence, B: Determination of iron saturation, C: Determination of serum copper, D: Detection of hepatitis B surface antigen ### Response:

Iron overload should be considered among patients who present with any one or a combination of the following: hepatomegaly, weakness, hyperpigmentation, atypical arthritis, diabetes, erectile dysfunction, unexplained chronic abdominal pain, or cardiomyopathy. Diagnostic suspicion should be particularly high when the family history is positive for similar clinical findings. The most frequent cause of iron overload is the common genetic disorder, idiopathic hemochromatosis. Secondary iron storage problems can occur after multiple transfusions in a variety of anemias. The most practical screening test is the determination of serum iron, transferrin saturation, and ferritin. Transferrin saturation greater than 50% in males or 45% in females suggests increased iron stores. Substantially elevated serum ferritin levels confirm total body iron overload. Genetic screening is now used to assess which patients are at risk for severe fibrosis of the liver. Definitive diagnosis can be established by liver biopsy. Determination of serum copper is needed when Wilson disease is the probable cause of hepatic abnormalities. Wilson disease does not cause hypogonadism, heart failure, diabetes, or arthropathy. Chronic liver disease caused by hepatitis B would not account for the heart failure, hyperpigmentation, or diabetes. Nocturnal penile tumescence and echocardiogram can confirm clinical findings but will not establish the underlying diagnosis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 52-year-old man complains of impotence. On physical examination, he has an elevated jugular venous pressure, S3 gallop, and hepatomegaly. He also appears tanned, with pigmentation along skin folds. He has joint pain and bony overgrowth primarily affecting the second and third metacarpophalangeal joints bilaterally. The plasma glucose is 250 mg/dL, and liver enzymes are elevated. Which of the following studies will help establish the diagnosis?, with the following options: A: Detection of nocturnal penile tumescence, B: Determination of iron saturation, C: Determination of serum copper, D: Detection of hepatitis B surface antigen ### Response: Iron overload should be considered among patients who present with any one or a combination of the following: hepatomegaly, weakness, hyperpigmentation, atypical arthritis, diabetes, erectile dysfunction, unexplained chronic abdominal pain, or cardiomyopathy. Diagnostic suspicion should be particularly high when the family history is positive for similar clinical findings. The most frequent cause of iron overload is the common genetic disorder, idiopathic hemochromatosis. Secondary iron storage problems can occur after multiple transfusions in a variety of anemias. The most practical screening test is the determination of serum iron, transferrin saturation, and ferritin. Transferrin saturation greater than 50% in males or 45% in females suggests increased iron stores. Substantially elevated serum ferritin levels confirm total body iron overload. Genetic screening is now used to assess which patients are at risk for severe fibrosis of the liver. Definitive diagnosis can be established by liver biopsy. Determination of serum copper is needed when Wilson disease is the probable cause of hepatic abnormalities. Wilson disease does not cause hypogonadism, heart failure, diabetes, or arthropathy. Chronic liver disease caused by hepatitis B would not account for the heart failure, hyperpigmentation, or diabetes. Nocturnal penile tumescence and echocardiogram can confirm clinical findings but will not establish the underlying diagnosis. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: cat acts as reservoir in the following ?, with the following options: A: toxoplasma gondii, B: rabies, C: streptocerca infection, D: plague ### Response:

Toxoplasma gondii * Worldwide * Zoonotic parasite; Toxoplasma is an oppounistic pathogen. * Infects animals, cattle, birds, rodents, pigs, and sheep. * and humans. * Causes the disease Toxoplasmosis. * Toxoplasmosis is leading cause of aboion in sheep and goats. * Intracellular parasite. * Final host (Felidae family, cat) * Intermediate host (mammals ) Toxoplasmosis 1. All parasite stages are infectious. 2. Risking group: Pregnant women, meat handlers (food preparation) or anyone who eats the raw meat ref : ananthanaryana 9rh ed

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: cat acts as reservoir in the following ?, with the following options: A: toxoplasma gondii, B: rabies, C: streptocerca infection, D: plague ### Response: Toxoplasma gondii * Worldwide * Zoonotic parasite; Toxoplasma is an oppounistic pathogen. * Infects animals, cattle, birds, rodents, pigs, and sheep. * and humans. * Causes the disease Toxoplasmosis. * Toxoplasmosis is leading cause of aboion in sheep and goats. * Intracellular parasite. * Final host (Felidae family, cat) * Intermediate host (mammals ) Toxoplasmosis 1. All parasite stages are infectious. 2. Risking group: Pregnant women, meat handlers (food preparation) or anyone who eats the raw meat ref : ananthanaryana 9rh ed ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Maximum concentration of coisol is seen at which time of day?, with the following options: A: Early morning, B: Noon, C: Late evening, D: Midnight ### Response:

Coisol is the principal glucocoicoid produced by the zona fasciculata of the adrenal coex. It promotes gluconeogenesis and lipolysis, suppresses protein synthesis, inhibits inflammatory and immune responses, and has mild mineralocoicoid(for example, hypernatremic, kaliuretic, antidiuretic) effects. Most plasma coisol is bound to transcoin and albumin. Synthetic coisol administered as a drug is usually known by the alternative name hydrocoisone.Ref: Ganong&;s review of medical physiology;24th edition; page no-362

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Maximum concentration of coisol is seen at which time of day?, with the following options: A: Early morning, B: Noon, C: Late evening, D: Midnight ### Response: Coisol is the principal glucocoicoid produced by the zona fasciculata of the adrenal coex. It promotes gluconeogenesis and lipolysis, suppresses protein synthesis, inhibits inflammatory and immune responses, and has mild mineralocoicoid(for example, hypernatremic, kaliuretic, antidiuretic) effects. Most plasma coisol is bound to transcoin and albumin. Synthetic coisol administered as a drug is usually known by the alternative name hydrocoisone.Ref: Ganong&;s review of medical physiology;24th edition; page no-362 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Not immunized previously in a 8 years male child which of the following vaccine is not given to that children, with the following options: A: Inactive polio vaccine, B: Hepatitis B vaccine, C: Acellular pertussis vaccine, D: Measles vaccine ### Response:

C. i.e. (Acellular pertossis vaccine) (191- 94 - Ghai 6th)IMMUNIZATION1. If immunization status of a child is unknown, there is no harm in giving appropriate vaccine again2. A minimum interval of 4 weeks is required between the administration of two live antigen3. Measles, mumps and rubella vaccines should not be given to children, who were given immune globulin within the previous three monthsInactivated polio vaccine (IPV) - Should be used in immuno- compromised children those with AIDS family members of immuno deficient individuals partially immunized or unimmunized adults and in some tropical countries with poor facilities for cold chainPertussis vaccine - should not be given to children over 5-6 years old. There is no scientific basis for this and in countries where adult pertussis occurs.IAP recommends two booster doses one each in the 2nd and 5th year of life following immunization with three dosesHepatitis - B Vaccine|||Carrier motherHBs Ag negative mother||3- dose of vaccine0 months0-2 monthsgiven in infants1 - 2 month1 - 4 months 6 month6-18 monthsDose* 10 mg children < 10 years in deltoid or antero lateral thigh region* 20 mg Adults > 10 yearsImmuno compromised patients should receive twice the recommended dose* Rubella vaccine dose should be given at least 3 months prior to conception * **

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Not immunized previously in a 8 years male child which of the following vaccine is not given to that children, with the following options: A: Inactive polio vaccine, B: Hepatitis B vaccine, C: Acellular pertussis vaccine, D: Measles vaccine ### Response: C. i.e. (Acellular pertossis vaccine) (191- 94 - Ghai 6th)IMMUNIZATION1. If immunization status of a child is unknown, there is no harm in giving appropriate vaccine again2. A minimum interval of 4 weeks is required between the administration of two live antigen3. Measles, mumps and rubella vaccines should not be given to children, who were given immune globulin within the previous three monthsInactivated polio vaccine (IPV) - Should be used in immuno- compromised children those with AIDS family members of immuno deficient individuals partially immunized or unimmunized adults and in some tropical countries with poor facilities for cold chainPertussis vaccine - should not be given to children over 5-6 years old. There is no scientific basis for this and in countries where adult pertussis occurs.IAP recommends two booster doses one each in the 2nd and 5th year of life following immunization with three dosesHepatitis - B Vaccine|||Carrier motherHBs Ag negative mother||3- dose of vaccine0 months0-2 monthsgiven in infants1 - 2 month1 - 4 months 6 month6-18 monthsDose* 10 mg children < 10 years in deltoid or antero lateral thigh region* 20 mg Adults > 10 yearsImmuno compromised patients should receive twice the recommended dose* Rubella vaccine dose should be given at least 3 months prior to conception * ** ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Normal tidal volume is ?, with the following options: A: 500 ml, B: 12 00 ml, C: 3000 ml, D: 2400 ml ### Response:

Ans. is'a' i.e., 500 ml(Ref: Ganong 24e/e p.629)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Normal tidal volume is ?, with the following options: A: 500 ml, B: 12 00 ml, C: 3000 ml, D: 2400 ml ### Response: Ans. is'a' i.e., 500 ml(Ref: Ganong 24e/e p.629) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Total duration of antibiotics in acute osteomyelitis, with the following options: A: 4 weeks, B: 2 weeks, C: 6weeks, D: 8 weeks ### Response:

Appropriate antimicrobial therapy 2 weeks intravenous and 4 weeks oral Refer Maheshwari 6th/e p 168

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Total duration of antibiotics in acute osteomyelitis, with the following options: A: 4 weeks, B: 2 weeks, C: 6weeks, D: 8 weeks ### Response: Appropriate antimicrobial therapy 2 weeks intravenous and 4 weeks oral Refer Maheshwari 6th/e p 168 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Latzko procedure is done in case of, with the following options: A: Uterine inversion, B: Retroverted uterus, C: Vesicovaginal fistula repair, D: Urethrocele repair ### Response:

Latzko procedure is surgical technique for vesicovaginal fistula repair.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Latzko procedure is done in case of, with the following options: A: Uterine inversion, B: Retroverted uterus, C: Vesicovaginal fistula repair, D: Urethrocele repair ### Response: Latzko procedure is surgical technique for vesicovaginal fistula repair. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which muscle is irritated by retrocecal appendicitis?, with the following options: A: Psoas, B: Obturator, C: Gluteus maximus, D: Quadratus ### Response:

Ans. (a) PsoasRef: Bailey and Love 27th edition, Page 1303On hyperextension of hip by putting psoas muscle into action -- retrocecal appendicitis pain is exhibited.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which muscle is irritated by retrocecal appendicitis?, with the following options: A: Psoas, B: Obturator, C: Gluteus maximus, D: Quadratus ### Response: Ans. (a) PsoasRef: Bailey and Love 27th edition, Page 1303On hyperextension of hip by putting psoas muscle into action -- retrocecal appendicitis pain is exhibited. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Transport of two substances in the same direction is called as?, with the following options: A: Symport, B: Antiport, C: Exocytosis, D: Pinocytosis ### Response:

When the transported molecule and cotransported ion move in the same direction, the process is called Symport; when they move in opposite directions, the process is called Antiport

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Transport of two substances in the same direction is called as?, with the following options: A: Symport, B: Antiport, C: Exocytosis, D: Pinocytosis ### Response: When the transported molecule and cotransported ion move in the same direction, the process is called Symport; when they move in opposite directions, the process is called Antiport ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: False about Giardia lambia is, with the following options: A: Quadrinucleate cyst is infective form, B: Cysts can survive in water upto 3 months, C: Trophozoite has Axostyle to Adhere to surfaces., D: Exhibits falling leaf motility ### Response:

Trophozoite has sucking disc to adhere to surfaces.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: False about Giardia lambia is, with the following options: A: Quadrinucleate cyst is infective form, B: Cysts can survive in water upto 3 months, C: Trophozoite has Axostyle to Adhere to surfaces., D: Exhibits falling leaf motility ### Response: Trophozoite has sucking disc to adhere to surfaces. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A pregnant mother at 32 weeks gestation presents in preterm labour. Therapy with antenatal steroids to induce lung maturity in the fetus may be given in all of the following condition except :, with the following options: A: Prolonged rupture of membranes for more than 24 hours, B: Pregnancy induced hypeension, C: Diabetes mellitus, D: Chorioamnionitis ### Response:

The condition in which steroid are given to the patient is :- Premature rupture of membrane Polyhydramnios Hypeension Diabetes Severe anemia Indicated preterm delivery due to medical or obstetric complication We dont give steroids in Chorioamnionitis as it is an Infective condition and the risk of flare up of infection increases with steroids

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A pregnant mother at 32 weeks gestation presents in preterm labour. Therapy with antenatal steroids to induce lung maturity in the fetus may be given in all of the following condition except :, with the following options: A: Prolonged rupture of membranes for more than 24 hours, B: Pregnancy induced hypeension, C: Diabetes mellitus, D: Chorioamnionitis ### Response: The condition in which steroid are given to the patient is :- Premature rupture of membrane Polyhydramnios Hypeension Diabetes Severe anemia Indicated preterm delivery due to medical or obstetric complication We dont give steroids in Chorioamnionitis as it is an Infective condition and the risk of flare up of infection increases 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: A 15 year old boy feels that the dirt has hung onto him whenever he passes through the dirty street. This repetitive thought causes much distress and anxiety. He knows that there is actually no such thing after he has cleaned once but he is not satisfied and is compelled to think so. This has led to social withdrawal. He spends much of his time thinking about dirt and contamination. This has affected his studies also. The most likely diagnosis is -, with the following options: A: Obsessive compulsive disorder, B: Conduct disorder, C: Agoraphobia, D: Adjustment disorder ### Response:

In this question, the patient is presenting with classical features of OCD:- Recurrent unwanted thoughts of dirt and contamination, i.e. obsession. The thought is recognized as irrational and absurd (patient knows that there are no such things) Irresistible thought causing marked distress and anxiety Compulsion for cleaning

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 15 year old boy feels that the dirt has hung onto him whenever he passes through the dirty street. This repetitive thought causes much distress and anxiety. He knows that there is actually no such thing after he has cleaned once but he is not satisfied and is compelled to think so. This has led to social withdrawal. He spends much of his time thinking about dirt and contamination. This has affected his studies also. The most likely diagnosis is -, with the following options: A: Obsessive compulsive disorder, B: Conduct disorder, C: Agoraphobia, D: Adjustment disorder ### Response: In this question, the patient is presenting with classical features of OCD:- Recurrent unwanted thoughts of dirt and contamination, i.e. obsession. The thought is recognized as irrational and absurd (patient knows that there are no such things) Irresistible thought causing marked distress and anxiety Compulsion for cleaning ### End