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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: Wagner and Grossman theory is related to, with the following options: A: Palatal palsy, B: Vocal cord palsy, C: Facial palsy, D: Hypoglossal palsy ### Response:

Wagner and Grossman hypothesis which states that cricothyroid muscle which receives innervation from superior laryngeal nerve keeps the cord in paramedian position due to its adductor function. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 7, page - 338

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Wagner and Grossman theory is related to, with the following options: A: Palatal palsy, B: Vocal cord palsy, C: Facial palsy, D: Hypoglossal palsy ### Response: Wagner and Grossman hypothesis which states that cricothyroid muscle which receives innervation from superior laryngeal nerve keeps the cord in paramedian position due to its adductor function. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 7, page - 338 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Enzyme defect in Classic Phenylketonuria, with the following options: A: Phenylalanine hydroxylase, B: Dihydrobiopterin reductase, C: Fumarylacetoacetate hydrolase, D: Homogentisate oxidase ### Response:

Hyperphenylalaninemias arise from defects in phenylalanine hydroxylase (type I, classic phenylketonuria (PKU), frequency 1 in 10,000 bihs), in dihydrobiopterin reductase (types II and III), or in dihydrobiopterin biosynthesis (types IV and V).Ref: Harper&;s Biochemistry; 30th edition; Chapter 29 Catabolism of the Carbon Skeletons of Amino Acids

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Enzyme defect in Classic Phenylketonuria, with the following options: A: Phenylalanine hydroxylase, B: Dihydrobiopterin reductase, C: Fumarylacetoacetate hydrolase, D: Homogentisate oxidase ### Response: Hyperphenylalaninemias arise from defects in phenylalanine hydroxylase (type I, classic phenylketonuria (PKU), frequency 1 in 10,000 bihs), in dihydrobiopterin reductase (types II and III), or in dihydrobiopterin biosynthesis (types IV and V).Ref: Harper&;s Biochemistry; 30th edition; Chapter 29 Catabolism of the Carbon Skeletons of Amino Acids ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Formication is seen, with the following options: A: Cannabis, B: Cocaine, C: Opioids, D: Ecstasy ### Response:

Formication - also know as magnan phenomenon or cocaine bugs it is tactile type of hallucination seen in cocaine intoxication Jet black pigmentation - also seen in cocaine Flashback phenomenon / run amok / amotivational syndrome - seen in cannabis Flu like syndrome (water from everywhere - lacrimation, sweating, rhinorrhea and diarrhea) seen in opioids withdrawal

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Formication is seen, with the following options: A: Cannabis, B: Cocaine, C: Opioids, D: Ecstasy ### Response: Formication - also know as magnan phenomenon or cocaine bugs it is tactile type of hallucination seen in cocaine intoxication Jet black pigmentation - also seen in cocaine Flashback phenomenon / run amok / amotivational syndrome - seen in cannabis Flu like syndrome (water from everywhere - lacrimation, sweating, rhinorrhea and diarrhea) seen in opioids withdrawal ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is true about fouh hea sound 'S4'?, with the following options: A: Can be heard by the unaided ear, B: Frequency is greater than 20 Hz, C: Heard during ventricular filling phase, D: Heard during ventricular ejection phase ### Response:

Precordial vibrations resulting from atrial contraction are normally neither palpable nor audible. Under pathologic conditions, forceful atrial contraction generates a low-frequency sound (S4) just before the first hea sound (S1).S4 is also termed the atrial diastolic gallop or the presystolic gallop.Atrial contraction must be present for the production of S4. It is absent in atrial fibrillation.The S4 follows the onset of the P wave of the ECG by approximately70 ms.S 4 has a very low frequency--usually 20 cycles/sec or less. (Guyton and Hall)Audibility of the S4 depends not only on its intensity and frequency but also on its separation from S1. A loud S1 also can mask the audibility of a preceding softer S4.The S4 is best heard at the apex impulse with the patient turned in the left lateral position. It varies considerably with respiration, usually being heard best during expiration.Both the intensity and timing of the S4 are closely related to the end-diastolic volume of the ventricle.Audible fouh hea sounds are usually accompanied by a palpable presystolic apical impulse in the absence of obesity, emphysema, and so foh.The S4 generated by a forceful right atrial contraction is usually heard best at the lower left sternal border. Unlike the left-sided S4, it tends to be accentuated with inspiration. It is also accompanied by prominent 'a waves' in the JVP.An audible S4 with a palpable presystolic impulse is common in patients with ischemic hea disease during an acute episode of angina and in the early phases of transmural MI.In patients with LV an aneurysm or idiopathic or ischemic cardiomyopathy, abnormal fouh hea sounds are commonly present and are often associated with an S3, producing a quadruple rhythm.Ref: Hurst's The Hea 13/e p288, Guyton & Hall's Textbook of Medical Physiology 12/e p266

