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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: The best surgical treatment for chronic maxillary sinusitis is:, with the following options: A: Repeated antral washout, B: Fiberoptic endoscopic sinus surgery, C: Caldwell-Luc's operation, D: Horgan's operation ### Response:

CHRONIC MAXILLARY SINUSITIS 1. Antral puncture and irrigation. Sinus cavity is irrigated with a cannula passed through the inferior meatus. Removal of pus and exudates helps the sinus mucosa to reve to normal. 2. Intranasal antrostomy. It is indicated if sinus irrigations fail to resolve infection. A window is created in the inferior meatus to provide aeration to the sinus and its free drainage. 3. Caldwell-Luc operation. In this operation, antrum is entered through its anterior wall by a sublabial incision. All irreversible diseases are removed and a window is created between the antrum and inferior meatus. Ref: Dhingra 7e pg 219

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The best surgical treatment for chronic maxillary sinusitis is:, with the following options: A: Repeated antral washout, B: Fiberoptic endoscopic sinus surgery, C: Caldwell-Luc's operation, D: Horgan's operation ### Response: CHRONIC MAXILLARY SINUSITIS 1. Antral puncture and irrigation. Sinus cavity is irrigated with a cannula passed through the inferior meatus. Removal of pus and exudates helps the sinus mucosa to reve to normal. 2. Intranasal antrostomy. It is indicated if sinus irrigations fail to resolve infection. A window is created in the inferior meatus to provide aeration to the sinus and its free drainage. 3. Caldwell-Luc operation. In this operation, antrum is entered through its anterior wall by a sublabial incision. All irreversible diseases are removed and a window is created between the antrum and inferior meatus. Ref: Dhingra 7e pg 219 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Giant's rollover test for PIH is done at-(Orrisa R), with the following options: A: 22-24 weeks, B: 28-32 weeks, C: 24-26 weeks, D: 32-34 weeks ### Response:

Ans-BNote-THE ROLL-OVER TEST Between the 28th and 32nd week of pregnancy, the woman lies quietly on her left side for about 5 minutes. A blood pressure cuff is applied to the right arm and the blood pressure is taken. After releasing the valve and expelling all air from the blood pressure cuff bladder, the cuff is left loosely in place on the arm. The woman then rolls over on her back and the blood pressure is taken again immediately. If the bottom number (diastolic pressure) is elevated 20 points between the first and the second readings, this is said to demonstrate a contracted blood volume and indicate a risk of developing metabolic toxemia. The test is positive in many normal pregnancies and even in the nonpregnant person. Again, this test has been discredited and should not be used.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Giant's rollover test for PIH is done at-(Orrisa R), with the following options: A: 22-24 weeks, B: 28-32 weeks, C: 24-26 weeks, D: 32-34 weeks ### Response: Ans-BNote-THE ROLL-OVER TEST Between the 28th and 32nd week of pregnancy, the woman lies quietly on her left side for about 5 minutes. A blood pressure cuff is applied to the right arm and the blood pressure is taken. After releasing the valve and expelling all air from the blood pressure cuff bladder, the cuff is left loosely in place on the arm. The woman then rolls over on her back and the blood pressure is taken again immediately. If the bottom number (diastolic pressure) is elevated 20 points between the first and the second readings, this is said to demonstrate a contracted blood volume and indicate a risk of developing metabolic toxemia. The test is positive in many normal pregnancies and even in the nonpregnant person. Again, this test has been discredited and should not 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: False -ve hydrostatic test in live born fetus is for-, with the following options: A: Atelectasis, B: Meconium aspiration, C: Emphysema, D: Putrefaction ### Response:

Hydrostatic (Raygat's) test is false negative in atelectasis and diseases like acute pulmonary edema, pneumonia and congenital syphilis etc.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: False -ve hydrostatic test in live born fetus is for-, with the following options: A: Atelectasis, B: Meconium aspiration, C: Emphysema, D: Putrefaction ### Response: Hydrostatic (Raygat's) test is false negative in atelectasis and diseases like acute pulmonary edema, pneumonia and congenital syphilis etc. ### 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 male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from :, with the following options: A: Korsakoff's psychosis, B: Wernicke encephalopathy, C: DeClerambault syndrome, D: Delirium tremens ### Response:

Confusion, nystagmus, ataxia and 6th cranial nerve weakness in an alcohol dependent patient suggest the diagnosis of Wernicke's encephalopathy.

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 male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from :, with the following options: A: Korsakoff's psychosis, B: Wernicke encephalopathy, C: DeClerambault syndrome, D: Delirium tremens ### Response: Confusion, nystagmus, ataxia and 6th cranial nerve weakness in an alcohol dependent patient suggest the diagnosis of Wernicke's encephalopathy. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Zonular cataract, with the following options: A: Riders not seen, B: Developmental cataract, C: Acquired cataract, D: After complication ### Response:

i.e. (Developmental cataract): (265-Parson 21st) (172-Khurana 4th)ZONULAR OR LAMELLAR CATARACT - refers to the developmental cataract in which the opacity occupies a discrete zone in the lensMost common types of congenital cataract presenting with visual impaiment*** Usually bilateral* Lineal opacities like spikes of a wheel (called riders) may run outwards towards the equator- Other most common types of developmental cataract- Punctate cataract- Fusiform cataract- Nuclear cataract- Coronary cataract- Anterior capsular (polar) cataract- Posterior capsular (polar) cataract

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Zonular cataract, with the following options: A: Riders not seen, B: Developmental cataract, C: Acquired cataract, D: After complication ### Response: i.e. (Developmental cataract): (265-Parson 21st) (172-Khurana 4th)ZONULAR OR LAMELLAR CATARACT - refers to the developmental cataract in which the opacity occupies a discrete zone in the lensMost common types of congenital cataract presenting with visual impaiment*** Usually bilateral* Lineal opacities like spikes of a wheel (called riders) may run outwards towards the equator- Other most common types of developmental cataract- Punctate cataract- Fusiform cataract- Nuclear cataract- Coronary cataract- Anterior capsular (polar) cataract- Posterior capsular (polar) cataract ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Non-functional enzymes are all except:, with the following options: A: Alkaline phosphatase, B: Acid phosphatase, C: Lipoprotein lipase, D: Gamma glutamyl transpeptidase ### Response:

Ans. is 'c' i.e. Lipoprotein lipase Plasma enzymes can be classified into functional and non-functional plasma enzymes. Functional plasma enzymesNon-functional plasma enzymesFunctionHas known physiological functionHas no known physiological functionCone, in plasmaNormally present in plasma in higher conc.in comparison to tissues.Normally, present in plasma in very low cone, in comparison to tissues.SubstrateTheir substrates are always present in bloodTheir substrates are absent from the bloodSite of synthesisMajority synthesized and secreted by liverDifferent organs e.g. Liver, heart, muscles etc.These non-funtional plasma enzymes arise from:Cell damage or necrosis with the release of enzymes into the blood e.g. blood cells, liver cells in viral hepatitis, myocardial cells in infarctionObstruction of normal pathway e.g. obstruction of bile ducts alkaline phosphatase.Clinical importance of Non-functional plasma enzymes- Measurement of non-functional plasma enzymes is important for:diagnosis of diseaseprognosis of diseasePrinciple non-functional plasma enzymes used in clinical diagnosisSerum EnzymesDiagnostic useAmylase and lipase enzymesAcute pancreatitisAminotransferasesAspartate aminotransferase(AST or SGOT)Alanine aminotransferase (ALT or SGPT)Myocardial infarction Viral hepatitisAcid PhosphataseProstate cancerAlkaline phosphataseObstructive liver diseases, bone diseases and hyperparathyroidismCreatine kinaseMuscle disorders and Myocardial infarctionCeruloplasminWilson's diseaseGamma-glutamyl transpeptidaseLiver diseasesLactate dehydrogenaseMyocardial infarctionLipoproteinlipase is a functional enzyme that hydrolyzes lipids in lipoproteins, such as those found in chylomicrons and very low-density lipoproteins (VLDL), into free fatty acids and glycerol molecule.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Non-functional enzymes are all except:, with the following options: A: Alkaline phosphatase, B: Acid phosphatase, C: Lipoprotein lipase, D: Gamma glutamyl transpeptidase ### Response: Ans. is 'c' i.e. Lipoprotein lipase Plasma enzymes can be classified into functional and non-functional plasma enzymes. Functional plasma enzymesNon-functional plasma enzymesFunctionHas known physiological functionHas no known physiological functionCone, in plasmaNormally present in plasma in higher conc.in comparison to tissues.Normally, present in plasma in very low cone, in comparison to tissues.SubstrateTheir substrates are always present in bloodTheir substrates are absent from the bloodSite of synthesisMajority synthesized and secreted by liverDifferent organs e.g. Liver, heart, muscles etc.These non-funtional plasma enzymes arise from:Cell damage or necrosis with the release of enzymes into the blood e.g. blood cells, liver cells in viral hepatitis, myocardial cells in infarctionObstruction of normal pathway e.g. obstruction of bile ducts alkaline phosphatase.Clinical importance of Non-functional plasma enzymes- Measurement of non-functional plasma enzymes is important for:diagnosis of diseaseprognosis of diseasePrinciple non-functional plasma enzymes used in clinical diagnosisSerum EnzymesDiagnostic useAmylase and lipase enzymesAcute pancreatitisAminotransferasesAspartate aminotransferase(AST or SGOT)Alanine aminotransferase (ALT or SGPT)Myocardial infarction Viral hepatitisAcid PhosphataseProstate cancerAlkaline phosphataseObstructive liver diseases, bone diseases and hyperparathyroidismCreatine kinaseMuscle disorders and Myocardial infarctionCeruloplasminWilson's diseaseGamma-glutamyl transpeptidaseLiver diseasesLactate dehydrogenaseMyocardial infarctionLipoproteinlipase is a functional enzyme that hydrolyzes lipids in lipoproteins, such as those found in chylomicrons and very low-density lipoproteins (VLDL), into free fatty acids and glycerol molecule. ### 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 follow ing is an example of heterophile antibody test-, with the following options: A: Widal test, B: Weil-Felix reaction, C: Rose-wraler test, D: Blood grouping & cross matching ### Response:

Ans. is 'b' i.e., Weil-Felix reaction Ref: Ananthanarayan 9th/ep. 109 &- 8th/e p. 108; Immunology Lachmann 4th/ ep. 1534. 1535]Heterophilic agglutination reactiono Some organisms of different class or species share closely related antigens.o When serum containing agglutinin (antibody) of one organism gives agglutination reaction with antigen of other organism, it is called heterophilic agglutination test.Examples areo Streptococcus M.G agglutination test for primary atypical pneumonia,o Weil - Felix reaction for typhus fever.o Paul Bunnell test for IMN.

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 follow ing is an example of heterophile antibody test-, with the following options: A: Widal test, B: Weil-Felix reaction, C: Rose-wraler test, D: Blood grouping & cross matching ### Response: Ans. is 'b' i.e., Weil-Felix reaction Ref: Ananthanarayan 9th/ep. 109 &- 8th/e p. 108; Immunology Lachmann 4th/ ep. 1534. 1535]Heterophilic agglutination reactiono Some organisms of different class or species share closely related antigens.o When serum containing agglutinin (antibody) of one organism gives agglutination reaction with antigen of other organism, it is called heterophilic agglutination test.Examples areo Streptococcus M.G agglutination test for primary atypical pneumonia,o Weil - Felix reaction for typhus fever.o Paul Bunnell test for IMN. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Openings of the tube of bronchoscope are known as:, with the following options: A: Holes, B: Apeures, C: Vents, D: Any of the above ### Response:

Bronchoscope is similar to esophagoscope, but has openings at the distal pa of the tube, called Vents which help in aeration of the side bronchi.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Openings of the tube of bronchoscope are known as:, with the following options: A: Holes, B: Apeures, C: Vents, D: Any of the above ### Response: Bronchoscope is similar to esophagoscope, but has openings at the distal pa of the tube, called Vents which help in aeration of the side bronchi. ### 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 immunohistochemical markers would be expected to be positive in biopsies of Ewings Sarcoma?, with the following options: A: CD3, B: CD21, C: Myogenin, D: S-100 ### Response:

S-100 protein and neuron-specific enolase, both of which are markers for tumors with neuroendocrine differentiation, are usually positive in Ewing sarcoma. The tumor also usually contains glycogen, which can be helpful in the distinction with other "small blue cell tumors" (including lymphomas, neuroblastoma, and Wilms tumor) of childhood. GOOD TO KNOW: CD3 is a T cell marker. CD21 is a B-cell marker. Myogenin is a marker for rhabdomyosarcoma. Ewing sarcoma: It typically involves the diaphyseal region of long bones and also has an affinity for flat bones. The plain radiograph may show a characteristic "onion peel" periosteal reaction with a generous soft tissue mass, which is better demonstrated by CT or MRI. The presence of p30/32, the product of the mic-2 gene (which maps to the pseudoautosomal region of the X and Y chromosomes) is a cell-surface marker for Ewing's sarcoma (and other members of the Ewing's family of tumors, sometimes called PNETs. Ref: Patel S.R., Benjamin R.S. (2012). Chapter 98. Soft Tissue and Bone Sarcomas and Bone Metastases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

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 immunohistochemical markers would be expected to be positive in biopsies of Ewings Sarcoma?, with the following options: A: CD3, B: CD21, C: Myogenin, D: S-100 ### Response: S-100 protein and neuron-specific enolase, both of which are markers for tumors with neuroendocrine differentiation, are usually positive in Ewing sarcoma. The tumor also usually contains glycogen, which can be helpful in the distinction with other "small blue cell tumors" (including lymphomas, neuroblastoma, and Wilms tumor) of childhood. GOOD TO KNOW: CD3 is a T cell marker. CD21 is a B-cell marker. Myogenin is a marker for rhabdomyosarcoma. Ewing sarcoma: It typically involves the diaphyseal region of long bones and also has an affinity for flat bones. The plain radiograph may show a characteristic "onion peel" periosteal reaction with a generous soft tissue mass, which is better demonstrated by CT or MRI. The presence of p30/32, the product of the mic-2 gene (which maps to the pseudoautosomal region of the X and Y chromosomes) is a cell-surface marker for Ewing's sarcoma (and other members of the Ewing's family of tumors, sometimes called PNETs. Ref: Patel S.R., Benjamin R.S. (2012). Chapter 98. Soft Tissue and Bone Sarcomas and Bone Metastases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Birbeck granules in the cytoplasm are seen in ?, with the following options: A: Mast cells, B: Langerhan's cells, C: Thrombocytes, D: Myelocytes ### Response:

Ans. is 'b' i.e., Langerhan's cells

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Birbeck granules in the cytoplasm are seen in ?, with the following options: A: Mast cells, B: Langerhan's cells, C: Thrombocytes, D: Myelocytes ### Response: Ans. is 'b' i.e., Langerhan's cells ### 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 about macular function test is:, with the following options: A: Two-point discrimination, B: Maddox rod, C: Laser interferometry, D: Retinogram ### Response:

Ans.Retinogram

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Not true about macular function test is:, with the following options: A: Two-point discrimination, B: Maddox rod, C: Laser interferometry, D: Retinogram ### Response: Ans.Retinogram ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vaginal delivery is allowed in all except, with the following options: A: Monochorionic monoamniotic twins, B: First twin cephalic and second breech, C: Extended breech, D: Mento anterior ### Response:

Ans. Is a i.e. Monochorinoic monoamniotic twins In face presentation the best presentation is mento anterior, especially left mento anterior and delivery is possible. In twins, the chances of vaginal delivery are high if the first twin or presenting twin is cephalic. Extended beech is the commonest breech presentation and is also the best possible presentation for a normal vaginal delivery in breech. In Monochorionic monoamniotic presentations the twins share a single amniotic sac and placate so there is almost a 50% incidence of cord accidents and that is one reason which even prompts to do a preterm cesarean to many practioners to avoid a sudden fetal cord entrapment and fetal death. "A situation requiring cesarean delivery in twin pregnancy is a monoamniotic placentation. The fetal moality in these pregnancies is greater than 50% and the overwhelming cause is cord accidents such as cord prolapse or entaglement." Also Know: Indications for elective cesarean section in Twin pregnancy First twin presenting as non veex (breech or transverse) or both the fetuses non veex. Collision of both the heads at brim preventing engagement of either head. Monoamniotic twins. Chronic Twin-Twin Transfusion Syndrome. Conjoined twins at term. Severe IUGR of one or both fetus. Previous cesarean section. In discordant twin - weight of smaller twin < 1500 gm. Obstetric factors necessitating cesarean section like contracted pelvis, placenta pre, severe preeclampsia, cord prolapse of first baby. Note : There is no valid reason to perform LSCS in all cases of second twins for non cephalic presentation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vaginal delivery is allowed in all except, with the following options: A: Monochorionic monoamniotic twins, B: First twin cephalic and second breech, C: Extended breech, D: Mento anterior ### Response: Ans. Is a i.e. Monochorinoic monoamniotic twins In face presentation the best presentation is mento anterior, especially left mento anterior and delivery is possible. In twins, the chances of vaginal delivery are high if the first twin or presenting twin is cephalic. Extended beech is the commonest breech presentation and is also the best possible presentation for a normal vaginal delivery in breech. In Monochorionic monoamniotic presentations the twins share a single amniotic sac and placate so there is almost a 50% incidence of cord accidents and that is one reason which even prompts to do a preterm cesarean to many practioners to avoid a sudden fetal cord entrapment and fetal death. "A situation requiring cesarean delivery in twin pregnancy is a monoamniotic placentation. The fetal moality in these pregnancies is greater than 50% and the overwhelming cause is cord accidents such as cord prolapse or entaglement." Also Know: Indications for elective cesarean section in Twin pregnancy First twin presenting as non veex (breech or transverse) or both the fetuses non veex. Collision of both the heads at brim preventing engagement of either head. Monoamniotic twins. Chronic Twin-Twin Transfusion Syndrome. Conjoined twins at term. Severe IUGR of one or both fetus. Previous cesarean section. In discordant twin - weight of smaller twin < 1500 gm. Obstetric factors necessitating cesarean section like contracted pelvis, placenta pre, severe preeclampsia, cord prolapse of first baby. Note : There is no valid reason to perform LSCS in all cases of second twins for non cephalic presentation. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Rate of induction of the anaesthesia is increased by all of the following except, with the following options: A: agents with low blood gas solubility, B: high Cardiac Output, C: Second gas effect, D: high alveolar ventilation ### Response:

High cardiac output causes fast uptake of potent inhalational agent from alveoli thus slow speed of induction. rest all options maintain alveolar concentration .

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Rate of induction of the anaesthesia is increased by all of the following except, with the following options: A: agents with low blood gas solubility, B: high Cardiac Output, C: Second gas effect, D: high alveolar ventilation ### Response: High cardiac output causes fast uptake of potent inhalational agent from alveoli thus slow speed of induction. rest all options maintain alveolar concentration . ### 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 these amino acids does not have asymmetric carbon atom?, with the following options: A: Valine, B: Glycine, C: Alanine, D: Tryosine ### Response:

Glycine is the simplest amino acid with no optical activity.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of these amino acids does not have asymmetric carbon atom?, with the following options: A: Valine, B: Glycine, C: Alanine, D: Tryosine ### Response: Glycine is the simplest amino acid with no optical activity. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: True about inferior vena cava - a) Passes through diaphragm at level of D10 vertebra b) Rt. Suprarenal artery directly drains to it. c) It lies anterior to the renal vein. d) It forms the posterior wall of the epiploic foramen e) It is related to psoas muscle, with the following options: A: abc, B: bce, C: de, D: d only ### Response:

Inferior vena cava passes diaphragm at the level of T8. Inferior vena cava does not receive blood from an artery. Epiploic foramen lies anterior to the inferior vena cava.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: True about inferior vena cava - a) Passes through diaphragm at level of D10 vertebra b) Rt. Suprarenal artery directly drains to it. c) It lies anterior to the renal vein. d) It forms the posterior wall of the epiploic foramen e) It is related to psoas muscle, with the following options: A: abc, B: bce, C: de, D: d only ### Response: Inferior vena cava passes diaphragm at the level of T8. Inferior vena cava does not receive blood from an artery. Epiploic foramen lies anterior to the inferior vena cava. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Azygos vein drains into:, with the following options: A: Left brachiocephalic vein, B: Inferior vena cava, C: Superior vena cava, D: Right brachiocephalic vein ### Response:

The azygos vein ends by joining the posterior aspect of the superior vena cavaThe Azygos VeinThe azygos vein connects the superior and inferior venae cavae, either directly by joining the IVC or indirectly by the hemiazygos and accessory hemiazygos veins.The azygos vein drains blood from the posterior walls of the thorax and abdomen.It ascends in the posterior mediastinum, passing close to the right QA des of the bodies of the inferior eight thoracic veebrae (T4-T12).It is covered anteriorly by the oesophagus as it passes posterior to the root of the right lung.It then arches over the superior aspect of this root to join the SVC.In addition to the posterior intercostal veins, the azygos vein communicates with the veebral venous plexuses.This vein also receives the mediastinal, oesophageal, and bronchial veins.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Azygos vein drains into:, with the following options: A: Left brachiocephalic vein, B: Inferior vena cava, C: Superior vena cava, D: Right brachiocephalic vein ### Response: The azygos vein ends by joining the posterior aspect of the superior vena cavaThe Azygos VeinThe azygos vein connects the superior and inferior venae cavae, either directly by joining the IVC or indirectly by the hemiazygos and accessory hemiazygos veins.The azygos vein drains blood from the posterior walls of the thorax and abdomen.It ascends in the posterior mediastinum, passing close to the right QA des of the bodies of the inferior eight thoracic veebrae (T4-T12).It is covered anteriorly by the oesophagus as it passes posterior to the root of the right lung.It then arches over the superior aspect of this root to join the SVC.In addition to the posterior intercostal veins, the azygos vein communicates with the veebral venous plexuses.This vein also receives the mediastinal, oesophageal, and bronchial veins. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which organ is the primary site of hematopoiesis in the fetus before mid-pregnancy?, with the following options: A: Bone, B: Liver, C: Spleen, D: Lung ### Response:

Ans. B. LiverFetal Hematopoiesisi. Begins in the yolk sac (2 -8 weeks) - progenitor cells migrate from the yolk sac to the liver at 5-8 weeks' gestationii. Only terminal differentiation of red cells occurs in the yolk saciii. Liver active from 5-8 weeks' gestation - mainly red cells. Spleen also involved before 20 weeksiv. Begins in the medullary cavity of the clavicle at about 10-12 weeks and in the medullary cavity of long of bones at 20 weeksv. gestationvi. Some lymphocytes are produced in lymph nodesvii. At term, all red cell production is in bones unless there is a reason for increased hematopoiesis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which organ is the primary site of hematopoiesis in the fetus before mid-pregnancy?, with the following options: A: Bone, B: Liver, C: Spleen, D: Lung ### Response: Ans. B. LiverFetal Hematopoiesisi. Begins in the yolk sac (2 -8 weeks) - progenitor cells migrate from the yolk sac to the liver at 5-8 weeks' gestationii. Only terminal differentiation of red cells occurs in the yolk saciii. Liver active from 5-8 weeks' gestation - mainly red cells. Spleen also involved before 20 weeksiv. Begins in the medullary cavity of the clavicle at about 10-12 weeks and in the medullary cavity of long of bones at 20 weeksv. gestationvi. Some lymphocytes are produced in lymph nodesvii. At term, all red cell production is in bones unless there is a reason for increased hematopoiesis ### 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 conditions are associated with the development of Necrotizing papillitis, EXCEPT:, with the following options: A: Diabetes mellitus, B: Sickle cell disease, C: Analgesic nephropathy, D: Tuberculous pyelonephritis ### Response:

Common causes of papillary necrosis are diabetes mellitus, analgesic nephropathy, sickle cell disease and urinary tract obstruction. Diabetes mellitus is the most common cause of renal papillary necrosis. Analgesic nephropathy is associated with the use of more than 1 kg analgesics. Ref: Radiology Illustrated: Uroradiology By Seung Hyup Kim, 2nd Edition, Pages 471-2

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 conditions are associated with the development of Necrotizing papillitis, EXCEPT:, with the following options: A: Diabetes mellitus, B: Sickle cell disease, C: Analgesic nephropathy, D: Tuberculous pyelonephritis ### Response: Common causes of papillary necrosis are diabetes mellitus, analgesic nephropathy, sickle cell disease and urinary tract obstruction. Diabetes mellitus is the most common cause of renal papillary necrosis. Analgesic nephropathy is associated with the use of more than 1 kg analgesics. Ref: Radiology Illustrated: Uroradiology By Seung Hyup Kim, 2nd Edition, Pages 471-2 ### 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 minimal cut off age for employment of children under the Factory Act?, with the following options: A: 12 years, B: 14 years, C: 15 years, D: 18 years ### Response:

The Factory Act prohibits the employment of children below 14 years and declares 15 to 18 years as belonging to the adolescent group. Adolescents require fitness ceificate prior to employment in a job. Ref: Park 21st edition page: 756.

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 minimal cut off age for employment of children under the Factory Act?, with the following options: A: 12 years, B: 14 years, C: 15 years, D: 18 years ### Response: The Factory Act prohibits the employment of children below 14 years and declares 15 to 18 years as belonging to the adolescent group. Adolescents require fitness ceificate prior to employment in a job. Ref: Park 21st edition page: 756. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vaccines that must be given before age of two years according to IAP are all of the following EXCEPT?, with the following options: A: Varicella vaccine, B: MMR vaccine, C: Conjugated typhoid vaccine, D: Pneumococcal polysaccharide vaccine ### Response:

Vaccine Recommended age of vaccination (1st dose) a. Varicella vaccine 15 months b. MMR vaccine 9 months c. Conjugated typhoid vaccine 9 months d. Pneumococcal polysaccharide vaccine Beyond 2 yrs age - As polysaccharides stimulate B-cells independent of T-cells, the pneumococcal polysaccharide is poorly immunogenic at <2yrs age & immunological memory is low - Hence, it is recommended beyond 2yrs of age.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vaccines that must be given before age of two years according to IAP are all of the following EXCEPT?, with the following options: A: Varicella vaccine, B: MMR vaccine, C: Conjugated typhoid vaccine, D: Pneumococcal polysaccharide vaccine ### Response: Vaccine Recommended age of vaccination (1st dose) a. Varicella vaccine 15 months b. MMR vaccine 9 months c. Conjugated typhoid vaccine 9 months d. Pneumococcal polysaccharide vaccine Beyond 2 yrs age - As polysaccharides stimulate B-cells independent of T-cells, the pneumococcal polysaccharide is poorly immunogenic at <2yrs age & immunological memory is low - Hence, it is recommended beyond 2yrs of age. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Russel bodies are seen in:, with the following options: A: Lymphocytes, B: Neutrophils, C: Macrophages, D: None of the above ### Response:

None of the above

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Russel bodies are seen in:, with the following options: A: Lymphocytes, B: Neutrophils, C: Macrophages, D: None of the above ### Response: None of the above ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In case of electromagnetic radiation, constant parameter is:, with the following options: A: Intensity, B: Wave length, C: Frequency, D: Velocity ### Response:

Ans: d (Velocity) Ref:Resnick and Halliday Fundamentals of General physicsElectromagnetic radiation is the spectrum of waves propagated through space or matter by the oscillation of electric field and a magnetic field at right angle to one another.Waves travel perpendicular to both electric and magnetic field.They have a constant velocity of 3 x 10s m/s in vacuum.Remember the formula E= me2 where c is the constant velocity.Electromagnetic waves include radio waves, heat waves, light waves, UV waves, X-rays, gamma raysNote:X rays are produced from orbital electrons where as gamma rays are produced from the nucleus of an atomSource of radiation that cause heat cataract -infra red radiationPrinciple used in radiotherapy -ionization of moleculeFunctional basis of ionizing radiation -excitation of electrons from orbitIn therapeutic x rays - Compton effectIn diagnostic x-rays - photoelectric effectIn accidental x-ray work * pair productionDevices used in radiotherapyLinear accelerator- used to accelerate electrons and produce x-ray beamCyclotron- produces neutrons and photonsMicrotron- an electron accelerator, combines principles of linear accelerator and cyclotronBetatron- device for accelerating electrons used for production of electron beam for RT and an x-ray beamTypes of therapy:Superficial therapy - treated with x-rays produced at a energy ranging from 50- 150 kvOrthovoltage or deep therapy - treated with x-rays ranging from 150- 500 kvSuper voltage therapy - x-ray therapy in the range of 500 - 1000 kvOxygen enhancement ratio is maximum with neutrons

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In case of electromagnetic radiation, constant parameter is:, with the following options: A: Intensity, B: Wave length, C: Frequency, D: Velocity ### Response: Ans: d (Velocity) Ref:Resnick and Halliday Fundamentals of General physicsElectromagnetic radiation is the spectrum of waves propagated through space or matter by the oscillation of electric field and a magnetic field at right angle to one another.Waves travel perpendicular to both electric and magnetic field.They have a constant velocity of 3 x 10s m/s in vacuum.Remember the formula E= me2 where c is the constant velocity.Electromagnetic waves include radio waves, heat waves, light waves, UV waves, X-rays, gamma raysNote:X rays are produced from orbital electrons where as gamma rays are produced from the nucleus of an atomSource of radiation that cause heat cataract -infra red radiationPrinciple used in radiotherapy -ionization of moleculeFunctional basis of ionizing radiation -excitation of electrons from orbitIn therapeutic x rays - Compton effectIn diagnostic x-rays - photoelectric effectIn accidental x-ray work * pair productionDevices used in radiotherapyLinear accelerator- used to accelerate electrons and produce x-ray beamCyclotron- produces neutrons and photonsMicrotron- an electron accelerator, combines principles of linear accelerator and cyclotronBetatron- device for accelerating electrons used for production of electron beam for RT and an x-ray beamTypes of therapy:Superficial therapy - treated with x-rays produced at a energy ranging from 50- 150 kvOrthovoltage or deep therapy - treated with x-rays ranging from 150- 500 kvSuper voltage therapy - x-ray therapy in the range of 500 - 1000 kvOxygen enhancement ratio is maximum with neutrons ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Long term complication of live kidney donors are, with the following options: A: Hypeension, B: HPV Infection, C: Renal Carcinoma, D: Pyelonephritis ### Response:

Answer- A. HypeensionHypeentionCardiovascular risksPreoteinuriaEnd stage renal disease

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Long term complication of live kidney donors are, with the following options: A: Hypeension, B: HPV Infection, C: Renal Carcinoma, D: Pyelonephritis ### Response: Answer- A. HypeensionHypeentionCardiovascular risksPreoteinuriaEnd stage renal disease ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: To prevent veical transmission of HIV in a child of pregnant mother, used is:, with the following options: A: Zidovudine for mother (36 weeks) and child (6 weeks), B: Zidovudine for 6 months to mother and 6 weeks to child, C: Zidovudine for 6 Weeks, D: Avoid zidovidine ### Response:

Zidovudine for mother (36 weeks) and child (6 weeks)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: To prevent veical transmission of HIV in a child of pregnant mother, used is:, with the following options: A: Zidovudine for mother (36 weeks) and child (6 weeks), B: Zidovudine for 6 months to mother and 6 weeks to child, C: Zidovudine for 6 Weeks, D: Avoid zidovidine ### Response: Zidovudine for mother (36 weeks) and child (6 weeks) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Group B Nerve fibers are situated in:, with the following options: A: Muscle spindles, B: Fibers carrying pain sensation, C: Preganglionic autonomic fibers, D: Post ganglionic autonomic fibers. ### Response:

Ans. is 'c' is Preganglionic autonomic fibres Nerve fiber types in mammalian nerve:Fiber Type AFunctionFiber Diameter (mm)Conduction Velocity (m/s)alphaProprioception; somatic motor*12-20(Max.)* 70-120betaTouch, pressure*5-1230-70gammaMotor to muscle spindles*3-615-30deltaPain, cold, touch*2-512-30BPreganglionic autonomic*<33-15C Dorsal rootPain, temperature, some mechanoreceptor, reflex responses0.4-1.20.5-2Sympathetic*Postganglionic sympathetic0.3-1.30.7-2.3* A and B fibres are myelinated; C fibres are unmyelinated.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Group B Nerve fibers are situated in:, with the following options: A: Muscle spindles, B: Fibers carrying pain sensation, C: Preganglionic autonomic fibers, D: Post ganglionic autonomic fibers. ### Response: Ans. is 'c' is Preganglionic autonomic fibres Nerve fiber types in mammalian nerve:Fiber Type AFunctionFiber Diameter (mm)Conduction Velocity (m/s)alphaProprioception; somatic motor*12-20(Max.)* 70-120betaTouch, pressure*5-1230-70gammaMotor to muscle spindles*3-615-30deltaPain, cold, touch*2-512-30BPreganglionic autonomic*<33-15C Dorsal rootPain, temperature, some mechanoreceptor, reflex responses0.4-1.20.5-2Sympathetic*Postganglionic sympathetic0.3-1.30.7-2.3* A and B fibres are myelinated; C fibres are unmyelinated. ### 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 about mucinous cystadenoma pancreasaEUR', with the following options: A: Microcystic adenoma, B: Lined by columnar epithelium, C: Pre malignant, D: Focus of ovarian stroma in it ### Response:

Microcystic adenoma [Ref. Robbin's Pathology 8/e p899; Schwaz 9/e p1232) Mutinous cystadenoma are macrocystic adenomas. Serous cystadenomas are microcystic adenomas. Cystic neoplasm of Pancreas Cystic neoplasms are of the following types: Common types? a. Serous cystadenomas (approx. 25-30% of all cystic neoplasms) b. Mucinous cystadenomas and cystadenocarcinomas (appro. 40-50% of all cystic neoplasms) Uncommon types? c. intraductal papillary mucinous tumor (approx.10% of all cystic neoplasms) d. solid pseudopapillary neoplasm (about 5-10% of all cystic neoplasms) Serous cystadenomas Serous cystadenomas are benign tumors without malignant potential. (Serous cystadenocarcinoma has been repoed very rarely (<1%) They have a spongy appearance, composed of multiple small cysts (microcystic). May contain central stellate fibrotic scar that may calcify (sunburst calcification) and it is highly specific and considered to be viually pathognomonic of serous cystadenoma. The cyst is lined by simple cuboidal epithelium. They do not produce mucin These lesions thus contain thin serous fluid that does not stain positive for mucin and is low in CEA (<200 ng/mL). Common in females (F:M ratio is 2:1), usually in 7th decade of life. Common in the head/ uncinate process region.(50% in the head/uncinate process, and 50% in the neck, body, or tail) Serous cystadenomas do not have malignant potential, hence operated only when symptomatic. Mucionous cystic neoplasms (cystadenoma and cystadenocarcinoma) Mucinous cystic neoplasms (MCNs) encompass a spectrum ranging from benign but potentially malignant (i.e. cystadenomas) to carcinoma with a very aggressive behavior (i.e. cystadenocarcinomas); suggesting a gradual malignant transformation. MCNs are composed of large thick-walled, septate cysts (macrocystic) with no connection to the ductal system. (difference .from 1PMN there tumor is connected to the ductal system) The cysts are lined by tall columnar epithelium that fills the cyst with viscous mucin. MCNs are characterised by the presence of ovarian-type stroma which is a key pathologic feature distinguishing these lesions. This stroma is not only morphologically similar to that of the ovarian coex, but also expresses oestrogen and progesterone receptors that are detectable by immunohistochemistry Females are much more commonly affected than males (ratio 9:1), with mean age of 50 years. MCNs predominantly involve the body and tail of the pancreas. High CEA levels in the fluid (>200 ng/mL) may suggest malignant transformation. Resection is the treatment of choice for MCNs as the best way to distinguish the entirely benign form (mucinous cystadenoma) from its malignant counterpa (mucinous cystadenocarcinoma) is pathologic assessment after complete surgical removal. Because most MCNs are located in the body and tail of the pancreas, distal pancreatectomy is the most common treatment. IPMNs IPMNs are similar to MCNs in that they are cystic tumors that secrete mucin. The epithelial lining of the cyst is by tall columnar mucin producing cells that frequently forms papillary projections. Two major differences from MCNs is: - IPMNs extensively involve the main pancreatic ducts or the major side branches (or both); whereas MCNs do not connect to the pancreatic duct system. - IPMNs lack the 'ovarian' stroma seen in MCNs. Mucin production by cells leads to intraductal mucin accumulation and subsequent cystic dilation. This mucin production may be so great that mucin can be seen extruding from the ampulla of Vater. On ERCP, mucin can be seen extruding from the ampulla of Vater, a so-called fish-eye lesion, that is viually diagnostic of IPMN Like MCNs IPMNs can range from benign (IPMN adenomas) to malignant (IPMN carcinomas) In contrast to mucinous cystic neoplasms, IPMNs arise more frequently in men than in women, and they involve the head of the pancreas more often than the tail. Age group: seventh to eighth decade of life Surgery is the treatment of choice. Solid- Pseudopapillary tumor Solid-pseudopapillary tumors are rare and typically occur in young women These are well encapsulated, typically large lesions (>10 cm), and may occur anywhere within the pancreas.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Not true about mucinous cystadenoma pancreasaEUR', with the following options: A: Microcystic adenoma, B: Lined by columnar epithelium, C: Pre malignant, D: Focus of ovarian stroma in it ### Response: Microcystic adenoma [Ref. Robbin's Pathology 8/e p899; Schwaz 9/e p1232) Mutinous cystadenoma are macrocystic adenomas. Serous cystadenomas are microcystic adenomas. Cystic neoplasm of Pancreas Cystic neoplasms are of the following types: Common types? a. Serous cystadenomas (approx. 25-30% of all cystic neoplasms) b. Mucinous cystadenomas and cystadenocarcinomas (appro. 40-50% of all cystic neoplasms) Uncommon types? c. intraductal papillary mucinous tumor (approx.10% of all cystic neoplasms) d. solid pseudopapillary neoplasm (about 5-10% of all cystic neoplasms) Serous cystadenomas Serous cystadenomas are benign tumors without malignant potential. (Serous cystadenocarcinoma has been repoed very rarely (<1%) They have a spongy appearance, composed of multiple small cysts (microcystic). May contain central stellate fibrotic scar that may calcify (sunburst calcification) and it is highly specific and considered to be viually pathognomonic of serous cystadenoma. The cyst is lined by simple cuboidal epithelium. They do not produce mucin These lesions thus contain thin serous fluid that does not stain positive for mucin and is low in CEA (<200 ng/mL). Common in females (F:M ratio is 2:1), usually in 7th decade of life. Common in the head/ uncinate process region.(50% in the head/uncinate process, and 50% in the neck, body, or tail) Serous cystadenomas do not have malignant potential, hence operated only when symptomatic. Mucionous cystic neoplasms (cystadenoma and cystadenocarcinoma) Mucinous cystic neoplasms (MCNs) encompass a spectrum ranging from benign but potentially malignant (i.e. cystadenomas) to carcinoma with a very aggressive behavior (i.e. cystadenocarcinomas); suggesting a gradual malignant transformation. MCNs are composed of large thick-walled, septate cysts (macrocystic) with no connection to the ductal system. (difference .from 1PMN there tumor is connected to the ductal system) The cysts are lined by tall columnar epithelium that fills the cyst with viscous mucin. MCNs are characterised by the presence of ovarian-type stroma which is a key pathologic feature distinguishing these lesions. This stroma is not only morphologically similar to that of the ovarian coex, but also expresses oestrogen and progesterone receptors that are detectable by immunohistochemistry Females are much more commonly affected than males (ratio 9:1), with mean age of 50 years. MCNs predominantly involve the body and tail of the pancreas. High CEA levels in the fluid (>200 ng/mL) may suggest malignant transformation. Resection is the treatment of choice for MCNs as the best way to distinguish the entirely benign form (mucinous cystadenoma) from its malignant counterpa (mucinous cystadenocarcinoma) is pathologic assessment after complete surgical removal. Because most MCNs are located in the body and tail of the pancreas, distal pancreatectomy is the most common treatment. IPMNs IPMNs are similar to MCNs in that they are cystic tumors that secrete mucin. The epithelial lining of the cyst is by tall columnar mucin producing cells that frequently forms papillary projections. Two major differences from MCNs is: - IPMNs extensively involve the main pancreatic ducts or the major side branches (or both); whereas MCNs do not connect to the pancreatic duct system. - IPMNs lack the 'ovarian' stroma seen in MCNs. Mucin production by cells leads to intraductal mucin accumulation and subsequent cystic dilation. This mucin production may be so great that mucin can be seen extruding from the ampulla of Vater. On ERCP, mucin can be seen extruding from the ampulla of Vater, a so-called fish-eye lesion, that is viually diagnostic of IPMN Like MCNs IPMNs can range from benign (IPMN adenomas) to malignant (IPMN carcinomas) In contrast to mucinous cystic neoplasms, IPMNs arise more frequently in men than in women, and they involve the head of the pancreas more often than the tail. Age group: seventh to eighth decade of life Surgery is the treatment of choice. Solid- Pseudopapillary tumor Solid-pseudopapillary tumors are rare and typically occur in young women These are well encapsulated, typically large lesions (>10 cm), and may occur anywhere within the pancreas. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Peaud' orange develops due to, with the following options: A: Vascular obstruction, B: Lymphatic obstruction, C: Local spread, D: Endocrinal abnormality ### Response:

(Lymphatic obstruction) (837-LB) (839-B & L 25th)Phenomena resulting from lymphatic obstruction In advanced breast cancer(i) Peaud's orange (ii) Cancer-en-cuirasse (iii) LymphangiosarcomaPeaud' orange - is due to cutaneous lymphatic oedema, where the infiltrate skin is fethered by the sweat ducts, it cannot swell leading to an appearance like orange skin. Occasionally the same phenomenon is seen over a chronic abscess

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Peaud' orange develops due to, with the following options: A: Vascular obstruction, B: Lymphatic obstruction, C: Local spread, D: Endocrinal abnormality ### Response: (Lymphatic obstruction) (837-LB) (839-B & L 25th)Phenomena resulting from lymphatic obstruction In advanced breast cancer(i) Peaud's orange (ii) Cancer-en-cuirasse (iii) LymphangiosarcomaPeaud' orange - is due to cutaneous lymphatic oedema, where the infiltrate skin is fethered by the sweat ducts, it cannot swell leading to an appearance like orange skin. Occasionally the same phenomenon is seen over a chronic abscess ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 17-year-old female underwent Fine Needle Aspiration cytology (FNAC) for a lump in the breast which was non-tender, firm and mobile. Which of the following features would suggest finding of a benign breast disease?, with the following options: A: Dyscohesive ductal epithelial cells without cellular fragments, B: Tightly arranged ductal epithelial cells with dyscohesive bare nuclei, C: Stromal predominance with spindle cells, D: Polymorphism with single or arranged ductal epithelial cells ### Response:

Ans. b. Tightly arranged ductal epithelial cells with dyscohesive bare nuclei Non-tender, firm and mobile breast lump in a female of age 17 years is suggestive of fibroadenoma, in which tightly arranged ductal epithelial cells with dyscohesive bare nuclei are seen on FNAC. (AIIMS May 2013 repeat) Fibroadenoma: Diagnostic findings on needle biopsy consist of: Abundant stromal cells which appear as bare bipolar nuclei Sheets of fairly uniform-size epithelial cells that are typically arranged in either an antler like pattern or a honeycomb pattern. Foam cells and apocrine cells may also be seen, although these are less diagnostic features. Fibroadenoma MC benign tumor of female breastQ MC age group: 15-30 yearsQ Known as breast mouseQ Etiology: Increased sensitivity of focal areas of breast tissue to estrogenQ Pathology: Encapsulated spherical lesion, composed of fibrous and glandular tissueQ Arise from interlobular stroma, stromal cells can be monoclonal or polyclonal Types of Fibroadenoma Pericanalicular Intracanalicular Hard Soft Due to proliferation of connective tissue inside the elastic lamina Due to proliferation of connective tissue outside the elastic lamina Clinical Features: Painless, slowly growing solitary mobile lump in the breast (Breast mouser) Diagnosis: Characteristic popcorn calcificationQon mammography IOC is FNACQ Diagnostic findings on needle biopsy consist of Abundant stromal cells which appear as bare bipolar nuclei Sheets of fairly uniform-size epithelial cells that are typically arranged in either an antler like pattern or a honeycomb pattern. Foam cells and apocrine cells may also be seen, although these are less diagnostic features. Treatment: No treatmentdeg is necessary when diagnosis is confirmed. Excision biopsy is the treatment of choice for suspicious lesionQand for cosmetic indications.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 17-year-old female underwent Fine Needle Aspiration cytology (FNAC) for a lump in the breast which was non-tender, firm and mobile. Which of the following features would suggest finding of a benign breast disease?, with the following options: A: Dyscohesive ductal epithelial cells without cellular fragments, B: Tightly arranged ductal epithelial cells with dyscohesive bare nuclei, C: Stromal predominance with spindle cells, D: Polymorphism with single or arranged ductal epithelial cells ### Response: Ans. b. Tightly arranged ductal epithelial cells with dyscohesive bare nuclei Non-tender, firm and mobile breast lump in a female of age 17 years is suggestive of fibroadenoma, in which tightly arranged ductal epithelial cells with dyscohesive bare nuclei are seen on FNAC. (AIIMS May 2013 repeat) Fibroadenoma: Diagnostic findings on needle biopsy consist of: Abundant stromal cells which appear as bare bipolar nuclei Sheets of fairly uniform-size epithelial cells that are typically arranged in either an antler like pattern or a honeycomb pattern. Foam cells and apocrine cells may also be seen, although these are less diagnostic features. Fibroadenoma MC benign tumor of female breastQ MC age group: 15-30 yearsQ Known as breast mouseQ Etiology: Increased sensitivity of focal areas of breast tissue to estrogenQ Pathology: Encapsulated spherical lesion, composed of fibrous and glandular tissueQ Arise from interlobular stroma, stromal cells can be monoclonal or polyclonal Types of Fibroadenoma Pericanalicular Intracanalicular Hard Soft Due to proliferation of connective tissue inside the elastic lamina Due to proliferation of connective tissue outside the elastic lamina Clinical Features: Painless, slowly growing solitary mobile lump in the breast (Breast mouser) Diagnosis: Characteristic popcorn calcificationQon mammography IOC is FNACQ Diagnostic findings on needle biopsy consist of Abundant stromal cells which appear as bare bipolar nuclei Sheets of fairly uniform-size epithelial cells that are typically arranged in either an antler like pattern or a honeycomb pattern. Foam cells and apocrine cells may also be seen, although these are less diagnostic features. Treatment: No treatmentdeg is necessary when diagnosis is confirmed. Excision biopsy is the treatment of choice for suspicious lesionQand for cosmetic indications. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common site of genital tuberculosis is?, with the following options: A: Fallopian tubes, B: Uterus, C: Ovary, D: Fimbriae ### Response:

ANSWER: (A) Fallopian tubesREF: Shaw 14th edition p. 139"Most common site od genital tuberculosis id fallopian tube"Genital Tuberculosis:Secondary to focus anywhere elseMost common route of spread- HematogenousMost common route of transmission to endometrium - retrograde spreadMost common site - fallopian tubeMost common symptom- infertility

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common site of genital tuberculosis is?, with the following options: A: Fallopian tubes, B: Uterus, C: Ovary, D: Fimbriae ### Response: ANSWER: (A) Fallopian tubesREF: Shaw 14th edition p. 139"Most common site od genital tuberculosis id fallopian tube"Genital Tuberculosis:Secondary to focus anywhere elseMost common route of spread- HematogenousMost common route of transmission to endometrium - retrograde spreadMost common site - fallopian tubeMost common symptom- infertility ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most recommended film among the following is:, with the following options: A: C film, B: E film, C: D film, D: U film ### Response:

The types of film used most often in the United States are Ultra-speed (group D) and INSIGHT (high end of the E speed range with manual processing and F with automatic processing conditions). INSIGHT film is preferred because it requires approximately half the exposure time and thus half the radiation dose of Ultra-speed film.  Multiple studies have found that E/F-speed film is preferred because it has the same useful density range, latitude, contrast, and image quality as D-speed films and can be used in routine intraoral radiographic examinations without sacrifice of diagnostic information. The current F speed film require about 75% less exposure of E speed film and only 40% of D speed film. White and Pharoah's Oral  Radiology Principles and Interpretation 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 recommended film among the following is:, with the following options: A: C film, B: E film, C: D film, D: U film ### Response: The types of film used most often in the United States are Ultra-speed (group D) and INSIGHT (high end of the E speed range with manual processing and F with automatic processing conditions). INSIGHT film is preferred because it requires approximately half the exposure time and thus half the radiation dose of Ultra-speed film.  Multiple studies have found that E/F-speed film is preferred because it has the same useful density range, latitude, contrast, and image quality as D-speed films and can be used in routine intraoral radiographic examinations without sacrifice of diagnostic information. The current F speed film require about 75% less exposure of E speed film and only 40% of D speed film. White and Pharoah's Oral  Radiology Principles and Interpretation 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: A 34-year-old woman has a routine Pap smear for the first time. The results indicate that dysplastic cells are present, consistent with a high-grade squamous intraepithelial lesion (HSIL), also called cervical intraepithelial neoplasia (CIN) III. She is referred to a gynecologist, who performs colposcopy and takes multiple cervical biopsy specimens that all show CIN III. The conization of the cervix shows a focus of micro invasion at the squamocolumnar junction. Based on these findings, what is the next most likely step in treating this patient?, with the following options: A: Bone scan for metastatic lesions, B: Course of radiation therapy, C: No further therapy, D: Pelvic exenteration ### Response:

Micro invasive squamous cell carcinomas of the cervix are stage I lesions that have a survival rate similar to that of in situ lesions. Such minimal invasiveness does not warrant more aggressive therapies. The likelihood of metastasis or recurrence is minimal.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 34-year-old woman has a routine Pap smear for the first time. The results indicate that dysplastic cells are present, consistent with a high-grade squamous intraepithelial lesion (HSIL), also called cervical intraepithelial neoplasia (CIN) III. She is referred to a gynecologist, who performs colposcopy and takes multiple cervical biopsy specimens that all show CIN III. The conization of the cervix shows a focus of micro invasion at the squamocolumnar junction. Based on these findings, what is the next most likely step in treating this patient?, with the following options: A: Bone scan for metastatic lesions, B: Course of radiation therapy, C: No further therapy, D: Pelvic exenteration ### Response: Micro invasive squamous cell carcinomas of the cervix are stage I lesions that have a survival rate similar to that of in situ lesions. Such minimal invasiveness does not warrant more aggressive therapies. The likelihood of metastasis or recurrence is minimal. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: String sign in angiography is suggestive of:, with the following options: A: Aerial dissection, B: Aoa aneurysm, C: Stroke, D: None of the above ### Response:

Traditional angiography remains the basis of diagnosis and characterization of aerial dissection. Angiographic abnormalities include stenosis of the true lumen, or "string-sign," visible intimal flaps, and the appearance of contrast in the false lumen. Four-vessel cerebral angiography should be performed when suspicion of dissection exists. Ref: Schwaz's principle of surgery 9th edition, chapter 42.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: String sign in angiography is suggestive of:, with the following options: A: Aerial dissection, B: Aoa aneurysm, C: Stroke, D: None of the above ### Response: Traditional angiography remains the basis of diagnosis and characterization of aerial dissection. Angiographic abnormalities include stenosis of the true lumen, or "string-sign," visible intimal flaps, and the appearance of contrast in the false lumen. Four-vessel cerebral angiography should be performed when suspicion of dissection exists. Ref: Schwaz's principle of surgery 9th edition, chapter 42. ### 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 ulcerative colitis, with the following options: A: Continuous inflammation, B: Leadpipe appearance, C: String sign is seen, D: Crypt abscesses are typical ### Response:

String sign is seen in chron's disease.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: False about ulcerative colitis, with the following options: A: Continuous inflammation, B: Leadpipe appearance, C: String sign is seen, D: Crypt abscesses are typical ### Response: String sign is seen in chron's disease. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: SIADH- all are features except -, with the following options: A: Decreased sodium, maintaining the concentrating ability of the urine osmolality (> 100 mOsm), B: Normal sodium balance maintained indicating excess urinary sodium is due to efficient sodium intake, C: Hypouricemia, D: Low blood pressure due to volume depletion ### Response:

The serum sodium concentration is normally regulated by - The balance of water intake. Renal excretion of sodium and ADH mediated water conservation by distal renal tubule. These processes are mediated by - Stimulation of thirst Secretion of ADH Feedback mechanisms of the renin angiotensin aldosterone system and variation of renal handling of filtered sodium. Disorders in any one of the these components of sodium balance can result in sodium imbalance. Action of ADH ADH is secreted by the posterior pituitary gland. Its effect in kidney is mediated by the vasopressin. (V2 receptors) on the basolateral surface of the principal cells of the collecting duct. The key action of ADH in the kidney is increasing the permeability of water. It allows water to be reabsorbed from the medullary interstitium thus enhancing water reabsorption. In SIADH the A.D.H. level is inappropriately elevated The inappropriately elevated level of vasopressin enhances the reabsorption of water thereby leading to. Production of concentrated urine.  Inability to excrete water and consequently  Hyponatremia  ​​Clinical features of SIADH - Hyponatremie (sodium < 135 mEq/L) - Inappropriately elevated urine osmolality (> 150 mosm/kg) - Excessive urine sodium excretion ( Na > 30 mEq/L) - Decreased serum osmolality- (< 280 mosm/kg) These findings occur in - Absence of diuretic therapy - In the presence of euvulemia without edema - In the setting of otherwise normal cardiac, renal, adrenal, hepatic and thyroid function. Remember, . The key to pathophysiological signs, symptoms and eventual treatment of SIADH is an understanding that the hyponatremia is a result of excess water and not a sodium deficiency. Laboratory features of SIADH   Hyponatremia (sodium < 135 mEq/L) B.U.1V. and serum uric acide tends to fallQ because of plasma dilution and increased excretion of nitrogenous products. Serum potassium and Bicarbonate levels are normal in SIADH (hypokalemia and metabolic acidosis suggests, diuretic therapy or vomiting) Low serum osmolality. ​Remember, These characteristic features of SIADH There is increase in urinary concentration of sodium in the presence of hyponatremia. There is increase in urine osmolarity in the presence of with decrease in serum osmolarity.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: SIADH- all are features except -, with the following options: A: Decreased sodium, maintaining the concentrating ability of the urine osmolality (> 100 mOsm), B: Normal sodium balance maintained indicating excess urinary sodium is due to efficient sodium intake, C: Hypouricemia, D: Low blood pressure due to volume depletion ### Response: The serum sodium concentration is normally regulated by - The balance of water intake. Renal excretion of sodium and ADH mediated water conservation by distal renal tubule. These processes are mediated by - Stimulation of thirst Secretion of ADH Feedback mechanisms of the renin angiotensin aldosterone system and variation of renal handling of filtered sodium. Disorders in any one of the these components of sodium balance can result in sodium imbalance. Action of ADH ADH is secreted by the posterior pituitary gland. Its effect in kidney is mediated by the vasopressin. (V2 receptors) on the basolateral surface of the principal cells of the collecting duct. The key action of ADH in the kidney is increasing the permeability of water. It allows water to be reabsorbed from the medullary interstitium thus enhancing water reabsorption. In SIADH the A.D.H. level is inappropriately elevated The inappropriately elevated level of vasopressin enhances the reabsorption of water thereby leading to. Production of concentrated urine.  Inability to excrete water and consequently  Hyponatremia  ​​Clinical features of SIADH - Hyponatremie (sodium < 135 mEq/L) - Inappropriately elevated urine osmolality (> 150 mosm/kg) - Excessive urine sodium excretion ( Na > 30 mEq/L) - Decreased serum osmolality- (< 280 mosm/kg) These findings occur in - Absence of diuretic therapy - In the presence of euvulemia without edema - In the setting of otherwise normal cardiac, renal, adrenal, hepatic and thyroid function. Remember, . The key to pathophysiological signs, symptoms and eventual treatment of SIADH is an understanding that the hyponatremia is a result of excess water and not a sodium deficiency. Laboratory features of SIADH   Hyponatremia (sodium < 135 mEq/L) B.U.1V. and serum uric acide tends to fallQ because of plasma dilution and increased excretion of nitrogenous products. Serum potassium and Bicarbonate levels are normal in SIADH (hypokalemia and metabolic acidosis suggests, diuretic therapy or vomiting) Low serum osmolality. ​Remember, These characteristic features of SIADH There is increase in urinary concentration of sodium in the presence of hyponatremia. There is increase in urine osmolarity in the presence of with decrease in serum osmolarity. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Barrier method is: JIPMER 13, with the following options: A: Oral contraceptive pill, B: Intrauterine devices, C: Spermicidal, D: Tubectomy ### Response:

Ans. Spermicidal

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Barrier method is: JIPMER 13, with the following options: A: Oral contraceptive pill, B: Intrauterine devices, C: Spermicidal, D: Tubectomy ### Response: Ans. Spermicidal ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Fibroma belongs to ?, with the following options: A: Germ cell tumor, B: Sex cord stromal tumor, C: Surface epithelial stromal tumors, D: Metastatic tumors from non ovarian primary ### Response:

Ans. is 'b' i.e., Sex cord stromal tumor

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Fibroma belongs to ?, with the following options: A: Germ cell tumor, B: Sex cord stromal tumor, C: Surface epithelial stromal tumors, D: Metastatic tumors from non ovarian primary ### Response: Ans. is 'b' i.e., Sex cord stromal tumor ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At the altitude of 6500 meters, the atmospheric pressure is 347 Hg. What is the inspired PO2?, with the following options: A: 73 mmHg, B: 63 mmHg, C: 53 mmHg, D: 83 mmHg ### Response:

PO2 of the inspired air is 21 percent of ihe total barometric (atmospheric) pressure. Hence, (21/100) 347 = 72.87. Decreased ambient oxygen pressure results in hypoxemia. This is most commonly seen at high altitude or in nonobstructive asphyxia. The A-a O2 gradient is normal, and hypoxemia improves with supplemental oxygen. Ref: Sarko J., Stapczynski J.S. (2011). Chapter 65. Respiratory Distress. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: At the altitude of 6500 meters, the atmospheric pressure is 347 Hg. What is the inspired PO2?, with the following options: A: 73 mmHg, B: 63 mmHg, C: 53 mmHg, D: 83 mmHg ### Response: PO2 of the inspired air is 21 percent of ihe total barometric (atmospheric) pressure. Hence, (21/100) 347 = 72.87. Decreased ambient oxygen pressure results in hypoxemia. This is most commonly seen at high altitude or in nonobstructive asphyxia. The A-a O2 gradient is normal, and hypoxemia improves with supplemental oxygen. Ref: Sarko J., Stapczynski J.S. (2011). Chapter 65. Respiratory Distress. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: 1% silver nitrate is used for:, with the following options: A: Ophthalmia neonatorum, B: Sympathetic ophthalmitis, C: Inclusion conjunctivitis, D: Pharyngoconjunctival fever ### Response:

Ans. A. Ophthalmia neonatorum1% silver nitrate (crede's method) is used for Ophthalmia neonatorum acquired during birth caused by Neisseria gonorrhea in mother's vagina

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: 1% silver nitrate is used for:, with the following options: A: Ophthalmia neonatorum, B: Sympathetic ophthalmitis, C: Inclusion conjunctivitis, D: Pharyngoconjunctival fever ### Response: Ans. A. Ophthalmia neonatorum1% silver nitrate (crede's method) is used for Ophthalmia neonatorum acquired during birth caused by Neisseria gonorrhea in mother's vagina ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The secretory component of immunoglobulin molecule is -, with the following options: A: Formed by epithelial cells of lining mucosa, B: Formed by plasma cell, C: Formed by epithelial cell and plasma cell, D: Secreted by bone marrow ### Response:

The secretory component is a component of immunoglobulin A (IgA). Secretory component is a proteolytic cleavage product of the polymeric immunoglobulin receptor which remains associated with dimeric IgA in sero-mucus secretions. Polymeric IgA binds to the polymeric immunoglobulin receptor on the basolateral surface of epithelial cells and is taken up into the cell transcytosis. Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:97