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is true about fouh hea sound 'S4'?, with the following options: A: Can be heard by the unaided ear, B: Frequency is greater than 20 Hz, C: Heard during ventricular filling phase, D: Heard during ventricular ejection phase ### Response: Precordial vibrations resulting from atrial contraction are normally neither palpable nor audible. Under pathologic conditions, forceful atrial contraction generates a low-frequency sound (S4) just before the first hea sound (S1).S4 is also termed the atrial diastolic gallop or the presystolic gallop.Atrial contraction must be present for the production of S4. It is absent in atrial fibrillation.The S4 follows the onset of the P wave of the ECG by approximately70 ms.S 4 has a very low frequency--usually 20 cycles/sec or less. (Guyton and Hall)Audibility of the S4 depends not only on its intensity and frequency but also on its separation from S1. A loud S1 also can mask the audibility of a preceding softer S4.The S4 is best heard at the apex impulse with the patient turned in the left lateral position. It varies considerably with respiration, usually being heard best during expiration.Both the intensity and timing of the S4 are closely related to the end-diastolic volume of the ventricle.Audible fouh hea sounds are usually accompanied by a palpable presystolic apical impulse in the absence of obesity, emphysema, and so foh.The S4 generated by a forceful right atrial contraction is usually heard best at the lower left sternal border. Unlike the left-sided S4, it tends to be accentuated with inspiration. It is also accompanied by prominent 'a waves' in the JVP.An audible S4 with a palpable presystolic impulse is common in patients with ischemic hea disease during an acute episode of angina and in the early phases of transmural MI.In patients with LV an aneurysm or idiopathic or ischemic cardiomyopathy, abnormal fouh hea sounds are commonly present and are often associated with an S3, producing a quadruple rhythm.Ref: Hurst's The Hea 13/e p288, Guyton & Hall's Textbook of Medical Physiology 12/e p266 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Neostigmine can reverse the effect of muscle relaxants in all of the below conditions except, with the following options: A: Blockade by Non Depolarizing muscle relaxants, B: Phase 1 block by Depolarizing muscle relaxants, C: Phase 2 block by Depolarizing muscle relaxants, D: All of the above ### Response:

Neostigmine is an anticholinesterase used to reverse effects of muscle relaxants in all of the above conditions except for Phase 1 block by depolarizing muscle relaxants.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Neostigmine can reverse the effect of muscle relaxants in all of the below conditions except, with the following options: A: Blockade by Non Depolarizing muscle relaxants, B: Phase 1 block by Depolarizing muscle relaxants, C: Phase 2 block by Depolarizing muscle relaxants, D: All of the above ### Response: Neostigmine is an anticholinesterase used to reverse effects of muscle relaxants in all of the above conditions except for Phase 1 block by depolarizing muscle relaxants. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Secondary action of Inferior oblique, with the following options: A: Intortion, B: Extortion, C: Elevation, D: Depression ### Response:

Inferior oblique 1o - Extortion 2o - Elevation 3o - Abduction.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Secondary action of Inferior oblique, with the following options: A: Intortion, B: Extortion, C: Elevation, D: Depression ### Response: Inferior oblique 1o - Extortion 2o - Elevation 3o - Abduction. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Age of marriage age for women: Gujarat 10, with the following options: A: 16 years, B: 17 years, C: 18 years, D: 21 years ### Response:

Ans. 18 years Prohibition of Child Marriage Act(2006), and it came into effect on 1 November 2007; states that a girl in India can't marry before the age of 18, and a boy before 21.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Age of marriage age for women: Gujarat 10, with the following options: A: 16 years, B: 17 years, C: 18 years, D: 21 years ### Response: Ans. 18 years Prohibition of Child Marriage Act(2006), and it came into effect on 1 November 2007; states that a girl in India can't marry before the age of 18, and a boy before 21. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Short acting non deipolarizing blocker -, with the following options: A: Rocurorium, B: Suxamethonium, C: Mivacurium, D: Pancuronium ### Response:

Ans. is 'c' i.e., Mivacurium SKELETAL MUSCLE RELAXANTSo Skeletal muscle relaxants are drugs that act peripherally at neuromuscular junction/muscle fibre itself or centrally in the cerebrospinal axis to reduce muscle tone.o The neuromuscular blocking agents are used primarily in conjuction with general anaesthetics to provide muscle relaxation for surgery', while centrally acting muscle relaxants are used mainly for painful muscle spasms and spastic neurological conditions.Muscle relaxantsPeripherally actingCentrally acting o Mephenesin congenersNeuromuscular blocking agentsDirectly acting agents# Chlorzoxazone o Dantrolene sodium#ChlormezanoneNondepolarizing (competitive) blockersDepolarizing blockers# Diazepama)Long acting - d. tubocurarine, Pancuronium,o SuccinyIcholineo GABA derivativesDoxacurium, Pipecuroniumo Decamethonium# Baclofenb) Intermediate - Vecuronium, Atracurium o Central a2 - agonistactingcisatracurium, Rocuronium, Rapacuronium# Tizanidinec) Short acting - MivacuriumCompetitive (nondepolarizing) blockers are of two types1. Benzytisoquinolone derivativeso This includes -d-TC, doxacurium, atracurium, cisatracurium, mivacurium, metocurine.o These drugs have tendency to release histamine and to block autonomic ganglion.2. Amminio steroid derivativeso This include pancuronium, rocuronium, vecuronium, pipecuronium, rapacuronium.These drugs do not block autonomic ganglia and have minimal histamine releasing property'.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Short acting non deipolarizing blocker -, with the following options: A: Rocurorium, B: Suxamethonium, C: Mivacurium, D: Pancuronium ### Response: Ans. is 'c' i.e., Mivacurium SKELETAL MUSCLE RELAXANTSo Skeletal muscle relaxants are drugs that act peripherally at neuromuscular junction/muscle fibre itself or centrally in the cerebrospinal axis to reduce muscle tone.o The neuromuscular blocking agents are used primarily in conjuction with general anaesthetics to provide muscle relaxation for surgery', while centrally acting muscle relaxants are used mainly for painful muscle spasms and spastic neurological conditions.Muscle relaxantsPeripherally actingCentrally acting o Mephenesin congenersNeuromuscular blocking agentsDirectly acting agents# Chlorzoxazone o Dantrolene sodium#ChlormezanoneNondepolarizing (competitive) blockersDepolarizing blockers# Diazepama)Long acting - d. tubocurarine, Pancuronium,o SuccinyIcholineo GABA derivativesDoxacurium, Pipecuroniumo Decamethonium# Baclofenb) Intermediate - Vecuronium, Atracurium o Central a2 - agonistactingcisatracurium, Rocuronium, Rapacuronium# Tizanidinec) Short acting - MivacuriumCompetitive (nondepolarizing) blockers are of two types1. Benzytisoquinolone derivativeso This includes -d-TC, doxacurium, atracurium, cisatracurium, mivacurium, metocurine.o These drugs have tendency to release histamine and to block autonomic ganglion.2. Amminio steroid derivativeso This include pancuronium, rocuronium, vecuronium, pipecuronium, rapacuronium.These drugs do not block autonomic ganglia and have minimal histamine releasing property'. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Organism lacking cell wall:, with the following options: A: Bacillus, B: Actinomycetes, C: Chlamydiae, D: Mycoplasma ### Response:

Ans: d (Mycoplasma) Ref: Ananthanarayanan, 7th ed, p. 395Mycoplasma are a group of bacteria that are devoid of cell walls and so highly pleomorphic with no size and shape.The cells are bounded by a soft trilaminar unit membrane containing sterols.Cell wall: Between capsule & cytoplasmic membrane-CELL WALL COMPONENTS Gram positiveGram negativePeptidoglycanPeptidoglycanTeichoic acidLipoproteinPolysaccharideLipopolysaccharide Peptidoglycan (mucopeptide or murien)Formed ofN acetyl glucosamine and N acetyl muramic acid.In Gram positive around 40 sheets while inGram negative only 1-2 are present.It provides tensile strength.LipopolysacchrideHas endotoxic activity; released only when cells are lysed.LipoproteinMost abundant part of Gram negative cell wallTeichoic acidMajor antigenic determinantPolymer of ribitol or glycerol

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Organism lacking cell wall:, with the following options: A: Bacillus, B: Actinomycetes, C: Chlamydiae, D: Mycoplasma ### Response: Ans: d (Mycoplasma) Ref: Ananthanarayanan, 7th ed, p. 395Mycoplasma are a group of bacteria that are devoid of cell walls and so highly pleomorphic with no size and shape.The cells are bounded by a soft trilaminar unit membrane containing sterols.Cell wall: Between capsule & cytoplasmic membrane-CELL WALL COMPONENTS Gram positiveGram negativePeptidoglycanPeptidoglycanTeichoic acidLipoproteinPolysaccharideLipopolysaccharide Peptidoglycan (mucopeptide or murien)Formed ofN acetyl glucosamine and N acetyl muramic acid.In Gram positive around 40 sheets while inGram negative only 1-2 are present.It provides tensile strength.LipopolysacchrideHas endotoxic activity; released only when cells are lysed.LipoproteinMost abundant part of Gram negative cell wallTeichoic acidMajor antigenic determinantPolymer of ribitol or glycerol ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: WHO guidelines for minimal sperm count is:September 2007, with the following options: A: 10 million/ ml, B: 20 million/ml, C: 50 million/ ml, D: 60 million/ ml ### Response:

Ans. B: 20 million/mlAccording to WHO guidelines, minimum sperm values of normal sperm areVolume: 2 mlConcentration:20 million/ mlMotility: 50%Normal morphology: 30%

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: WHO guidelines for minimal sperm count is:September 2007, with the following options: A: 10 million/ ml, B: 20 million/ml, C: 50 million/ ml, D: 60 million/ ml ### Response: Ans. B: 20 million/mlAccording to WHO guidelines, minimum sperm values of normal sperm areVolume: 2 mlConcentration:20 million/ mlMotility: 50%Normal morphology: 30% ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Compament syndrome is treated by, with the following options: A: Fasciotomy, B: Bicarbonate, C: Chloride rich fluid, D: Early aggressive fluid ### Response:

A i.e. Fasciotomy

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Compament syndrome is treated by, with the following options: A: Fasciotomy, B: Bicarbonate, C: Chloride rich fluid, D: Early aggressive fluid ### Response: A i.e. Fasciotomy ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Natural method of horizontal gene transfer among bacteria includes -, with the following options: A: Electroporation, B: Transduction, C: Transformation, D: Conjugation ### Response:

TRANSDUCTION: the trannsfer of a poion of the DNA from one bacterium to another by a abactriophage is known as transduction . bacteriophages are viruses that parasitise the bacteria and consist of a nucleic acid core and a protein coat. a phage paicle may have its core beside its own nucleic acid a segment of hostDNA . when this paicle infects another bacterium DNA transfer is effected and the recepient cells acquire new characteristic coded by the donor DNA. it appers to be the most widespread mechanism of gene transfer among prokaryotes and provides an excellent tool for the genetic mapping of bacteria . it has been propsed as a method of genetic engineering in the treatment of some inborn errors of metabolism. REF:Ananthanarayan and Panicker's Textbook ofMicrobiology 8thEdition pg no:63