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The secretory component of immunoglobulin molecule is -, with the following options: A: Formed by epithelial cells of lining mucosa, B: Formed by plasma cell, C: Formed by epithelial cell and plasma cell, D: Secreted by bone marrow ### Response: The secretory component is a component of immunoglobulin A (IgA). Secretory component is a proteolytic cleavage product of the polymeric immunoglobulin receptor which remains associated with dimeric IgA in sero-mucus secretions. Polymeric IgA binds to the polymeric immunoglobulin receptor on the basolateral surface of epithelial cells and is taken up into the cell transcytosis. Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:97 ### 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 tactile receptors respond to the vibration sense of 30 - 800 Hz?, with the following options: A: Pacinian corpuscles, B: Ruffini ending, C: Merkel's disk, D: Meissner's corpuscles ### Response:

Ans. A. Pacinian corpuscles. (Ref. Guyton Physiology 11th/pg. 587; Ganong 23rd/pg. 121-127, 746)Guyton Physiology 11th/pg. 587........."Detection of Vibration: All tactile receptors are involved in detection of vibration, although different receptors detect different frequencies of vibration. Pacinian corpuscles can detect signal vibrations from 30 to 800 cycles per second because they respond extremely rapidly to minute and rapid deformations of the tissues, and they also transmit their signals over type Ab nerve fibers, which can transmit as many as 1000 impulses per second. Low-frequency vibrations from 2 up to 80 cycles per second, in contrast, stimulate other tactile receptors, especially Meissner's corpuscles, which are less rapidly adapting than pacinian corpuscles". The Ruffini ending is a tonic receptor that produces a train of action potentials proportional to the intensity of pressure applied to the skin.Free nerve endings:# found everywhere in the skin and in many other tissues# Can detect touch and pressure.# For instance, even light contact with the cornea of the eye, which contains no other type of nerve ending besides free nerve endings, can nevertheless elicit touch and pressure sensations.Meissner fs corpuscle:# It is a touch receptor with great sensitivity is the Meissner's corpuscle# It is an elongated encapsulated nerve ending of a large (type Ab) myelinated sensory nerve fiber.# Present in the nonhairy parts of the skin and are particularly abundant in the finger- tips, lips, and other areas of the skin where one's ability to discern spatial locations of touch sensations is highly developed.# Meissner's corpuscles adapt in a fraction of a second after they are stimulated, which means that they are particularly sensitive to movement of objects over the surface of the skin as well as to low- frequency vibration.Merkel's discs:# Merkel's discs are often grouped together in a receptor organ called the Iggo dome receptor, which projects upward against the underside of the epithelium of the skin. This causes the epithelium at this point to protrude outward, thus creating a dome and constituting an extremely sensitive receptor.# Also note that the entire group of Merkel's discs is innervated by a single large myelinated nerve fiber (type Ab).# These receptors, along with the Meissner's corpuscles, play extremely important roles in localizing touch sensations to specific surface areas of the body and in determining the texture of what is felt.Hair end-organ:# Slight movement of any hair on the body stimulates a nerve fiber entwining its base. Thus, each hair and its basal nerve fiber, called the hair end-organ, are also a touch receptor.# This receptor adapts readily and, like Meissner's corpuscles, detects mainly- (a) movement of objects on the surface of the body or- (b) initial contact with the body.Ruffini's end-organs:# Located in the deeper layers of the skin and also in still deeper internal tissues are many Ruffini's end-organs, which are multibranched, encapsulated endings.# These endings adapt very slowly and, therefore, are important for signaling continuous states of deformation of the tissues, such as heavy prolonged touch and pressure signals.# They are also found in joint capsules and help to signal the degree of joint rotation.Pacinian corpuscles:# lie both immediately beneath the skin and deep in the fascial tissues of the body.# They are stimulated only by rapid local compression of the tissues because they adapt in a few hundredths of a second.# Therefore, they are particularly important for detecting tissue vibration or other rapid changes in the mechanical state of the tissues.

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 tactile receptors respond to the vibration sense of 30 - 800 Hz?, with the following options: A: Pacinian corpuscles, B: Ruffini ending, C: Merkel's disk, D: Meissner's corpuscles ### Response: Ans. A. Pacinian corpuscles. (Ref. Guyton Physiology 11th/pg. 587; Ganong 23rd/pg. 121-127, 746)Guyton Physiology 11th/pg. 587........."Detection of Vibration: All tactile receptors are involved in detection of vibration, although different receptors detect different frequencies of vibration. Pacinian corpuscles can detect signal vibrations from 30 to 800 cycles per second because they respond extremely rapidly to minute and rapid deformations of the tissues, and they also transmit their signals over type Ab nerve fibers, which can transmit as many as 1000 impulses per second. Low-frequency vibrations from 2 up to 80 cycles per second, in contrast, stimulate other tactile receptors, especially Meissner's corpuscles, which are less rapidly adapting than pacinian corpuscles". The Ruffini ending is a tonic receptor that produces a train of action potentials proportional to the intensity of pressure applied to the skin.Free nerve endings:# found everywhere in the skin and in many other tissues# Can detect touch and pressure.# For instance, even light contact with the cornea of the eye, which contains no other type of nerve ending besides free nerve endings, can nevertheless elicit touch and pressure sensations.Meissner fs corpuscle:# It is a touch receptor with great sensitivity is the Meissner's corpuscle# It is an elongated encapsulated nerve ending of a large (type Ab) myelinated sensory nerve fiber.# Present in the nonhairy parts of the skin and are particularly abundant in the finger- tips, lips, and other areas of the skin where one's ability to discern spatial locations of touch sensations is highly developed.# Meissner's corpuscles adapt in a fraction of a second after they are stimulated, which means that they are particularly sensitive to movement of objects over the surface of the skin as well as to low- frequency vibration.Merkel's discs:# Merkel's discs are often grouped together in a receptor organ called the Iggo dome receptor, which projects upward against the underside of the epithelium of the skin. This causes the epithelium at this point to protrude outward, thus creating a dome and constituting an extremely sensitive receptor.# Also note that the entire group of Merkel's discs is innervated by a single large myelinated nerve fiber (type Ab).# These receptors, along with the Meissner's corpuscles, play extremely important roles in localizing touch sensations to specific surface areas of the body and in determining the texture of what is felt.Hair end-organ:# Slight movement of any hair on the body stimulates a nerve fiber entwining its base. Thus, each hair and its basal nerve fiber, called the hair end-organ, are also a touch receptor.# This receptor adapts readily and, like Meissner's corpuscles, detects mainly- (a) movement of objects on the surface of the body or- (b) initial contact with the body.Ruffini's end-organs:# Located in the deeper layers of the skin and also in still deeper internal tissues are many Ruffini's end-organs, which are multibranched, encapsulated endings.# These endings adapt very slowly and, therefore, are important for signaling continuous states of deformation of the tissues, such as heavy prolonged touch and pressure signals.# They are also found in joint capsules and help to signal the degree of joint rotation.Pacinian corpuscles:# lie both immediately beneath the skin and deep in the fascial tissues of the body.# They are stimulated only by rapid local compression of the tissues because they adapt in a few hundredths of a second.# Therefore, they are particularly important for detecting tissue vibration or other rapid changes in the mechanical state of the tissues. ### 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 markers is specific for Gastro intestinal stromal tumors (GIST)?, with the following options: A: CD 117, B: CD 34, C: CD 23, D: S-100 ### Response:

CD 117 is most specific marker for Gastrolintestinal stromal tumor, than CD 34. GIST has a universal expression of CD117. It can also be present in fibroblastic and endothelail tumors. Ref: M. Wasif Saif (2010), Chapter "Gastrointestinal Stromal Tumors", In the book, "Gastrointestinal Malignancies", Volume 1, Issue 1, USA, Page 152; Robbin's Basic Pathology, 7th Edition, Page 826; Oncology: An Evidence Based Approach, (2006), Pages 413-14; Sternberg's-Diagnostic Surgical Pathology, 4th Edition, Page 1590

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 markers is specific for Gastro intestinal stromal tumors (GIST)?, with the following options: A: CD 117, B: CD 34, C: CD 23, D: S-100 ### Response: CD 117 is most specific marker for Gastrolintestinal stromal tumor, than CD 34. GIST has a universal expression of CD117. It can also be present in fibroblastic and endothelail tumors. Ref: M. Wasif Saif (2010), Chapter "Gastrointestinal Stromal Tumors", In the book, "Gastrointestinal Malignancies", Volume 1, Issue 1, USA, Page 152; Robbin's Basic Pathology, 7th Edition, Page 826; Oncology: An Evidence Based Approach, (2006), Pages 413-14; Sternberg's-Diagnostic Surgical Pathology, 4th Edition, Page 1590 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A woman is said to be have menorrhagia if the menstrual blood loss is MORE than:, with the following options: A: 20 ml, B: 40 ml, C: 60 ml, D: 80 ml ### Response:

Menorrhagia is defined as loss more than 80 ml of blood per cycle and frequently producing anemia. Predictors of menorrhagia includes bleeding resulting in iron deficiency anemia or a need of transfusion, passage of clots more than 1 inch diameter and changing pad or tampon more than hourly. Normal menstrual bleeding last for an average of 5 days with a mean blood loss of 40 ml. Menorrhagia is defined as bleeding between periods. Polymenorrhea is defined as bleeding that occurs more often than every 21 days. Oligomenorrhea is defined as bleeding that occur less frequently than every 35 days. Ref: Konkle B. (2012). Chapter 58. Bleeding and Thrombosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A woman is said to be have menorrhagia if the menstrual blood loss is MORE than:, with the following options: A: 20 ml, B: 40 ml, C: 60 ml, D: 80 ml ### Response: Menorrhagia is defined as loss more than 80 ml of blood per cycle and frequently producing anemia. Predictors of menorrhagia includes bleeding resulting in iron deficiency anemia or a need of transfusion, passage of clots more than 1 inch diameter and changing pad or tampon more than hourly. Normal menstrual bleeding last for an average of 5 days with a mean blood loss of 40 ml. Menorrhagia is defined as bleeding between periods. Polymenorrhea is defined as bleeding that occurs more often than every 21 days. Oligomenorrhea is defined as bleeding that occur less frequently than every 35 days. Ref: Konkle B. (2012). Chapter 58. Bleeding and Thrombosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Oxyhaemoglobin Dissociation Curve is shifted to the right in the following condition, with the following options: A: Acidosis, B: Increased 2-3 DPG level, C: Hyperthermia, D: All the above ### Response:

(D) All the above # Major factors involved in dissociation curve are:pH - increase, results in shift to the left. Decrease, results in shift to the right.Temperature - increase, results in shift to the right. Decrease, results in shift to the leftpCO2 - increase results in shift to the right. Decrease results in shift to the left.2,3-DPG - increase results in shift to the right, decrease results in shift to the left.OXYHAEMOGLOBIN DISSOCIATION CURVE Shift to LEFT(increase in O2 affinity)Shift to RIGHT(decrease in O2 affinity)> Fall in> Rise in |p50 | P50 |PCO2 | PCO2 | Temperature | Temperature> Decrease in> Increase in | Temperature | Temperature | Red cell 2,3-DPG | Red cell 2,3-DPG | Adenosine diphosphate | Adenosine diphosphate | Adenosine triphosphate | Adenosine triphosphate | Inorganic phosphates | Inorganic phosphates | Fetal blood> Anaemia> Residence at high altitude > Rise in> Fall in | pH | pH | Red cell carboxyHb | Methaemoglobin

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Oxyhaemoglobin Dissociation Curve is shifted to the right in the following condition, with the following options: A: Acidosis, B: Increased 2-3 DPG level, C: Hyperthermia, D: All the above ### Response: (D) All the above # Major factors involved in dissociation curve are:pH - increase, results in shift to the left. Decrease, results in shift to the right.Temperature - increase, results in shift to the right. Decrease, results in shift to the leftpCO2 - increase results in shift to the right. Decrease results in shift to the left.2,3-DPG - increase results in shift to the right, decrease results in shift to the left.OXYHAEMOGLOBIN DISSOCIATION CURVE Shift to LEFT(increase in O2 affinity)Shift to RIGHT(decrease in O2 affinity)> Fall in> Rise in |p50 | P50 |PCO2 | PCO2 | Temperature | Temperature> Decrease in> Increase in | Temperature | Temperature | Red cell 2,3-DPG | Red cell 2,3-DPG | Adenosine diphosphate | Adenosine diphosphate | Adenosine triphosphate | Adenosine triphosphate | Inorganic phosphates | Inorganic phosphates | Fetal blood> Anaemia> Residence at high altitude > Rise in> Fall in | pH | pH | Red cell carboxyHb | Methaemoglobin ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A round cell having fine nuclear chromatin, prominent nucleoli and fine azurophilic granule. The cell is:, with the following options: A: Myeloblast, B: Lymphoblast, C: Monoblast, D: None ### Response:

The myeloblast (precursor of the granulocytes) varies considerably in size (10-18 μm in diameter), having a large round to oval nucleus nearly filling the cell, has fine nuclear chromatin and contains 2-5 well-defined pale nucleoli. The thin rim of cytoplasm is deeply basophilic and devoid of granules. The myeloblasts of acute myeloid leukemia may, however, show the presence of rod-like cytoplasmic inclusions called Auer’s rods which represent abnormal derivatives of primary azurophilic granules.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A round cell having fine nuclear chromatin, prominent nucleoli and fine azurophilic granule. The cell is:, with the following options: A: Myeloblast, B: Lymphoblast, C: Monoblast, D: None ### Response: The myeloblast (precursor of the granulocytes) varies considerably in size (10-18 μm in diameter), having a large round to oval nucleus nearly filling the cell, has fine nuclear chromatin and contains 2-5 well-defined pale nucleoli. The thin rim of cytoplasm is deeply basophilic and devoid of granules. The myeloblasts of acute myeloid leukemia may, however, show the presence of rod-like cytoplasmic inclusions called Auer’s rods which represent abnormal derivatives of primary azurophilic granules. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Polychromatic lusture is seen in :, with the following options: A: Complicated cataract, B: Diabetes mellitus, C: Post radiation cataract, D: Congenital cataract ### Response:

A i.e. Complicated cataract Complicated cataract (i.e. cataract secondary to some intraocular disease) may be - Anterior coical Q in anterior segmental lesions as glaucoma, acute iritis, or, - Posterior coical Q in posterior segmental lesions as uveitis, RD, pigmentary retinal dystrophy. The second type of complicated cataract presents with posterior coical bread crumb appearance/ polychromatic lusture or rainbow cataract Q Complicated cataract occurs secondary intraocular disease e.g. Inflammatory conditions as uveitis. Degenerative conditions as retinitis pigmentosa, high myopia etc. Intraocular tumors Retinal detachment, Glaucoma etc.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Polychromatic lusture is seen in :, with the following options: A: Complicated cataract, B: Diabetes mellitus, C: Post radiation cataract, D: Congenital cataract ### Response: A i.e. Complicated cataract Complicated cataract (i.e. cataract secondary to some intraocular disease) may be - Anterior coical Q in anterior segmental lesions as glaucoma, acute iritis, or, - Posterior coical Q in posterior segmental lesions as uveitis, RD, pigmentary retinal dystrophy. The second type of complicated cataract presents with posterior coical bread crumb appearance/ polychromatic lusture or rainbow cataract Q Complicated cataract occurs secondary intraocular disease e.g. Inflammatory conditions as uveitis. Degenerative conditions as retinitis pigmentosa, high myopia etc. Intraocular tumors Retinal detachment, Glaucoma etc. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Calcareous degeneration occurs most commonly in which type of fibroids :, with the following options: A: Submucous, B: Subserous, C: Interstitial, D: Cervical ### Response:

Ans. is b i.e. Subserous Ref. Dutta Gynae 4/e, p 256 Calcareous degeneration usually involves the subserous fibroids with small peduncle or myomas of postmenopausal women. It is usually preceded by fatty degeneration. There is precipitate of calcium carbonate or calcium phosphate within the tumour, when whole of the tumour is conveed into a calcified mass it is termed as 'womb stone'. Also Know : Most common type of fibroid * Interstitial (Intramural) To sta with all fibroids are * Interstitial (Intramural) Most common fibroid to undergo malignant change * Interstitial (Intramural ) Most common fibroid to cause Retention of urine * Anterior cervical fibroid & central cervical fibroid Torsion is most common in * Large pedunculated subserous fibroid Fibroid causing pseudo Meig's syndrome * Subserous fibroid Most common symptom of fibroid * Menorrhagia Inversion is seen in * Fundal fibroid M/C symptom of fundal fibroid * Menorrhagia Fibroid with maximum symptoms * Submucous fibroid. Wandering or parasitic fibroid * Subserous fibroid. Lantern on dome of St. Paul * Cervical fibroid. Pseudo cervical fibroid * Fibroid polyp. Most common fibroid to undergo calcerous degeneration * Subserous fibroid

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Calcareous degeneration occurs most commonly in which type of fibroids :, with the following options: A: Submucous, B: Subserous, C: Interstitial, D: Cervical ### Response: Ans. is b i.e. Subserous Ref. Dutta Gynae 4/e, p 256 Calcareous degeneration usually involves the subserous fibroids with small peduncle or myomas of postmenopausal women. It is usually preceded by fatty degeneration. There is precipitate of calcium carbonate or calcium phosphate within the tumour, when whole of the tumour is conveed into a calcified mass it is termed as 'womb stone'. Also Know : Most common type of fibroid * Interstitial (Intramural) To sta with all fibroids are * Interstitial (Intramural) Most common fibroid to undergo malignant change * Interstitial (Intramural ) Most common fibroid to cause Retention of urine * Anterior cervical fibroid & central cervical fibroid Torsion is most common in * Large pedunculated subserous fibroid Fibroid causing pseudo Meig's syndrome * Subserous fibroid Most common symptom of fibroid * Menorrhagia Inversion is seen in * Fundal fibroid M/C symptom of fundal fibroid * Menorrhagia Fibroid with maximum symptoms * Submucous fibroid. Wandering or parasitic fibroid * Subserous fibroid. Lantern on dome of St. Paul * Cervical fibroid. Pseudo cervical fibroid * Fibroid polyp. Most common fibroid to undergo calcerous degeneration * Subserous fibroid ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Apixaban is:, with the following options: A: Antithrombin inhibitor, B: Direct Xa inhibitor, C: Platelet activator, D: Clotting Factor XII ### Response:

Ref. KDT. Page. 617 Apixaban is an oral, direct, and highly selective factor Xa (FXa) inhibitor (of both free and prothrombinase-bound FXa independently of antithrombin III) for the prevention and treatment of thromboembolic diseases Apixaban prolongs clotting tests such as prothrombin time (PT), INR, and activated partial thromboplastin time (aptt) Apixaban is absorbed in the stomach and small intestine 87% plasma protein bound. Apixaban mainly undergoes o-demethylation and hydroxylation to metabolites Grapefruit juice may increase apixaban serum concentration. St. John's wort will likely decrease apixaban serum concentration

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Apixaban is:, with the following options: A: Antithrombin inhibitor, B: Direct Xa inhibitor, C: Platelet activator, D: Clotting Factor XII ### Response: Ref. KDT. Page. 617 Apixaban is an oral, direct, and highly selective factor Xa (FXa) inhibitor (of both free and prothrombinase-bound FXa independently of antithrombin III) for the prevention and treatment of thromboembolic diseases Apixaban prolongs clotting tests such as prothrombin time (PT), INR, and activated partial thromboplastin time (aptt) Apixaban is absorbed in the stomach and small intestine 87% plasma protein bound. Apixaban mainly undergoes o-demethylation and hydroxylation to metabolites Grapefruit juice may increase apixaban serum concentration. St. John's wort will likely decrease apixaban serum concentration ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Inhibition of platelet aggregation by -, with the following options: A: ADP, B: Thromboxane A2, C: Thrombin, D: Bradykinin ### Response:

Ans. is 'd' i.e., Bradykinin Platelet aggregationAggregating factorPreventing aggregatng factoro ADPo Epinephrineo VWFo ThrombospondinoTXA2o Serotonino Fibrinogeno Collegeno Immune complexo Thrombin.oPGI2o EndochelinoNOo Bradykinin.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Inhibition of platelet aggregation by -, with the following options: A: ADP, B: Thromboxane A2, C: Thrombin, D: Bradykinin ### Response: Ans. is 'd' i.e., Bradykinin Platelet aggregationAggregating factorPreventing aggregatng factoro ADPo Epinephrineo VWFo ThrombospondinoTXA2o Serotonino Fibrinogeno Collegeno Immune complexo Thrombin.oPGI2o EndochelinoNOo Bradykinin. ### 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 traditional medicines is effective in the treatment of hea failure, with the following options: A: Terminalia Arjuna, B: Neem bark extract, C: St. John's wo, D: Gingkoba biloba ### Response:

Ans. a. Terminalia Arjuna Terminalia Arjuna (An ayurvedic cardioprotective botanical) Although many Ayurvedic plants have shown to help coronary aery disease, Arjuna (Terminalia Arjuna) by far seems to be the best plant for hea health. Terminalia arjuna is a traditional ayurvedic plant containing tannins, triterpenoid saponins (arjungenin, arjunglucosides), flavonoids (arjunon, arjonolone), phytosterols, oligomeric proanthocyanidins (OPC's), calcium, magnesium, zinc, and copper.

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 traditional medicines is effective in the treatment of hea failure, with the following options: A: Terminalia Arjuna, B: Neem bark extract, C: St. John's wo, D: Gingkoba biloba ### Response: Ans. a. Terminalia Arjuna Terminalia Arjuna (An ayurvedic cardioprotective botanical) Although many Ayurvedic plants have shown to help coronary aery disease, Arjuna (Terminalia Arjuna) by far seems to be the best plant for hea health. Terminalia arjuna is a traditional ayurvedic plant containing tannins, triterpenoid saponins (arjungenin, arjunglucosides), flavonoids (arjunon, arjonolone), phytosterols, oligomeric proanthocyanidins (OPC's), calcium, magnesium, zinc, and copper. ### 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 regarding progressive supranuclear palsy except, with the following options: A: Tremors, B: Unsteadiness, C: Dysahria, D: Gaze palsy ### Response:

Progressive supranuclear palsy presents with symmetrical parkinsonism, cognitive impairement, early falls and bulbar involvement. The charecteristic eye movement disorder, with up and down gaze. There will be dysahria, but not tremors. Reference : Harrison20th edition pg 2456

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 regarding progressive supranuclear palsy except, with the following options: A: Tremors, B: Unsteadiness, C: Dysahria, D: Gaze palsy ### Response: Progressive supranuclear palsy presents with symmetrical parkinsonism, cognitive impairement, early falls and bulbar involvement. The charecteristic eye movement disorder, with up and down gaze. There will be dysahria, but not tremors. Reference : Harrison20th edition pg 2456 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Hormone replacement therapy is contraindicated in-, with the following options: A: Atherosclerosis, B: Thromboembolism, C: Osteoporosis, D: Gall stones ### Response:

Ans. is 'b' i.e., Thromboembolism Contraincations of hormone replacement therapyo Pregnancy and breast feeding,o Undiagnose vaginal bleeding.o Recent angina or MI.o Venous thromboembolic diseaio Breast cancer,o Active liver disease,o Endometrial cancer,o Uncontrolled hypertension.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Hormone replacement therapy is contraindicated in-, with the following options: A: Atherosclerosis, B: Thromboembolism, C: Osteoporosis, D: Gall stones ### Response: Ans. is 'b' i.e., Thromboembolism Contraincations of hormone replacement therapyo Pregnancy and breast feeding,o Undiagnose vaginal bleeding.o Recent angina or MI.o Venous thromboembolic diseaio Breast cancer,o Active liver disease,o Endometrial cancer,o Uncontrolled hypertension. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 34 year old housewife reports a three month history of feeling low, lack of interest in activities, lethargy, multiple body-aches, ideas of worthlessness, decreased appetite and disturbed sleep with early morning awakening. She is likely to benefit from -, with the following options: A: Anti-psychotics, B: Anti-depressants, C: Anxiolytics, D: Hypno-sedatives ### Response:

This patient has (for 3 months) Depressed mood (feeling low)        Lack of interest     Loss of energy / fatigue (lethargy) Ideas of worthlessness Disturbed sleep (insomnia / hypersomnia)        Decreased appetite As more than 5 symptoms are present for more than 2 weeks, Diagnosis is major depression Antidepressant should be given.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 34 year old housewife reports a three month history of feeling low, lack of interest in activities, lethargy, multiple body-aches, ideas of worthlessness, decreased appetite and disturbed sleep with early morning awakening. She is likely to benefit from -, with the following options: A: Anti-psychotics, B: Anti-depressants, C: Anxiolytics, D: Hypno-sedatives ### Response: This patient has (for 3 months) Depressed mood (feeling low)        Lack of interest     Loss of energy / fatigue (lethargy) Ideas of worthlessness Disturbed sleep (insomnia / hypersomnia)        Decreased appetite As more than 5 symptoms are present for more than 2 weeks, Diagnosis is major depression Antidepressant should be given. ### 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 inserted into the floor of the intertubercular sulcus of the humerus?, with the following options: A: Latissimus dorsi, B: Teres major, C: Pectoralis major, D: Deltoid ### Response:

Ans. is 'a' i.e., Latissimus dorsi o The shaft of humerus is cylindrical in the upper half and triangular on cross-section in the lower half. The upper part has intertnbercular sulcus {bicipital groove) anteriorly. Bicipital groove contains long head of biceps w ith its synovial sheath and an ascending branch of anterior circumflex humeral artery. Middle third of posterior surface of shaft of the humerus has a spiral groove {radial groove) which contains radial nerve and profunda brachi vessels.o Attachment to shafts are -Insertions of pectoralis major (on lateral lip of bicipital groove), latissimus dorsi (on floor of bicipital groove), teres major (on deltoid tuberosity) and coracobrachialis (medially on mid shaft).Origin of brachialis (anterior surface); Lateral and medial head of triceps (posterior surface); pronater teres (from medial supracondylar ridge); brachioradialis (from lateral supracondylar ridge) and ECRL (from lateral supracondylar ridge).

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 inserted into the floor of the intertubercular sulcus of the humerus?, with the following options: A: Latissimus dorsi, B: Teres major, C: Pectoralis major, D: Deltoid ### Response: Ans. is 'a' i.e., Latissimus dorsi o The shaft of humerus is cylindrical in the upper half and triangular on cross-section in the lower half. The upper part has intertnbercular sulcus {bicipital groove) anteriorly. Bicipital groove contains long head of biceps w ith its synovial sheath and an ascending branch of anterior circumflex humeral artery. Middle third of posterior surface of shaft of the humerus has a spiral groove {radial groove) which contains radial nerve and profunda brachi vessels.o Attachment to shafts are -Insertions of pectoralis major (on lateral lip of bicipital groove), latissimus dorsi (on floor of bicipital groove), teres major (on deltoid tuberosity) and coracobrachialis (medially on mid shaft).Origin of brachialis (anterior surface); Lateral and medial head of triceps (posterior surface); pronater teres (from medial supracondylar ridge); brachioradialis (from lateral supracondylar ridge) and ECRL (from lateral supracondylar ridge). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In hyperkalemia with bradycardia treatment is: -, with the following options: A: Calcium gluconate, B: Steroid, C: Salbutamol, D: K+ resin ### Response:

The treatment for hyperkalemia can be thought of in 3 distinct steps. First, antagonize the effects of hyperkalemia at the cellular level (membrane stabilization). Second, decrease serum potassium levels by promoting the influx of potassium into cells throughout the body.(insulin,beta2 agonist) Third, remove potassium from the body.(k+resins) In cells with calcium-dependent action potentials, such as SA and atrioventricular nodal cells, and in cells in which the sodium current is depressed, an increase in extracellular calcium concentration will increase the magnitude of the calcium inward current and the Vmax by increasing the electrochemical gradient across the myocyte. This would be expected to speed impulse propagation in such tissues, reversing the myocyte depression seen with severe hyperkalemia. The effects of intravenous calcium occur within 1 to 3 minutes but last for only 30 to 60 minutes. Therefore, fuher, more definitive treatment is needed to lower serum potassium levels. Calcium gluconate is the preferred preparation of intravenous calcium. The dose should be 10 mL of a 10% calcium gluconate solution infused over 2 to 3 minutes.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In hyperkalemia with bradycardia treatment is: -, with the following options: A: Calcium gluconate, B: Steroid, C: Salbutamol, D: K+ resin ### Response: The treatment for hyperkalemia can be thought of in 3 distinct steps. First, antagonize the effects of hyperkalemia at the cellular level (membrane stabilization). Second, decrease serum potassium levels by promoting the influx of potassium into cells throughout the body.(insulin,beta2 agonist) Third, remove potassium from the body.(k+resins) In cells with calcium-dependent action potentials, such as SA and atrioventricular nodal cells, and in cells in which the sodium current is depressed, an increase in extracellular calcium concentration will increase the magnitude of the calcium inward current and the Vmax by increasing the electrochemical gradient across the myocyte. This would be expected to speed impulse propagation in such tissues, reversing the myocyte depression seen with severe hyperkalemia. The effects of intravenous calcium occur within 1 to 3 minutes but last for only 30 to 60 minutes. Therefore, fuher, more definitive treatment is needed to lower serum potassium levels. Calcium gluconate is the preferred preparation of intravenous calcium. The dose should be 10 mL of a 10% calcium gluconate solution infused over 2 to 3 minutes. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Longest acting statin is, with the following options: A: Simvastatin, B: Pravastatin, C: Rosuvastatin, D: Lovastatin ### Response:

Among statins, shoest acting is simvastatin and longest acting is rosuvastatinRef: KD Tripathi 7thed.Pg: 637

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Longest acting statin is, with the following options: A: Simvastatin, B: Pravastatin, C: Rosuvastatin, D: Lovastatin ### Response: Among statins, shoest acting is simvastatin and longest acting is rosuvastatinRef: KD Tripathi 7thed.Pg: 637 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common uterine malignancy, with the following options: A: Leiomyosarcoma of uterus, B: Endometroid adeno carcinoma, C: Serous Uterine carcinoma, D: Clear cell carcinoma ### Response:

75 to 80 % of endometrial tumors are type1, which are endometroid adenocarcinomas.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common uterine malignancy, with the following options: A: Leiomyosarcoma of uterus, B: Endometroid adeno carcinoma, C: Serous Uterine carcinoma, D: Clear cell carcinoma ### Response: 75 to 80 % of endometrial tumors are type1, which are endometroid adenocarcinomas. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The best possible intervention for acute myocardial infarction is -, with the following options: A: Streptokinase, B: Streptokinase and aspirin, C: Early primary coronary intervention, D: Streptokinase and heparin ### Response:

Ref : harrisons-manual-of-medicine-16th-edition pg no: 622-624 TREATMENT Initial Therapy Initial goals are to: (1) quickly identify if patient is candidate for reperfusion therapy, (2) relieve pain, and (3) prevent/treat arrhythmias and mechanical complications. * Aspirin should be administered immediately (162-325 mg chewed at presentation, then 162-325 mg PO qd), unless pt is aspirin-intolerant. * Perform targeted history, exam, and ECG to identify STEMI (
1 mmST elevation in two contiguous leads or new LBBB) and appropriateness of reperfusion therapy , which reduces infarct size, LV dysfunction, and moality. * Primary PCI is generally more effective than fibrinolysis and is preferred at experienced centers capable of performing procedure rapidly , especially when diagnosis is in doubt, cardiogenic shock is present, bleeding risk is increased, or if symptoms have been present for
3 h. * Proceed with IV fibrinolysis if PCI is not available or if logistics would delay PCI
1 h longer than fibrinolysis could be initiated (Fig. 123-1). Dooo- needle time should be  30 min for maximum benefit. Ensure absence of contraindications before administering fibrinolytic agent. Those treated within 1-3 h benefit most; can still be useful up to 12 h if chest pain is persistent or ST remains elevated in leads that have not developed new Q waves. Complications include bleeding, reperfusion arrhythmias, and, in case of streptokinase (SK), allergic reactions. Heparin should be initiated with fibrinolytic agents other than SK ; maintain aPTTT at 1.5-2.0 control (
50-70 s). * If chest pain or ST elevation persists
90 min after fibrinolysis, consider referral for rescue PCI. Later coronary angiography after fibrinolysis generally reserved for pts with recurrent angina or positive stress test. The initial management of NSTEMI (non-Q MI) is different . In paicular, fibrinolytic therapy should not be Additional Standard Treatment (Whether or not reperfusion therapy is undeaken): * Hospitalize in CCU with continuous ECG monitoring. * IV line for emergency arrhythmia treatment. * Pain control: (1) Morphine sulfate 2-4 mg IV q5-10min until pain is relieved or side effects develop ; (2) nitroglycerin 0.3 mg SL if systolic bp
100 mmHg; for refractory pain: IV nitroglycerin (begin at 10 g/min, titrate upward to maximum of 200 g/min, monitoring bp closely); do not administer nitrates within 24 h of sildenafil or within 48 h of tadalafil (used for erectile dysfunction); (3) -adrenergic antagonists * Oxygen 2-4 L/min by nasal cannula (maintain O2 saturation
90%). * Mild sedation (e.g., diazepam 5 mg PO qid). * Soft diet and stool softeners (e.g., docusate sodium 100-200 mg/d). * -Adrenergic blockers reduce myocardial O2 consumption, limit infarct size, and reduce moality. Especially useful in pts with hypeension, tachycardia, or persistent ischemic pain; contraindications include active CHF, systolic bp  95 mmHg, hea rate  50 beats/min, AV block,or history of bronchospasm. Administer IV (e.g., metoprolol 5 mg q5-10min to total dose of 15 mg), followed by PO regimen (e.g., metoprolol 25-100 mg bid). * Anticoagulation/antiplatelet agents: Pts who receive fibrinolytic therapy are begun on heparin and aspirin as indicated above. In absence of fibrinolytic therapy, administer aspirin, 160-325 mg qd, and low-dose heparin (5000 U SC q12h for DVT prevention). Full-dose IV heparin (PTT 2 control) or low-molecular-weight heparin (e.g., enoxaparin 1 mg/kg SC q12h) followed by oral anticoagulants is recommended for pts with severe CHF, presence of ventricular thrombus by echocardiogram, or large dyskinetic region in anterior MI. Oral anticoagulants are continued for 3 to 6 months, then replaced by aspirin. * ACE inhibitors reduce moality in pts following acute MI and should be prescribed within 24 h of hospitalization for pts with STEMI--e.g., captopril (6.25 mg PO test dose) advanced to 50 mg PO tid. ACE inhibitors should be continued indefinitely after discharge in pts with CHF or those with asymptomatic LV dysfunction ; if ACE inhibitor intolerant, use angiotensin receptor blocker (e.g., valsaan or candesaan). * Serum magnesium level should be measured and repleted if necessary to reduce risk of arrhythmias.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The best possible intervention for acute myocardial infarction is -, with the following options: A: Streptokinase, B: Streptokinase and aspirin, C: Early primary coronary intervention, D: Streptokinase and heparin ### Response: Ref : harrisons-manual-of-medicine-16th-edition pg no: 622-624 TREATMENT Initial Therapy Initial goals are to: (1) quickly identify if patient is candidate for reperfusion therapy, (2) relieve pain, and (3) prevent/treat arrhythmias and mechanical complications. * Aspirin should be administered immediately (162-325 mg chewed at presentation, then 162-325 mg PO qd), unless pt is aspirin-intolerant. * Perform targeted history, exam, and ECG to identify STEMI (
1 mmST elevation in two contiguous leads or new LBBB) and appropriateness of reperfusion therapy , which reduces infarct size, LV dysfunction, and moality. * Primary PCI is generally more effective than fibrinolysis and is preferred at experienced centers capable of performing procedure rapidly , especially when diagnosis is in doubt, cardiogenic shock is present, bleeding risk is increased, or if symptoms have been present for
3 h. * Proceed with IV fibrinolysis if PCI is not available or if logistics would delay PCI
1 h longer than fibrinolysis could be initiated (Fig. 123-1). Dooo- needle time should be  30 min for maximum benefit. Ensure absence of contraindications before administering fibrinolytic agent. Those treated within 1-3 h benefit most; can still be useful up to 12 h if chest pain is persistent or ST remains elevated in leads that have not developed new Q waves. Complications include bleeding, reperfusion arrhythmias, and, in case of streptokinase (SK), allergic reactions. Heparin should be initiated with fibrinolytic agents other than SK ; maintain aPTTT at 1.5-2.0 control (
50-70 s). * If chest pain or ST elevation persists
90 min after fibrinolysis, consider referral for rescue PCI. Later coronary angiography after fibrinolysis generally reserved for pts with recurrent angina or positive stress test. The initial management of NSTEMI (non-Q MI) is different . In paicular, fibrinolytic therapy should not be Additional Standard Treatment (Whether or not reperfusion therapy is undeaken): * Hospitalize in CCU with continuous ECG monitoring. * IV line for emergency arrhythmia treatment. * Pain control: (1) Morphine sulfate 2-4 mg IV q5-10min until pain is relieved or side effects develop ; (2) nitroglycerin 0.3 mg SL if systolic bp
100 mmHg; for refractory pain: IV nitroglycerin (begin at 10 g/min, titrate upward to maximum of 200 g/min, monitoring bp closely); do not administer nitrates within 24 h of sildenafil or within 48 h of tadalafil (used for erectile dysfunction); (3) -adrenergic antagonists * Oxygen 2-4 L/min by nasal cannula (maintain O2 saturation
90%). * Mild sedation (e.g., diazepam 5 mg PO qid). * Soft diet and stool softeners (e.g., docusate sodium 100-200 mg/d). * -Adrenergic blockers reduce myocardial O2 consumption, limit infarct size, and reduce moality. Especially useful in pts with hypeension, tachycardia, or persistent ischemic pain; contraindications include active CHF, systolic bp  95 mmHg, hea rate  50 beats/min, AV block,or history of bronchospasm. Administer IV (e.g., metoprolol 5 mg q5-10min to total dose of 15 mg), followed by PO regimen (e.g., metoprolol 25-100 mg bid). * Anticoagulation/antiplatelet agents: Pts who receive fibrinolytic therapy are begun on heparin and aspirin as indicated above. In absence of fibrinolytic therapy, administer aspirin, 160-325 mg qd, and low-dose heparin (5000 U SC q12h for DVT prevention). Full-dose IV heparin (PTT 2 control) or low-molecular-weight heparin (e.g., enoxaparin 1 mg/kg SC q12h) followed by oral anticoagulants is recommended for pts with severe CHF, presence of ventricular thrombus by echocardiogram, or large dyskinetic region in anterior MI. Oral anticoagulants are continued for 3 to 6 months, then replaced by aspirin. * ACE inhibitors reduce moality in pts following acute MI and should be prescribed within 24 h of hospitalization for pts with STEMI--e.g., captopril (6.25 mg PO test dose) advanced to 50 mg PO tid. ACE inhibitors should be continued indefinitely after discharge in pts with CHF or those with asymptomatic LV dysfunction ; if ACE inhibitor intolerant, use angiotensin receptor blocker (e.g., valsaan or candesaan). * Serum magnesium level should be measured and repleted if necessary to reduce risk of arrhythmias. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following are true about rheumatic fever/ rheumatic heart disease except -, with the following options: A: Mitral stenosis is evident in the early stage of the disease, B: Mitral valve is most commonly affected, C: Presence of antischkow cells is pathognomic, D: MacCallum plaques are commonly seen in left atrium ### Response:

Ans. is 'a' i.e., Mitral stenosis is evident in the early stage of the disease Rheumatic fever/ Rheumatic heart disease* Rheumatic fever (RF) is an acute, immunologically mediated, multisystem inflammatory disease classically occurring a few weeks after an episode of group A streptococcal pharyngitis; occasionally, RF can follow streptococcal infections at other sites, such as the skin.* Acute rheumatic carditis is a common manifestation of active RF and may progress over time to chronic rheumatic heart disease (RHD), mainly manifesting as valvular abnormalities. RHD is characterized principally by deforming fibrotic valvular disease, particularly involving the mitral valve.* Distinctive lesions occur in the heart, called Aschoffbodies, consisting of foci of T lymphocytes, occasional plasma cells, and plump activated macrophages called Anitschkow cells (pathognomonic for RF). These macrophages have abundant cytoplasm and central round-to-ovoid nuclei (occasionally binucleate) in which the chromatin condenses into a central, slender, wavy ribbon (hence the designation "caterpillar cells").* During acute RF, diffuse inflammation and Aschoff bodies may be found in any of the three layers of the heart, resulting in pericarditis, myocarditis, or endocarditis (pancarditis).* Inflammation of the endocardium and the left-sided valves typically results in fibrinoid necrosis within the cusps or tendinous cords. Overlying these necrotic foci and along the lines of closure are small (1 to 2 mm) vegetations, called verrucae.* Subendocardial lesions, perhaps exacerbated by regurgitant jets, can induce irregular thickenings called MacCallum plaques, usually in the left atrium.* The cardinal anatomic changes of the mitral valve in chronic RHD are leaflet thickening, commissural fusion and short- ening, and thickening and fusion of the tendinous cords. In chronic disease the mitral valve is virtually always involved.* The mitral valve is affected in isolation in roughly two thirds of RHD, and along with the aortic valve in another 25% of cases. Tricuspid valve involvement is infrequent, and the pulmonary valve is only rarely affected.* Up to 60% of patients with ARF progress to RHD.* Valvular damage is the hallmark of rheumatic carditis. The mitral valve is almost always affected, sometimes together with the aortic valve; isolated aortic valve involvement is rare.* Early valvular damage leads to regurgitation. Over ensuing years, usually as a result of recurrent episodes, leaflet thickening, scarring, calcification, and valvular stenosis may develop.* Therefore the characteristic manifestation of carditis in previously unaffected individuals is mitral regurgitation, sometimes accompanied by aortic regurgitation.* Myocardial inflammation may affect electrical conduction pathways, leading to P-R interval prolongation (first- degree AV block or rarely higher-level block) and softening of the first heart sound.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All of the following are true about rheumatic fever/ rheumatic heart disease except -, with the following options: A: Mitral stenosis is evident in the early stage of the disease, B: Mitral valve is most commonly affected, C: Presence of antischkow cells is pathognomic, D: MacCallum plaques are commonly seen in left atrium ### Response: Ans. is 'a' i.e., Mitral stenosis is evident in the early stage of the disease Rheumatic fever/ Rheumatic heart disease* Rheumatic fever (RF) is an acute, immunologically mediated, multisystem inflammatory disease classically occurring a few weeks after an episode of group A streptococcal pharyngitis; occasionally, RF can follow streptococcal infections at other sites, such as the skin.* Acute rheumatic carditis is a common manifestation of active RF and may progress over time to chronic rheumatic heart disease (RHD), mainly manifesting as valvular abnormalities. RHD is characterized principally by deforming fibrotic valvular disease, particularly involving the mitral valve.* Distinctive lesions occur in the heart, called Aschoffbodies, consisting of foci of T lymphocytes, occasional plasma cells, and plump activated macrophages called Anitschkow cells (pathognomonic for RF). These macrophages have abundant cytoplasm and central round-to-ovoid nuclei (occasionally binucleate) in which the chromatin condenses into a central, slender, wavy ribbon (hence the designation "caterpillar cells").* During acute RF, diffuse inflammation and Aschoff bodies may be found in any of the three layers of the heart, resulting in pericarditis, myocarditis, or endocarditis (pancarditis).* Inflammation of the endocardium and the left-sided valves typically results in fibrinoid necrosis within the cusps or tendinous cords. Overlying these necrotic foci and along the lines of closure are small (1 to 2 mm) vegetations, called verrucae.* Subendocardial lesions, perhaps exacerbated by regurgitant jets, can induce irregular thickenings called MacCallum plaques, usually in the left atrium.* The cardinal anatomic changes of the mitral valve in chronic RHD are leaflet thickening, commissural fusion and short- ening, and thickening and fusion of the tendinous cords. In chronic disease the mitral valve is virtually always involved.* The mitral valve is affected in isolation in roughly two thirds of RHD, and along with the aortic valve in another 25% of cases. Tricuspid valve involvement is infrequent, and the pulmonary valve is only rarely affected.* Up to 60% of patients with ARF progress to RHD.* Valvular damage is the hallmark of rheumatic carditis. The mitral valve is almost always affected, sometimes together with the aortic valve; isolated aortic valve involvement is rare.* Early valvular damage leads to regurgitation. Over ensuing years, usually as a result of recurrent episodes, leaflet thickening, scarring, calcification, and valvular stenosis may develop.* Therefore the characteristic manifestation of carditis in previously unaffected individuals is mitral regurgitation, sometimes accompanied by aortic regurgitation.* Myocardial inflammation may affect electrical conduction pathways, leading to P-R interval prolongation (first- degree AV block or rarely higher-level block) and softening of the first heart sound. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In child survival and safe motherhood programme which is not advised as a provision in conduct of delivery -, with the following options: A: Clean room, B: Clean tie, C: Clean perineum, D: Clean cord ### Response:

Ans. is 'c' i.e., Clean perineum

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In child survival and safe motherhood programme which is not advised as a provision in conduct of delivery -, with the following options: A: Clean room, B: Clean tie, C: Clean perineum, D: Clean cord ### Response: Ans. is 'c' i.e., Clean perineum ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The following test is not used for dignosis of leprosy-, with the following options: A: Lepromin test, B: slit skin smear, C: Fine needle aspiration cytology, D: skin biopsy ### Response:

Lepromatous test it is not a diagnostic test but a prognostic test. it helps in the classification of leprosy. antigens used for skin testing: mitsuda lepromin, Dharmendra leprominmanifests as biphasic reaction: early Fernandez (48-72hrs)and late mitsuda reaction (3-4weeks)Represents Cmi towards antigen. Erythema and induration more than 5mm indicates positive and good delayed hypersensitivity. lepromin test positive: tuberculoid, borderline tuberculoid leprosy lepromin test negative in lepromatous leprosy, borderline lepromatous leprosyand mid borderline leprosy iadvl textbook of dermatologypage 2060

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The following test is not used for dignosis of leprosy-, with the following options: A: Lepromin test, B: slit skin smear, C: Fine needle aspiration cytology, D: skin biopsy ### Response: Lepromatous test it is not a diagnostic test but a prognostic test. it helps in the classification of leprosy. antigens used for skin testing: mitsuda lepromin, Dharmendra leprominmanifests as biphasic reaction: early Fernandez (48-72hrs)and late mitsuda reaction (3-4weeks)Represents Cmi towards antigen. Erythema and induration more than 5mm indicates positive and good delayed hypersensitivity. lepromin test positive: tuberculoid, borderline tuberculoid leprosy lepromin test negative in lepromatous leprosy, borderline lepromatous leprosyand mid borderline leprosy iadvl textbook of dermatologypage 2060 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Oxidative capacity is high in which type of skeletal muscle fiber, with the following options: A: Type I fiber, B: Type IIA fiber, C: Type IIB fiber, D: All of the above ### Response:

Oxidative capacity is high in type I fiber (slow-oxidative), moderate in type IIA (fast-oxidative-glycolytic), low in Type IIB fiber (fast-glycolytic).Reference: Ganong's review of Medical Physiology,25th ed, p 108

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Oxidative capacity is high in which type of skeletal muscle fiber, with the following options: A: Type I fiber, B: Type IIA fiber, C: Type IIB fiber, D: All of the above ### Response: Oxidative capacity is high in type I fiber (slow-oxidative), moderate in type IIA (fast-oxidative-glycolytic), low in Type IIB fiber (fast-glycolytic).Reference: Ganong's review of Medical Physiology,25th ed, p 108 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Nicoladoni sign is positive in a young patient with an aeriovenous fistula. This sign is also known as:, with the following options: A: Murray sign, B: Frei sign, C: Darrier sign, D: Branham sign ### Response:

Nicoladoni-Branham sign: Compression of a large aeriovenous fistula may cause reflex slowing of the hea rate. Duplex ultrasonography may detect an aeriovenous fistula, especially one that affects the femoral aery and vein at the site of catheter access. Computed tomographic and conventional angiography can confirm the diagnosis. Ref: Creager M.A., Loscalzo J. (2012). Chapter 249. Vascular Diseases of the Extremities. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Nicoladoni sign is positive in a young patient with an aeriovenous fistula. This sign is also known as:, with the following options: A: Murray sign, B: Frei sign, C: Darrier sign, D: Branham sign ### Response: Nicoladoni-Branham sign: Compression of a large aeriovenous fistula may cause reflex slowing of the hea rate. Duplex ultrasonography may detect an aeriovenous fistula, especially one that affects the femoral aery and vein at the site of catheter access. Computed tomographic and conventional angiography can confirm the diagnosis. Ref: Creager M.A., Loscalzo J. (2012). Chapter 249. Vascular Diseases of the Extremities. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Ezetimibe acts on ?, with the following options: A: LPL, B: PPAR, C: NPC ILI, D: HMG-CoA reductase inhibitor ### Response:

Ans. is 'c' i.e., NPC1LI

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Ezetimibe acts on ?, with the following options: A: LPL, B: PPAR, C: NPC ILI, D: HMG-CoA reductase inhibitor ### Response: Ans. is 'c' i.e., NPC1LI ### 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 statement regarding Gastrochisis is TRUE?, with the following options: A: Herniation occur through umbilical cord, B: Herniation from right of umbilical cord from obliteration of right umbilical vein, C: Covered with amniotic sac, D: Associated with multiple anomalies ### Response:

Gastrochisis is an abdominal wall defect located at the junction of the umbilicus and normal skin and is almost right of the umbilicus. It is a congenital anomaly characterized by a defect in the anterior abdominal wall through which the intestinal contents protrude freely. There is no overlying sac and the size of the defect is much small (less than 4cm). If the intestine appears normal that suggests that rupture had occurred late in pregnancy. If the intestine appear thickened, edematous, discoloured and covered with exudate it indicates a long standing process. Ref:Schwaz's Principles of Surgery, 9e chapter 39.

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 statement regarding Gastrochisis is TRUE?, with the following options: A: Herniation occur through umbilical cord, B: Herniation from right of umbilical cord from obliteration of right umbilical vein, C: Covered with amniotic sac, D: Associated with multiple anomalies ### Response: Gastrochisis is an abdominal wall defect located at the junction of the umbilicus and normal skin and is almost right of the umbilicus. It is a congenital anomaly characterized by a defect in the anterior abdominal wall through which the intestinal contents protrude freely. There is no overlying sac and the size of the defect is much small (less than 4cm). If the intestine appears normal that suggests that rupture had occurred late in pregnancy. If the intestine appear thickened, edematous, discoloured and covered with exudate it indicates a long standing process. Ref:Schwaz's Principles of Surgery, 9e chapter 39. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common site of cholangiocarcinoma?, with the following options: A: Distal biliary duct, B: Hilum, C: Intrahepatic duct, D: Multifocal ### Response:

Most common site for cholangiocarcinoma is perihilar region(65%).Distal pa of duct constitutes 25% &Intrahepatic pa constitutes around 10%. Reference:SRB's manual of surgery,5th edition,page no:661.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common site of cholangiocarcinoma?, with the following options: A: Distal biliary duct, B: Hilum, C: Intrahepatic duct, D: Multifocal ### Response: Most common site for cholangiocarcinoma is perihilar region(65%).Distal pa of duct constitutes 25% &Intrahepatic pa constitutes around 10%. Reference:SRB's manual of surgery,5th edition,page no:661. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Microvesicular type of fatty liver is Seen in the following except, with the following options: A: Acute fatty liver of pregnancy, B: Alcoholic liver disease, C: Reye's syndrome, D: Phosphorus intoxication ### Response:

Fatty liver disease means you have extra fat in your liver. You might hear your doctor call it hepatic steatosis. Heavy drinking makes you more likely to get it. Over time, too much alcohol leads to a buildup of fat inside your liver cells. This makes it harder for your liver to work. But you can get fatty liver disease even if you don't drink a lot of alcohol Refer robbins 9/e

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Microvesicular type of fatty liver is Seen in the following except, with the following options: A: Acute fatty liver of pregnancy, B: Alcoholic liver disease, C: Reye's syndrome, D: Phosphorus intoxication ### Response: Fatty liver disease means you have extra fat in your liver. You might hear your doctor call it hepatic steatosis. Heavy drinking makes you more likely to get it. Over time, too much alcohol leads to a buildup of fat inside your liver cells. This makes it harder for your liver to work. But you can get fatty liver disease even if you don't drink a lot of alcohol Refer robbins 9/e ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Child with recurrent mouth ulcer which usually begin as a round yellowish elevated spot surrounded by a red halo and heals within 7-10 days:, with the following options: A: Gingivitis, B: Aphthous ulcers, C: Malignancy, D: Herpetic ulcer ### Response:

Ans.: (b) Aphthous ulcersRef.: Harrison's 19th ed. /239* Apthous ulcers are also called as canker sores/apthous stomatitis and present as round ulcer with yellowish base and surrounded by a red halo.# The usual sites are oral mucosa on the insides of lips , cheeks or below the tongue.# Most of apthous ulcers are <5mm in size and heal within 1-2 weeks.# Painless recurrent apthous ulcers are seen in SLE# Painful recurrent apthous ulcers in oral cavity and genitilia is seen are in Behcet disease

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Child with recurrent mouth ulcer which usually begin as a round yellowish elevated spot surrounded by a red halo and heals within 7-10 days:, with the following options: A: Gingivitis, B: Aphthous ulcers, C: Malignancy, D: Herpetic ulcer ### Response: Ans.: (b) Aphthous ulcersRef.: Harrison's 19th ed. /239* Apthous ulcers are also called as canker sores/apthous stomatitis and present as round ulcer with yellowish base and surrounded by a red halo.# The usual sites are oral mucosa on the insides of lips , cheeks or below the tongue.# Most of apthous ulcers are <5mm in size and heal within 1-2 weeks.# Painless recurrent apthous ulcers are seen in SLE# Painful recurrent apthous ulcers in oral cavity and genitilia is seen are in Behcet disease ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: DOC for chemoprophylaxis of plague ?, with the following options: A: Streptomycin, B: Erythromycin, C: Tetracycline, D: Vancomycin ### Response:

Ans. is 'c' i.e., Tetracycline

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: DOC for chemoprophylaxis of plague ?, with the following options: A: Streptomycin, B: Erythromycin, C: Tetracycline, D: Vancomycin ### Response: Ans. is 'c' i.e., Tetracycline ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Consent from guardian/husband for MTP is required in, with the following options: A: Female is below 28 years of age, B: Female is below 23 years of age, C: Female is below 17 years of age, D: Unmaried Female ### Response:

The written consent of the guardian is necessary before performing aboion in women under 18 years of age and in lunatics even if they are older than 18 years Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 506

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Consent from guardian/husband for MTP is required in, with the following options: A: Female is below 28 years of age, B: Female is below 23 years of age, C: Female is below 17 years of age, D: Unmaried Female ### Response: The written consent of the guardian is necessary before performing aboion in women under 18 years of age and in lunatics even if they are older than 18 years Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 506 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which among the following shows that pulmonary circulation differs from systemic circulation?, with the following options: A: Pulmonary vasodilation in hypoxia, B: Pulmonary vasoconstriction in hypoxia, C: Decreased blood volume during systole, D: Increased basal vasoconstrictor tone ### Response:

The vasoconstrictor response of the pulmonary circulation to low oxygen tension is exact opposite of response of systemic aerioles. The opposite effect in pulmonary vessels occurs in order to distribute the blood flow to better ventilated area and be more effective. This vasoconstriction occurs because of presence of potassium gated channel in pulmonary vessels. Ref: Barst R.J., Rubin L.J. (2011). Chapter 71. Pulmonary Hypeension. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which among the following shows that pulmonary circulation differs from systemic circulation?, with the following options: A: Pulmonary vasodilation in hypoxia, B: Pulmonary vasoconstriction in hypoxia, C: Decreased blood volume during systole, D: Increased basal vasoconstrictor tone ### Response: The vasoconstrictor response of the pulmonary circulation to low oxygen tension is exact opposite of response of systemic aerioles. The opposite effect in pulmonary vessels occurs in order to distribute the blood flow to better ventilated area and be more effective. This vasoconstriction occurs because of presence of potassium gated channel in pulmonary vessels. Ref: Barst R.J., Rubin L.J. (2011). Chapter 71. Pulmonary Hypeension. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Kamla, age 48 yrs, presents with unilateral mild axial proptosis. There is no redness or pain. Investigation of choice is:, with the following options: A: T3&T4 measurements to rule out thyrotoxicosis, B: CT scan to rule out meningioma, C: Doppler to rule out hemangioma, D: USG to rule out orbital pseudotumor ### Response:

All of the above conditions can cause proptosis. But, Graves' ophthalmopathy is the most common cause of unilateral or bilateral proptosis in adults or children. Orbital inflammation and engorgement of the extraocular muscles, paicularly the medial rectus and the inferior rectus, account for the protrusion of the globe. The accompanying upper eyelid retraction, manifesting as dispropoionately greater exposure of sclera superiorly than inferiorly, and lid lag, manifesting as impaired descent of the upper eyelid on downward gaze, distinguishes it from other causes of proptosis. Ref: Sullivan J.H. (2011). Chapter 13. Orbit. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Kamla, age 48 yrs, presents with unilateral mild axial proptosis. There is no redness or pain. Investigation of choice is:, with the following options: A: T3&T4 measurements to rule out thyrotoxicosis, B: CT scan to rule out meningioma, C: Doppler to rule out hemangioma, D: USG to rule out orbital pseudotumor ### Response: All of the above conditions can cause proptosis. But, Graves' ophthalmopathy is the most common cause of unilateral or bilateral proptosis in adults or children. Orbital inflammation and engorgement of the extraocular muscles, paicularly the medial rectus and the inferior rectus, account for the protrusion of the globe. The accompanying upper eyelid retraction, manifesting as dispropoionately greater exposure of sclera superiorly than inferiorly, and lid lag, manifesting as impaired descent of the upper eyelid on downward gaze, distinguishes it from other causes of proptosis. Ref: Sullivan J.H. (2011). Chapter 13. Orbit. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e. ### 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 derived from the Wolffian duct?, with the following options: A: Appendix of testis, B: Uterus, C: Appendix of epididymis, D: Prostate ### Response:

An appendix of the epididymis is a developmental remnant of the mesonephric duct (Wolffian duct) which can be found in the head of the epididymis. In the female, in the absence of testosterone, the Wolffian duct regresses. However, inclusions may persist resulting in the epoophoron and Skene's glands. Where a remnant exists lateral to the wall of the vagina a Ganer's duct or Ganer's cyst may form. In males, the Wolffian duct develops into the rete testis, the efferent ducts, the epididymis, the ductus deferens and the seminal vesicles. The prostate is formed separately from the urogenital sinus. In both the male and the female the Wolffian duct develops into the trigone of the urinary bladder. Ref: Gray's 39e/p-1289

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 derived from the Wolffian duct?, with the following options: A: Appendix of testis, B: Uterus, C: Appendix of epididymis, D: Prostate ### Response: An appendix of the epididymis is a developmental remnant of the mesonephric duct (Wolffian duct) which can be found in the head of the epididymis. In the female, in the absence of testosterone, the Wolffian duct regresses. However, inclusions may persist resulting in the epoophoron and Skene's glands. Where a remnant exists lateral to the wall of the vagina a Ganer's duct or Ganer's cyst may form. In males, the Wolffian duct develops into the rete testis, the efferent ducts, the epididymis, the ductus deferens and the seminal vesicles. The prostate is formed separately from the urogenital sinus. In both the male and the female the Wolffian duct develops into the trigone of the urinary bladder. Ref: Gray's 39e/p-1289 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The commonest site of fracture in Base of Skull?, with the following options: A: Anterior Cranial fossa, B: Middle cranial fossa, C: Posterior cranial fossa, D: Lateral cranial fossa ### Response:

The common sites of fracture in the skull are:(a) The parietal area of the vault.(b) The middle cranial fossa of the base. This fossa is weakened by numerous foramina and canals.The facial bones commonly fractured are: (a) The nasal bone and (b) the mandible.Some clinical features of petrous temporal bone fractureBattle signCSF otorrheaotorrhagia

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The commonest site of fracture in Base of Skull?, with the following options: A: Anterior Cranial fossa, B: Middle cranial fossa, C: Posterior cranial fossa, D: Lateral cranial fossa ### Response: The common sites of fracture in the skull are:(a) The parietal area of the vault.(b) The middle cranial fossa of the base. This fossa is weakened by numerous foramina and canals.The facial bones commonly fractured are: (a) The nasal bone and (b) the mandible.Some clinical features of petrous temporal bone fractureBattle signCSF otorrheaotorrhagia ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Based on the type of life cycle, zoonoses are classified into all of the following except -, with the following options: A: Cyclo-zoonoses, B: Meta-zoonoses, C: Anthropozoonoses, D: Sporozoonoses ### Response:

Ans. is 'c' i.e., Anthropozoonoses Classification of zoonoses 1) Based on direction of transmission : (i) Anthropozoonoses, (ii) Zoonthroponoses, and (iii) Amphixenoses 2) Based on type of life cycle : (i) Direct zoonoses, (ii) Cyclo-zoonoses, (iii) Meta-zoonoses, and (iv) Sporozoonoses.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Based on the type of life cycle, zoonoses are classified into all of the following except -, with the following options: A: Cyclo-zoonoses, B: Meta-zoonoses, C: Anthropozoonoses, D: Sporozoonoses ### Response: Ans. is 'c' i.e., Anthropozoonoses Classification of zoonoses 1) Based on direction of transmission : (i) Anthropozoonoses, (ii) Zoonthroponoses, and (iii) Amphixenoses 2) Based on type of life cycle : (i) Direct zoonoses, (ii) Cyclo-zoonoses, (iii) Meta-zoonoses, and (iv) Sporozoonoses. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Saline infusion sonography is also called?, with the following options: A: Sonohysterography, B: Sonosalpingography, C: Hysterosalpingography, D: None of the above ### Response:

Ans. is 'a' i.e.,SonohysterographySaline Infusion SonographyIt is also called Sonohysteorgraphy.In this procedure sterile saline is instilled into the uterine cavity before ultrasound evaluation for more precise visualization of the endometrial structures.It is often used as second step in the evaluation of abnormal uterine bleeding.It is paicularly useful when ultrasonography suggests a focal lesion, when endometrial biopsy is nondiagnostic, or when abnormal bleeding persists despite normal initial work up.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Saline infusion sonography is also called?, with the following options: A: Sonohysterography, B: Sonosalpingography, C: Hysterosalpingography, D: None of the above ### Response: Ans. is 'a' i.e.,SonohysterographySaline Infusion SonographyIt is also called Sonohysteorgraphy.In this procedure sterile saline is instilled into the uterine cavity before ultrasound evaluation for more precise visualization of the endometrial structures.It is often used as second step in the evaluation of abnormal uterine bleeding.It is paicularly useful when ultrasonography suggests a focal lesion, when endometrial biopsy is nondiagnostic, or when abnormal bleeding persists despite normal initial work up. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Head gear causes, with the following options: A: Bucco lingual movement of maxillary molars, B: Mesio distal movement of maxillary molars, C: Intrusion of molars, D: All of the above ### Response:

Headgears are the most commonly used oral orthopedic appliances. They are indicated in patients with excessive horizontal growth of maxilla. They are used to distalize the maxillary dentition along with maxilla.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Head gear causes, with the following options: A: Bucco lingual movement of maxillary molars, B: Mesio distal movement of maxillary molars, C: Intrusion of molars, D: All of the above ### Response: Headgears are the most commonly used oral orthopedic appliances. They are indicated in patients with excessive horizontal growth of maxilla. They are used to distalize the maxillary dentition along with maxilla. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A person w anders in public places by removing his clothes it is called -, with the following options: A: Voyeurism, B: Frotterurism, C: Exhibitionism, D: Unidinism ### Response:

Ans. is 'c' i.e., Exhibitionism o Exhibitionism is willful and intentional exposure of genitalia in public place to obtain sexual pleasure,o Frotteurism : is contact with another person in order to obtain sexual gratification. Sexual gratification by rubbing private parts against a female body in crowd. It is punishable under Section 2901.P. C., with fine upto Rs 200.o Unidinism: is sexual pleasure is obtained by witnessing the act of urination by some one of same or opposite sex.o Voyeurism = scotophilia^ peeping tom: sexual gratification is obtained by looking at the sexual organs of other persons, watching the act of sexual intercourse, or witnessing undressing by a women.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A person w anders in public places by removing his clothes it is called -, with the following options: A: Voyeurism, B: Frotterurism, C: Exhibitionism, D: Unidinism ### Response: Ans. is 'c' i.e., Exhibitionism o Exhibitionism is willful and intentional exposure of genitalia in public place to obtain sexual pleasure,o Frotteurism : is contact with another person in order to obtain sexual gratification. Sexual gratification by rubbing private parts against a female body in crowd. It is punishable under Section 2901.P. C., with fine upto Rs 200.o Unidinism: is sexual pleasure is obtained by witnessing the act of urination by some one of same or opposite sex.o Voyeurism = scotophilia^ peeping tom: sexual gratification is obtained by looking at the sexual organs of other persons, watching the act of sexual intercourse, or witnessing undressing by a women. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Antonie van Leeuwenhoek is associated with?, with the following options: A: Telescope, B: Microscope, C: Stains, D: Immunization ### Response:

ANSWER: (B) MicroscopeREF: Ananthnarayan page 8Known as "Father of Microbiology ", and considered to be the first microbiologist. He is best known for his work on the improvement of the microscope and for his contributions towards the establishment of microbiology. Using his handcrafted microscopes, he was the first to observe and describe single-celled organisms, which he originally referred to as animalcules, and which we now refer to as microorganisms. He was also the first to record microscopic observations of muscle fibers, bacteria, spermatozoa, and blood flow in capillaries (small blood vessels)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Antonie van Leeuwenhoek is associated with?, with the following options: A: Telescope, B: Microscope, C: Stains, D: Immunization ### Response: ANSWER: (B) MicroscopeREF: Ananthnarayan page 8Known as "Father of Microbiology ", and considered to be the first microbiologist. He is best known for his work on the improvement of the microscope and for his contributions towards the establishment of microbiology. Using his handcrafted microscopes, he was the first to observe and describe single-celled organisms, which he originally referred to as animalcules, and which we now refer to as microorganisms. He was also the first to record microscopic observations of muscle fibers, bacteria, spermatozoa, and blood flow in capillaries (small blood vessels) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The gene responsible for folic acid transpo is situated on:, with the following options: A: Chromosome 10, B: Chromosome 5, C: X Chromosome, D: Chromosome 21 ### Response:

. Chromosome 21

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The gene responsible for folic acid transpo is situated on:, with the following options: A: Chromosome 10, B: Chromosome 5, C: X Chromosome, D: Chromosome 21 ### Response: . Chromosome 21 ### 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 the preferred route of access for total parenteral nutrition in a patient who requires the same for <14 days and there is otherwise no indication for use of central catheter?, with the following options: A: Internal jugular vein, B: External jugular vein, C: Periphaeral vein, D: PICC line ### Response:

Ans. is 'c' i.e., Peripheral vein * Following are the recommendations of the route of access for total parental nutrition :Route of access1.8.8In hospital, parenteral nutrition can be given via a dedicated peripherally inserted central catheter as an alternative to a dedicated centrally placed central venous catheter. A free dedicated lumen in a multilumen centrally placed catheter may also be used.1.8.9Administration of parenteral nutrition via a peripheral venous catheter should be considered for patients who are likely to need short-term parenteral nutrition (less than 14 days) who have no need for central access for other reasons. Care should be taken in catheter choice, and in attention to pH, tonicity and long-term compatibility of the parenteral nutrition formulations in order to avoid administration or stability problems.1.8.10Tunnelling subclavian lines is recommended for long-term use (more that 30 days).1.8.11Catheters do not have to be tunnelled for short-term use (less than 30 days).

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 the preferred route of access for total parenteral nutrition in a patient who requires the same for <14 days and there is otherwise no indication for use of central catheter?, with the following options: A: Internal jugular vein, B: External jugular vein, C: Periphaeral vein, D: PICC line ### Response: Ans. is 'c' i.e., Peripheral vein * Following are the recommendations of the route of access for total parental nutrition :Route of access1.8.8In hospital, parenteral nutrition can be given via a dedicated peripherally inserted central catheter as an alternative to a dedicated centrally placed central venous catheter. A free dedicated lumen in a multilumen centrally placed catheter may also be used.1.8.9Administration of parenteral nutrition via a peripheral venous catheter should be considered for patients who are likely to need short-term parenteral nutrition (less than 14 days) who have no need for central access for other reasons. Care should be taken in catheter choice, and in attention to pH, tonicity and long-term compatibility of the parenteral nutrition formulations in order to avoid administration or stability problems.1.8.10Tunnelling subclavian lines is recommended for long-term use (more that 30 days).1.8.11Catheters do not have to be tunnelled for short-term use (less than 30 days). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All aeries involved in anastomosis around scapula except, with the following options: A: Circumflex scapular, B: Suprascapular, C: Infrascapular, D: Tansverse cervical ### Response:

ANASTOMOSIS AROUND SCAPULA: Anastomosis occurs in the three fossae, subscapular, supraspinatus, and infraspinatus. It is formed by Suprascapular aery, a branch of the thyrocervical trunk Deep branch of the transverse cervical aery, another branch of the thyrocervical trunk Circumflex scapular aery, a branch of the subscapular aery which arises from the 3rd pa of the axillary aery. Note that this is an anastomosis between branches of the first pa of the subclan aery and branches of the third pa of axillar. ANASTOMOSIS AROUND THE ACROMIAN PROCESS: the acromial branch of the thoracoacromial aery. the acromial branch of the suprascapular aery. the acromial branch of the posterior circumflex humeral aery. REF: BD Chaurasia 7th edition Page no: 76.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All aeries involved in anastomosis around scapula except, with the following options: A: Circumflex scapular, B: Suprascapular, C: Infrascapular, D: Tansverse cervical ### Response: ANASTOMOSIS AROUND SCAPULA: Anastomosis occurs in the three fossae, subscapular, supraspinatus, and infraspinatus. It is formed by Suprascapular aery, a branch of the thyrocervical trunk Deep branch of the transverse cervical aery, another branch of the thyrocervical trunk Circumflex scapular aery, a branch of the subscapular aery which arises from the 3rd pa of the axillary aery. Note that this is an anastomosis between branches of the first pa of the subclan aery and branches of the third pa of axillar. ANASTOMOSIS AROUND THE ACROMIAN PROCESS: the acromial branch of the thoracoacromial aery. the acromial branch of the suprascapular aery. the acromial branch of the posterior circumflex humeral aery. REF: BD Chaurasia 7th edition Page no: 76. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Mental health programme was started in –, with the following options: A: 1982, B: 1987, C: 1990, D: 1995 ### Response:

The Government of India has launched the National Mental Health Programme (NMHP) in 1982. Also know Mental health act was started in 1987.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Mental health programme was started in –, with the following options: A: 1982, B: 1987, C: 1990, D: 1995 ### Response: The Government of India has launched the National Mental Health Programme (NMHP) in 1982. Also know Mental health act was started in 1987. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Call exner bodies are seen in:, with the following options: A: Granulosa cell tumor, B: Yolk sac, C: Dysgerminoma, D: Embryonal carcinoma ### Response:

Ans: (a) Granulosa cell tumorBerek and Novak's Gynecology, 14th editionWHO classification of ovarian tumoursCommon epithelial tumorsSex cord (gonadal stroma) tumorsGerm cell tumors*. Serous tumors*. Mucinous tumors*. Endometrioid tumors*. Clear cell (mesonephroid tumors)*. Brenner tumors (Transitional cell tumor)*. Mixed epithelial tumors*. Undifferentiated carcinoma*. Unclassified epithelial tumors*. Granulose-stromal cell tumors, theca cell tumors*. Androblastomas: Sertoli-Leydig cell tumors*. Gynandroblastomas*. UnclassifiedGonadoblastoma*. Pure*. Mixed with dysgerminoma or other germ cell tumors.*. Dysgerminoma*. Endodermal sinus tumors (yolk sac tumour)*. Embryonal carcinoma*. Polyembryoma*. Choriocarcinoma*. Teratoma*. Mixed formsLipid (lipoid) cell tumorsSoft tissue tumors not specific to ovaryUnclassified tumorsFamilial ovarian cancers: HNPCC (LYNCH-2), BRCA1 and BRCA2NOTE:Ovarian cancers are the most common cause of death among all gynecological malignancies.Ovarian cyst adeno carcinoma is most common malignant tumor of ovary (33-50% of epithelial cancers)Most common benign tumour of ovary: Dermoid cystMost common benign epithelial tumor: Serous cystadenomaLargest benign ovarian tumor: Mucinous cyst adenomaMost common ovarian tumour in <20 years of age group - germ cell tumourMost common germ cell tumour (GCT): Mature teratomaMost common malignant germ cell tumour (GCT): DysgerminomaOvarian tumor whose incidence is increased during pregnancy: Dermoid cystMost common ovarian tumor to undergo torsion in pregnancy: Dermoid cystMost common ovarian tumour to involve opposite side: Granulosa cell tumourSerous cyst adenoma is overall most common tumour of ovary.Of all the malignant tumors, 90% are epithelial in orgin, 80% are in primary in the ovary and 20% secondary from breasts, gastrointestinal tract and colon.Mucinous cyst becomes malignant in 5% but papillary cystadenoma becomes malignant in 50% if left untreated.Most common ovarian tumor associated with pseudomyxoma peritoni: Mucinous cystadeno Ca.Most common ovarian tumor associated with hyperthyroidism: Germ cell tumour with struma ovarii (struma ovarii is a teratoma with thyroid tissue).Ovarian tumors with calcification:Cystic teratoma / dermoid cyst (bone + teeth)GonadoblastomaFibromaTorsion of ovarian cyst in the most common complication and seen in teratoma/dermoid cyst most commonly.Tumors with lymphocytic infiltration: DysgerminomaOvarian serous tumors, both low- and high-grade, have a propensity to spread to the peritoneal surfaces and omentum and are commonly associated with the presence of ascites.Meig s syndrome: Combination of ovarian Fibroma + Ascites + right sided hemothoraxPseudo Meig's syndrome: Brenner's tumor, Granulosa Cell tumor, ThecomaRisk factorsProtective factors*. Repeated ovulation*. Old age*. Nullipara*. Early menarche, late menopause*. White race*. Late marriage, infertility*. Perineal exposure to talc*. OC pills*. Pregnancy*. Breastfeeding*. Chronic anovulation*. Bilateral salpingo oophorectomy*. Tubal sterilization*. HysterectomyAge Group:Malignant epithelial tumors40-60 yearsBenign cystic teratoma10-20 yearsDysgerminoma<20 yearsEndodermal sinus tumour15-20 yearsGranulose cell tumourPost-menopausalSertoli leydig cell20-30 yearsThecomaPost-menopausalGERM CELL TUMOURSAccount for 15-20% of all ovarian tumors.95% are benign cystic teratoma, also called as dermoids.Below the age of 20 years, 60% of the tumors are of germ cell origin.<10 years: 85% belong to this group and are malignant.Tumour markers of ovarian cancer:CA-125:>35U/ml indicates malignant and residual ovarian tumour. It is also raised in abdominal tuberculosis and endometriosis.CEA: >5 mg/dl seen in Mucinous ovarian tumour.Endodermal sinus tumors produce AFP.a fetoprotein and alpha-1-antitrypsin: Endodermal sinus tumorAFP and HCG: Embryonal carcinomaHCG: ChoriocarcinomaDysgerminomas and other germinomas: No markers, but secrete LDH Krukenberg's TumourPrimary site: Stomach (70%), large intestine (15%) and breast (6%), spread by retrograde lymphatics.Characteristic features: Signet ring cellsInvolvement of ovary by: Retrograde lymphatics.Always bilateral with smooth surface, slightly bossy and freely mobile over the pelvis.Maintains the shape of ovary and has a peculiar solid waxy consistency.No tendency of adhesion and no infiltration of nearby tissues.Ovarian Tumours and Their Specific FeaturesSchiller Duval bodies - Endodermal sinus tumourSignet ring cells - Krukenberg's tumourCoffee bean cells/Call Exner bodies - Granulosa cell tumourSertoli and Leydig cells - ArrhenoblastomaPsammoma bodies - Papillary Serous CystadenomaRokitansky's protuberance - Dermoid cyst (Mature teratoma)Hobnail cells - Clear cell Ca (mesonephroid Ca)Reinke's crystal - Hilus cell tumourWalthard cell nest - Brenner tumour

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Call exner bodies are seen in:, with the following options: A: Granulosa cell tumor, B: Yolk sac, C: Dysgerminoma, D: Embryonal carcinoma ### Response: Ans: (a) Granulosa cell tumorBerek and Novak's Gynecology, 14th editionWHO classification of ovarian tumoursCommon epithelial tumorsSex cord (gonadal stroma) tumorsGerm cell tumors*. Serous tumors*. Mucinous tumors*. Endometrioid tumors*. Clear cell (mesonephroid tumors)*. Brenner tumors (Transitional cell tumor)*. Mixed epithelial tumors*. Undifferentiated carcinoma*. Unclassified epithelial tumors*. Granulose-stromal cell tumors, theca cell tumors*. Androblastomas: Sertoli-Leydig cell tumors*. Gynandroblastomas*. UnclassifiedGonadoblastoma*. Pure*. Mixed with dysgerminoma or other germ cell tumors.*. Dysgerminoma*. Endodermal sinus tumors (yolk sac tumour)*. Embryonal carcinoma*. Polyembryoma*. Choriocarcinoma*. Teratoma*. Mixed formsLipid (lipoid) cell tumorsSoft tissue tumors not specific to ovaryUnclassified tumorsFamilial ovarian cancers: HNPCC (LYNCH-2), BRCA1 and BRCA2NOTE:Ovarian cancers are the most common cause of death among all gynecological malignancies.Ovarian cyst adeno carcinoma is most common malignant tumor of ovary (33-50% of epithelial cancers)Most common benign tumour of ovary: Dermoid cystMost common benign epithelial tumor: Serous cystadenomaLargest benign ovarian tumor: Mucinous cyst adenomaMost common ovarian tumour in <20 years of age group - germ cell tumourMost common germ cell tumour (GCT): Mature teratomaMost common malignant germ cell tumour (GCT): DysgerminomaOvarian tumor whose incidence is increased during pregnancy: Dermoid cystMost common ovarian tumor to undergo torsion in pregnancy: Dermoid cystMost common ovarian tumour to involve opposite side: Granulosa cell tumourSerous cyst adenoma is overall most common tumour of ovary.Of all the malignant tumors, 90% are epithelial in orgin, 80% are in primary in the ovary and 20% secondary from breasts, gastrointestinal tract and colon.Mucinous cyst becomes malignant in 5% but papillary cystadenoma becomes malignant in 50% if left untreated.Most common ovarian tumor associated with pseudomyxoma peritoni: Mucinous cystadeno Ca.Most common ovarian tumor associated with hyperthyroidism: Germ cell tumour with struma ovarii (struma ovarii is a teratoma with thyroid tissue).Ovarian tumors with calcification:Cystic teratoma / dermoid cyst (bone + teeth)GonadoblastomaFibromaTorsion of ovarian cyst in the most common complication and seen in teratoma/dermoid cyst most commonly.Tumors with lymphocytic infiltration: DysgerminomaOvarian serous tumors, both low- and high-grade, have a propensity to spread to the peritoneal surfaces and omentum and are commonly associated with the presence of ascites.Meig s syndrome: Combination of ovarian Fibroma + Ascites + right sided hemothoraxPseudo Meig's syndrome: Brenner's tumor, Granulosa Cell tumor, ThecomaRisk factorsProtective factors*. Repeated ovulation*. Old age*. Nullipara*. Early menarche, late menopause*. White race*. Late marriage, infertility*. Perineal exposure to talc*. OC pills*. Pregnancy*. Breastfeeding*. Chronic anovulation*. Bilateral salpingo oophorectomy*. Tubal sterilization*. HysterectomyAge Group:Malignant epithelial tumors40-60 yearsBenign cystic teratoma10-20 yearsDysgerminoma<20 yearsEndodermal sinus tumour15-20 yearsGranulose cell tumourPost-menopausalSertoli leydig cell20-30 yearsThecomaPost-menopausalGERM CELL TUMOURSAccount for 15-20% of all ovarian tumors.95% are benign cystic teratoma, also called as dermoids.Below the age of 20 years, 60% of the tumors are of germ cell origin.<10 years: 85% belong to this group and are malignant.Tumour markers of ovarian cancer:CA-125:>35U/ml indicates malignant and residual ovarian tumour. It is also raised in abdominal tuberculosis and endometriosis.CEA: >5 mg/dl seen in Mucinous ovarian tumour.Endodermal sinus tumors produce AFP.a fetoprotein and alpha-1-antitrypsin: Endodermal sinus tumorAFP and HCG: Embryonal carcinomaHCG: ChoriocarcinomaDysgerminomas and other germinomas: No markers, but secrete LDH Krukenberg's TumourPrimary site: Stomach (70%), large intestine (15%) and breast (6%), spread by retrograde lymphatics.Characteristic features: Signet ring cellsInvolvement of ovary by: Retrograde lymphatics.Always bilateral with smooth surface, slightly bossy and freely mobile over the pelvis.Maintains the shape of ovary and has a peculiar solid waxy consistency.No tendency of adhesion and no infiltration of nearby tissues.Ovarian Tumours and Their Specific FeaturesSchiller Duval bodies - Endodermal sinus tumourSignet ring cells - Krukenberg's tumourCoffee bean cells/Call Exner bodies - Granulosa cell tumourSertoli and Leydig cells - ArrhenoblastomaPsammoma bodies - Papillary Serous CystadenomaRokitansky's protuberance - Dermoid cyst (Mature teratoma)Hobnail cells - Clear cell Ca (mesonephroid Ca)Reinke's crystal - Hilus cell tumourWalthard cell nest - Brenner tumour ### 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 these antihypeensives do not have any central action?, with the following options: A: Propranolol, B: Methyl dopa, C: Minoxidil, D: Nitroprusside ### Response:

prpranolol is a beta blocker,methyldopa is a alpha agonist, minocidil is a potassium channel blocker and notroprusside is a nitrate all are used in treatment of hypeension. REF KD Tripathi 8th ed.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of these antihypeensives do not have any central action?, with the following options: A: Propranolol, B: Methyl dopa, C: Minoxidil, D: Nitroprusside ### Response: prpranolol is a beta blocker,methyldopa is a alpha agonist, minocidil is a potassium channel blocker and notroprusside is a nitrate all are used in treatment of hypeension. REF KD Tripathi 8th ed. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The fascia seperating rectum from coccyx is called, with the following options: A: Scarpa's fascia, B: Waldeyer's fascia, C: Denonvillier's fascia, D: Colle's fascia ### Response:

The lower third of the rectum is separated by a fascial condensation - Denonvilliers' fascia - from the prostate/vagina in front, and behind by another fascial layer - Waldeyer's fascia - from the coccyx and lower two sacral veebrae (Table 68.1). These fascial layers are surgically impoant as they are a barrier to malignant invasion . Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1219

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The fascia seperating rectum from coccyx is called, with the following options: A: Scarpa's fascia, B: Waldeyer's fascia, C: Denonvillier's fascia, D: Colle's fascia ### Response: The lower third of the rectum is separated by a fascial condensation - Denonvilliers' fascia - from the prostate/vagina in front, and behind by another fascial layer - Waldeyer's fascia - from the coccyx and lower two sacral veebrae (Table 68.1). These fascial layers are surgically impoant as they are a barrier to malignant invasion . Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1219 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The layer of the cornea once destroyed does not regenerate is:, with the following options: A: Epithelium, B: Bowman's membrane, C: Descemet's membrane, D: All of the above ### Response:

Ans. Bowman's membrane

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The layer of the cornea once destroyed does not regenerate is:, with the following options: A: Epithelium, B: Bowman's membrane, C: Descemet's membrane, D: All of the above ### Response: Ans. Bowman's membrane ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Hyper alodosteronism causes All except, with the following options: A: Hypernatremia, B: Hypokalamia, C: Metabolic acidosis, D: Hypeension ### Response:

Refer CMDT 2010/1056 Alodosterone causes retention of Na+ and water band removal of K+ and H+ Therefore excess of alodosterone may result in Hypernatremia, hypeension and hypokalamia and metabolic alkalosis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Hyper alodosteronism causes All except, with the following options: A: Hypernatremia, B: Hypokalamia, C: Metabolic acidosis, D: Hypeension ### Response: Refer CMDT 2010/1056 Alodosterone causes retention of Na+ and water band removal of K+ and H+ Therefore excess of alodosterone may result in Hypernatremia, hypeension and hypokalamia and metabolic alkalosis ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Mesalamine is used in:, with the following options: A: Ulcerative colitis, B: Diabetes, C: Erectile dysfunction, D: Tinea corporis ### Response:

Ref: Katzung 11th p.I087Explanation:Mesalamine is an aminosalicylate used in the treatment of inflammatory bowel diseasesDrugs that contain 5-aminosalicylic acid (5-ASA) have been used successfully for decades in the treatment of inflammatory bowel diseases. 5- ASA differs from salicylic acid only by the addition of an amino group at the 5 (meta) position.Aminosalicylates are believed to work topically (not systemically) in areas of diseased gastrointestinal mucosa. Up to 80% of unformulated, aqueous 5-ASA is absorbed from the small intestine and does not reach the distal small bowel or colon in appreciable quantities.To overcome the rapid absorption of 5-ASA from the proximal small intestine, a number of formulations have been designed to deliver 5- ASA to various distal segments of the small bowel or the colon. These include sulfasalazine, olsalazine, balsalazide, and various forms of mesalamine.Pentasa is a mesalamine formulation that contains timed-release microgranules that release 5-ASA throughout the small intestineAsacol has 5-ASA coated in a pH-sensitive resin that dissolves at pH 7 (the pH of the distal ileum and proximal colon).Lialda also uses a pH-dependent resin that encases a multimatrix core.On dissolution of the pH-sensitive resin in the colon, water slowly penetrates its hydrophilic and lipophilic core. leading to slow release of mesalamine throughout the colon.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Mesalamine is used in:, with the following options: A: Ulcerative colitis, B: Diabetes, C: Erectile dysfunction, D: Tinea corporis ### Response: Ref: Katzung 11th p.I087Explanation:Mesalamine is an aminosalicylate used in the treatment of inflammatory bowel diseasesDrugs that contain 5-aminosalicylic acid (5-ASA) have been used successfully for decades in the treatment of inflammatory bowel diseases. 5- ASA differs from salicylic acid only by the addition of an amino group at the 5 (meta) position.Aminosalicylates are believed to work topically (not systemically) in areas of diseased gastrointestinal mucosa. Up to 80% of unformulated, aqueous 5-ASA is absorbed from the small intestine and does not reach the distal small bowel or colon in appreciable quantities.To overcome the rapid absorption of 5-ASA from the proximal small intestine, a number of formulations have been designed to deliver 5- ASA to various distal segments of the small bowel or the colon. These include sulfasalazine, olsalazine, balsalazide, and various forms of mesalamine.Pentasa is a mesalamine formulation that contains timed-release microgranules that release 5-ASA throughout the small intestineAsacol has 5-ASA coated in a pH-sensitive resin that dissolves at pH 7 (the pH of the distal ileum and proximal colon).Lialda also uses a pH-dependent resin that encases a multimatrix core.On dissolution of the pH-sensitive resin in the colon, water slowly penetrates its hydrophilic and lipophilic core. leading to slow release of mesalamine throughout the colon. ### 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 high molecular weight heparin following is true about low molecular weight heparin ?, with the following options: A: Monitoring is not needed for low molecular weight heparin, B: Daily two subcutaneous doses are essential, C: They are easily filtered at the glomerulus, D: They do not interact with plasma proteins ### Response:

Ans. is 'b' i.e., Daily two subcutaneous doses are essential Advantages of LMWH Longer, more consistent and predictable response --> Single daily dose is sufficient by subcutaneous route. o Lower risk of osteoporosis and HIT syndrome. Bleeding chances are less : LMW heparins have a different anticoagulant profile. They selectively inhibit factor Xa with little effect on antithrombin and coagulation in general. They act only by inducing conformational change in AT III. They appear to have lesser antiplatelet action. As a result they have a small effect on a PTT and whole blood clotting time. Since a PTT/clotting times are not prolonged (much) laboratory monitoring is not needed, and the incidence of haemorrhagic complication is less. They are easily filtered from glomerular capillaries because of there smaller molecular weight. LMW heparins do not interact with plasma proteins.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Compared to high molecular weight heparin following is true about low molecular weight heparin ?, with the following options: A: Monitoring is not needed for low molecular weight heparin, B: Daily two subcutaneous doses are essential, C: They are easily filtered at the glomerulus, D: They do not interact with plasma proteins ### Response: Ans. is 'b' i.e., Daily two subcutaneous doses are essential Advantages of LMWH Longer, more consistent and predictable response --> Single daily dose is sufficient by subcutaneous route. o Lower risk of osteoporosis and HIT syndrome. Bleeding chances are less : LMW heparins have a different anticoagulant profile. They selectively inhibit factor Xa with little effect on antithrombin and coagulation in general. They act only by inducing conformational change in AT III. They appear to have lesser antiplatelet action. As a result they have a small effect on a PTT and whole blood clotting time. Since a PTT/clotting times are not prolonged (much) laboratory monitoring is not needed, and the incidence of haemorrhagic complication is less. They are easily filtered from glomerular capillaries because of there smaller molecular weight. LMW heparins do not interact with plasma proteins. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The common cause of bilateral internuclear ophthalmoplegia is:, with the following options: A: Multiple sclerosis, B: Lead toxicity, C: Diphtheria, D: Diabetes mellitus ### Response:

Ans. Multiple sclerosis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The common cause of bilateral internuclear ophthalmoplegia is:, with the following options: A: Multiple sclerosis, B: Lead toxicity, C: Diphtheria, D: Diabetes mellitus ### Response: Ans. Multiple sclerosis ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The following are the hallmarks of nephrotic syndrome in children except ___________, with the following options: A: Severe proteinuria >2 gm/m2/day, B: Hypoalbuminemia < 2.5 g/dL, C: Gross hematuria, D: Edema ### Response:

NEPHROTIC SYNDROME:- Characterised by massive proteinuria, hypoalbuminemua and edema, hyperlipidemia is often associated. Some patients show hematuria and hypeension. Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl). The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin angiotensin aldosterone axis and ADH secretion that enhances sodium and water retention. Hypoalbuminemia also induces hepatic synthesis of beta lipoproteins resulting in hypercholesterolemia. Main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy. Steroid sensitive nephrotic syndrome:- MCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non specific obliteration of epithelial foot processes. Immunofluorescence studies shows deposits of occassional mesangial IgM. Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia impa a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated. Low serum calcium level. Steroid resistant nephrotic stndrome:- Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and wilms tumor(WT1) genes. Reference: GHAI essential Paediatrics

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The following are the hallmarks of nephrotic syndrome in children except ___________, with the following options: A: Severe proteinuria >2 gm/m2/day, B: Hypoalbuminemia < 2.5 g/dL, C: Gross hematuria, D: Edema ### Response: NEPHROTIC SYNDROME:- Characterised by massive proteinuria, hypoalbuminemua and edema, hyperlipidemia is often associated. Some patients show hematuria and hypeension. Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl). The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin angiotensin aldosterone axis and ADH secretion that enhances sodium and water retention. Hypoalbuminemia also induces hepatic synthesis of beta lipoproteins resulting in hypercholesterolemia. Main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy. Steroid sensitive nephrotic syndrome:- MCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non specific obliteration of epithelial foot processes. Immunofluorescence studies shows deposits of occassional mesangial IgM. Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia impa a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated. Low serum calcium level. Steroid resistant nephrotic stndrome:- Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and wilms tumor(WT1) genes. Reference: GHAI essential Paediatrics ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which joint is most commonly affected in pseudogout, with the following options: A: Knee joint, B: Hip joint, C: MP joint great toe, D: MP joint thumb ### Response:

Pseudogout commonly involves the larger joints Knee joint is Most commonly involved Other sites are wrist, elbow, shoulder ankle Involvement of small joints is uncommon Refer Harrison 20th/e p 2167 maheswari 9th ed

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which joint is most commonly affected in pseudogout, with the following options: A: Knee joint, B: Hip joint, C: MP joint great toe, D: MP joint thumb ### Response: Pseudogout commonly involves the larger joints Knee joint is Most commonly involved Other sites are wrist, elbow, shoulder ankle Involvement of small joints is uncommon Refer Harrison 20th/e p 2167 maheswari 9th ed ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Inguinal ligament is formed due to:, with the following options: A: External oblique aponeurosis, B: Transversus abdominis, C: Internal oblique aponeurosis, D: Inguinal muscle ### Response:

Ans. A External oblique aponeurosis# Inguinal ligament is a fibrous, thickened, folded margin of the external oblique aponeurosis.# It extends from anterior superior iliac spine to pubic tubercle.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Inguinal ligament is formed due to:, with the following options: A: External oblique aponeurosis, B: Transversus abdominis, C: Internal oblique aponeurosis, D: Inguinal muscle ### Response: Ans. A External oblique aponeurosis# Inguinal ligament is a fibrous, thickened, folded margin of the external oblique aponeurosis.# It extends from anterior superior iliac spine to pubic tubercle. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The lens can be dislocated in all except -, with the following options: A: Homocystinuria, B: Marfan’s syndrome, C: Trauma, D: Wilson’sdisease ### Response:

Ectopia lentis Ectopia lentis is defined as displacement or malposition of the crystalline lens of the eye. The lens is considered dislocated (luxated) when it lies completely outside the lens patellar fossa. The lens is described as subluxated when it is partially displaced but contained within the lens space. Causes are

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The lens can be dislocated in all except -, with the following options: A: Homocystinuria, B: Marfan’s syndrome, C: Trauma, D: Wilson’sdisease ### Response: Ectopia lentis Ectopia lentis is defined as displacement or malposition of the crystalline lens of the eye. The lens is considered dislocated (luxated) when it lies completely outside the lens patellar fossa. The lens is described as subluxated when it is partially displaced but contained within the lens space. Causes are ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Treatment of torse de pointes:, with the following options: A: Propranolol, B: Calcium channel blocker, C: MgSO4, D: Lignocaine ### Response:

Ans. C. MgSO4 Torse de pointe blocks the out potassium and inward calcium channel due to which there is prolongation of QT interval. Drug causing this are thiazides, ondansetron, sotalol. Drug of choice to terminate this magnesium sulfate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Treatment of torse de pointes:, with the following options: A: Propranolol, B: Calcium channel blocker, C: MgSO4, D: Lignocaine ### Response: Ans. C. MgSO4 Torse de pointe blocks the out potassium and inward calcium channel due to which there is prolongation of QT interval. Drug causing this are thiazides, ondansetron, sotalol. Drug of choice to terminate this magnesium sulfate. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: X-rays are modified, with the following options: A: Protons, B: Electrons, C: Neutrons, D: Positrons ### Response:

X rays are the modified electrons from cathode striking the anode both are made up of tungsten which has a high melting point and low vapourisation pressure

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: X-rays are modified, with the following options: A: Protons, B: Electrons, C: Neutrons, D: Positrons ### Response: X rays are the modified electrons from cathode striking the anode both are made up of tungsten which has a high melting point and low vapourisation pressure ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Basic amino acids are, with the following options: A: Lysine and Arginine, B: Serine and cystein, C: Phenylalanine and Tyrosine, D: Aspartic acid and Glutamic acid ### Response:

(Lysine and Arginine) (47- U.Satyanarayan 3rd)Classification of Amino acids1.Amino acid with aliphatic side chains - Glycine, Alanine, valine, leucine and Isoleucine2.Hydroxyl group containing amino acids- Serine, threonine and tyrosine3.Sulfur containing amino acids - cysteine, methionine4.Acidic ami noacids - Aspartic acid, glutamic acid5.Basic amino acids - Lysine, arginine, histidine6.Aromatic amino acids - Phenyl alanine, tyrosine and tryptophan7.Imino acids - Proline

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Basic amino acids are, with the following options: A: Lysine and Arginine, B: Serine and cystein, C: Phenylalanine and Tyrosine, D: Aspartic acid and Glutamic acid ### Response: (Lysine and Arginine) (47- U.Satyanarayan 3rd)Classification of Amino acids1.Amino acid with aliphatic side chains - Glycine, Alanine, valine, leucine and Isoleucine2.Hydroxyl group containing amino acids- Serine, threonine and tyrosine3.Sulfur containing amino acids - cysteine, methionine4.Acidic ami noacids - Aspartic acid, glutamic acid5.Basic amino acids - Lysine, arginine, histidine6.Aromatic amino acids - Phenyl alanine, tyrosine and tryptophan7.Imino acids - Proline ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Dohle bodies can be seen in which of the following?, with the following options: A: Plasma cell myeloma, B: Sepsis, C: Chronic granulomatous disease, D: Rheumatoid ahritis ### Response:

In sepsis or severe inflammatory disorders (e.g., Kawasaki disease), leukocytosis is often accompanied by morphologic changes in neutrophils, such as toxic granulations, Dohle bodies, and cytoplasmic vacuoles Toxic granules are coarser and darker than normal neutrophilic granules, represent abnormal azurophilic (primary) granules Dohle bodies are patches of dilated endoplasmic reticulum that appear as sky-blue cytoplasmic "puddles."

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Dohle bodies can be seen in which of the following?, with the following options: A: Plasma cell myeloma, B: Sepsis, C: Chronic granulomatous disease, D: Rheumatoid ahritis ### Response: In sepsis or severe inflammatory disorders (e.g., Kawasaki disease), leukocytosis is often accompanied by morphologic changes in neutrophils, such as toxic granulations, Dohle bodies, and cytoplasmic vacuoles Toxic granules are coarser and darker than normal neutrophilic granules, represent abnormal azurophilic (primary) granules Dohle bodies are patches of dilated endoplasmic reticulum that appear as sky-blue cytoplasmic "puddles." ### 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 anticancer drugs act on G2 phase except:, with the following options: A: Paclitaxel, B: Etoposide, C: Irinotecan, D: Bleomycin ### Response:

Ans. (A) Paclitaxel(Ref: Katzung 13th/e p921)Paclitaxel is a taxane that act on mitotic spindle. Drugs acting on mitotic spindle act on M phase of cell cycle.Phase of cell cycleDrugs actingG1EtoposideSAntimetabolitesG2BleomycinEtoposideIrinoctecanTopotecanMVinca alkaloidsTaxanes

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 anticancer drugs act on G2 phase except:, with the following options: A: Paclitaxel, B: Etoposide, C: Irinotecan, D: Bleomycin ### Response: Ans. (A) Paclitaxel(Ref: Katzung 13th/e p921)Paclitaxel is a taxane that act on mitotic spindle. Drugs acting on mitotic spindle act on M phase of cell cycle.Phase of cell cycleDrugs actingG1EtoposideSAntimetabolitesG2BleomycinEtoposideIrinoctecanTopotecanMVinca alkaloidsTaxanes ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A lady undergoes radical hysterectomy for stage Ib ca cervix. It was found that cancer extends to lower part of body of uterus and upper part of cervix Next step of management will be:, with the following options: A: Chemotherapy, B: Radiotherapy, C: Chemoradiation, D: Follow up ### Response:

Postoperatively it was found that carcinoma extends to the lower part of uterus. Now this is a trap because uterine extension has no significance in cancer cervix and does not change the staging.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A lady undergoes radical hysterectomy for stage Ib ca cervix. It was found that cancer extends to lower part of body of uterus and upper part of cervix Next step of management will be:, with the following options: A: Chemotherapy, B: Radiotherapy, C: Chemoradiation, D: Follow up ### Response: Postoperatively it was found that carcinoma extends to the lower part of uterus. Now this is a trap because uterine extension has no significance in cancer cervix and does not change the staging. ### End