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Natural method of horizontal gene transfer among bacteria includes -, with the following options: A: Electroporation, B: Transduction, C: Transformation, D: Conjugation ### Response: TRANSDUCTION: the trannsfer of a poion of the DNA from one bacterium to another by a abactriophage is known as transduction . bacteriophages are viruses that parasitise the bacteria and consist of a nucleic acid core and a protein coat. a phage paicle may have its core beside its own nucleic acid a segment of hostDNA . when this paicle infects another bacterium DNA transfer is effected and the recepient cells acquire new characteristic coded by the donor DNA. it appers to be the most widespread mechanism of gene transfer among prokaryotes and provides an excellent tool for the genetic mapping of bacteria . it has been propsed as a method of genetic engineering in the treatment of some inborn errors of metabolism. REF:Ananthanarayan and Panicker's Textbook ofMicrobiology 8thEdition pg no:63 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In tissue, Coccidioides immitis produces:, with the following options: A: Spherules and endospores, B: Encapsulated yeast cells, C: Fine, delicate hyphae, D: Coarse, septate hyphae ### Response:

Ans. is 'a' i.e., Spherules and endospores(Ref: Ananthanarayan, 8th/e, p. 611, 612; Harrison, 18th/e, p. 1643, 17th/e, p. 1244)C. imitis reproduces in host tissue by forming small endospores within mature spherules.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In tissue, Coccidioides immitis produces:, with the following options: A: Spherules and endospores, B: Encapsulated yeast cells, C: Fine, delicate hyphae, D: Coarse, septate hyphae ### Response: Ans. is 'a' i.e., Spherules and endospores(Ref: Ananthanarayan, 8th/e, p. 611, 612; Harrison, 18th/e, p. 1643, 17th/e, p. 1244)C. imitis reproduces in host tissue by forming small endospores within mature spherules. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 5 days old, full term male infant was severely cyanotic at bih. PEE was administered initially and later balloon atrial septostomy was done which showed improvement in oxygenation. Most likely diagnosis:, with the following options: A: Tetralogy of Fallot, B: Transposition of great vessels, C: Truncus aeriosus, D: Tricuspid atresia ### Response:

Transposition of great vessels Transposition of great aeries with an intact ventricular septum is also referred to a simple TGA or isolated TGA. * Cyanosis and tachypnea are most often recognized within hours or day one of life, hypoxemia is severe but hea failure is less common. * Transposition of great aeries with VSD - cyanosis can generally recognized within the { 'l month of life, but it may remain diagnosed in some infants for several months. Treatment - Infusion of prostaglandin E2 should be initiated immediately to maintain patency of the ductus aeriosus and improve oxygenation * Infant who remain severely hypoxic or acidotic despite prostaglandin infusion should undergo Rashkind-halloon atrial septostomy Aerial switch (Jantene) procedure is the surgical treatment of choice for neonates with d-TGA and intact ventricular septum and is usually performed within the 1-2 week of life. Truncus Aeriosus (TA) a single aerial trunk :runcus aeriosus) arises from the hea and supplies the systemic pulmonary and coronary circulation. A VSD is always present Clinical picture - In the immediate newborn period, signs of hea failure are usually absent, a murmur and minimal cyanosis are the initial signs. As a conotruneal lesion, T A is often associated with a deletion of chromosome 22q 11 (DiGeorge syndrome) and associated endocrine immunologic, facial and pulmonary abnormalities Treatment - surgery is indicated usually in the 12 weeks of life Older patients -* Hea -lung transplantation is the only options.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 5 days old, full term male infant was severely cyanotic at bih. PEE was administered initially and later balloon atrial septostomy was done which showed improvement in oxygenation. Most likely diagnosis:, with the following options: A: Tetralogy of Fallot, B: Transposition of great vessels, C: Truncus aeriosus, D: Tricuspid atresia ### Response: Transposition of great vessels Transposition of great aeries with an intact ventricular septum is also referred to a simple TGA or isolated TGA. * Cyanosis and tachypnea are most often recognized within hours or day one of life, hypoxemia is severe but hea failure is less common. * Transposition of great aeries with VSD - cyanosis can generally recognized within the { 'l month of life, but it may remain diagnosed in some infants for several months. Treatment - Infusion of prostaglandin E2 should be initiated immediately to maintain patency of the ductus aeriosus and improve oxygenation * Infant who remain severely hypoxic or acidotic despite prostaglandin infusion should undergo Rashkind-halloon atrial septostomy Aerial switch (Jantene) procedure is the surgical treatment of choice for neonates with d-TGA and intact ventricular septum and is usually performed within the 1-2 week of life. Truncus Aeriosus (TA) a single aerial trunk :runcus aeriosus) arises from the hea and supplies the systemic pulmonary and coronary circulation. A VSD is always present Clinical picture - In the immediate newborn period, signs of hea failure are usually absent, a murmur and minimal cyanosis are the initial signs. As a conotruneal lesion, T A is often associated with a deletion of chromosome 22q 11 (DiGeorge syndrome) and associated endocrine immunologic, facial and pulmonary abnormalities Treatment - surgery is indicated usually in the 12 weeks of life Older patients -* Hea -lung transplantation is the only options. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not abrasion?, with the following options: A: Graze, B: Scratches, C: Impact, D: Avulsion ### Response:

Ans. is d i.e., Avulsion Types of abrasion are : ? 1) Scratches (linear abrasion) : It is an abrasion with legnth but no significant width produced by a sharp object e.g., pin, needles, knife, thorn and nail etc. Point scratch is a very superficial incision produced by a sharp or pointed object not sharp enough to incise but pointed enough to produce scratch. 2) Grazes (Sliding abrasion/scraping abrasion/grinding abrasion) : It is the most common type of abrasion, produced when a broad surface of skin slides against rough surface, e.g., during vehicular accidents. Injury is due to friction. The surface of injury show irregular parallel lines, i.e., furrows or grooves. A violent lateral graze, due to rubbing of skin (as in dragging) is known as brush burn (Gravel rash). Friction burn (Scuff or brush abrasion) occur due to tangential contact with a smooth surface or when the skin is covered by clothing. It is an extensive superficial, reddened excoriated area without bleeding and with little or no linear mark. 3) Pressure abrasions (crushing or friction abrasions) : Though it is called friction abrasion, it results from pressure of the object on the body with no or little friction (it is a misnomer). It is caused by crushing of superficial epidermis due to inward directed movement of object at around 90deg to skin. Example are ligature marks in hanging/strangulation, teeth bites and nail marks. 4) Impact abrasion (Imprint or contact abrasion) : It is caused by impact (but not pressure) with a rough object, when the force is applied at or near 90deg to skin surface. It is depressed below surface unless associated with contusion (bruise).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not abrasion?, with the following options: A: Graze, B: Scratches, C: Impact, D: Avulsion ### Response: Ans. is d i.e., Avulsion Types of abrasion are : ? 1) Scratches (linear abrasion) : It is an abrasion with legnth but no significant width produced by a sharp object e.g., pin, needles, knife, thorn and nail etc. Point scratch is a very superficial incision produced by a sharp or pointed object not sharp enough to incise but pointed enough to produce scratch. 2) Grazes (Sliding abrasion/scraping abrasion/grinding abrasion) : It is the most common type of abrasion, produced when a broad surface of skin slides against rough surface, e.g., during vehicular accidents. Injury is due to friction. The surface of injury show irregular parallel lines, i.e., furrows or grooves. A violent lateral graze, due to rubbing of skin (as in dragging) is known as brush burn (Gravel rash). Friction burn (Scuff or brush abrasion) occur due to tangential contact with a smooth surface or when the skin is covered by clothing. It is an extensive superficial, reddened excoriated area without bleeding and with little or no linear mark. 3) Pressure abrasions (crushing or friction abrasions) : Though it is called friction abrasion, it results from pressure of the object on the body with no or little friction (it is a misnomer). It is caused by crushing of superficial epidermis due to inward directed movement of object at around 90deg to skin. Example are ligature marks in hanging/strangulation, teeth bites and nail marks. 4) Impact abrasion (Imprint or contact abrasion) : It is caused by impact (but not pressure) with a rough object, when the force is applied at or near 90deg to skin surface. It is depressed below surface unless associated with contusion (bruise). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The parasympathetic nervous system has central connections with the brain through all of the following cranial nerves, except?, with the following options: A: III, B: VII, C: X, D: V ### Response:

The cranial nerves containing preganglionic general visceral efferent components of the parasympathetic system are the oculomotor, facial, glossopharyngeal, and vagus or III, VII, IX, and X, respectively.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The parasympathetic nervous system has central connections with the brain through all of the following cranial nerves, except?, with the following options: A: III, B: VII, C: X, D: V ### Response: The cranial nerves containing preganglionic general visceral efferent components of the parasympathetic system are the oculomotor, facial, glossopharyngeal, and vagus or III, VII, IX, and X, respectively. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Characteristic of chronic eczema is, with the following options: A: Erythema, B: Induration, C: Lichenification, D: Edema ### Response:

In chronic eczematous conditions, lichenification (cutaneous hyperophy and accentuation of normal skin markings) may alter the characteristic appearance of eczema.Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 71 Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders; Page no: 344

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Characteristic of chronic eczema is, with the following options: A: Erythema, B: Induration, C: Lichenification, D: Edema ### Response: In chronic eczematous conditions, lichenification (cutaneous hyperophy and accentuation of normal skin markings) may alter the characteristic appearance of eczema.Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 71 Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders; Page no: 344 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A young female presented with lacy linear lesions on buccal mucosa since a month with elongation of nail fold beyond the nail bed. What is the diagnosis -, with the following options: A: Psoriasis, B: Geographic tongue, C: Lichen planus, D: Candidiasis ### Response:

As per the clinical picture, features such as forward growth of nail fold beyond nailbed ( pterygium) and lacy linear lesions on tongue points towards lichen planus. LICHEN PLANUS:-Inflammatory T cell mediated auto immune disorder affecting skin, hair,nails and mucous membranes.Four Ps- purple , polygonal and pruritic papule. Nail finding:-thinning , longitudinal ridging, and distal splitting of nail plate. Pterygium/ forward growth of the proximal nailfold with adherence to the proximal nail plate is a classic sign. Mucosal lichen planus:-Reticular pattern.- Lacy white pattern on buccal mucosa- whitish streaks IADVL textbook of dermatology page 1074

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A young female presented with lacy linear lesions on buccal mucosa since a month with elongation of nail fold beyond the nail bed. What is the diagnosis -, with the following options: A: Psoriasis, B: Geographic tongue, C: Lichen planus, D: Candidiasis ### Response: As per the clinical picture, features such as forward growth of nail fold beyond nailbed ( pterygium) and lacy linear lesions on tongue points towards lichen planus. LICHEN PLANUS:-Inflammatory T cell mediated auto immune disorder affecting skin, hair,nails and mucous membranes.Four Ps- purple , polygonal and pruritic papule. Nail finding:-thinning , longitudinal ridging, and distal splitting of nail plate. Pterygium/ forward growth of the proximal nailfold with adherence to the proximal nail plate is a classic sign. Mucosal lichen planus:-Reticular pattern.- Lacy white pattern on buccal mucosa- whitish streaks IADVL textbook of dermatology page 1074 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The single most common feature in Aphasic patients is, with the following options: A: Agraphia, B: Alexia, C: Anomia, D: Apraxia ### Response:

(C) Anomia # Clinical Examination of Language should include the assessment of naming, spontaneous speech, comprehension, repetition, reading, and writing.> A deficit of naming (anomia) is the single most common finding in aphasic patients.# Anomic Aphasia:> Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy; and Alzheimer's disease.# Pure Alexia without Agraphia:> This is the visual equivalent of pure word deafness.> The lesions (usually a combination of damage to the left occipital cortex and to a posterior sector of the corpus callosum- -the splenium) interrupt the flow of visual input into the language network.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The single most common feature in Aphasic patients is, with the following options: A: Agraphia, B: Alexia, C: Anomia, D: Apraxia ### Response: (C) Anomia # Clinical Examination of Language should include the assessment of naming, spontaneous speech, comprehension, repetition, reading, and writing.> A deficit of naming (anomia) is the single most common finding in aphasic patients.# Anomic Aphasia:> Anomic aphasia is the single most common language disturbance seen in head trauma, metabolic encephalopathy; and Alzheimer's disease.# Pure Alexia without Agraphia:> This is the visual equivalent of pure word deafness.> The lesions (usually a combination of damage to the left occipital cortex and to a posterior sector of the corpus callosum- -the splenium) interrupt the flow of visual input into the language network. ### 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 deep palmar arch ?, with the following options: A: Main contribution is by ulnar aery, B: Lie superficial to lumbricals, C: Gives three perforating branches, D: Gives four palmar metacarpal aeries ### Response:

Deep palmar archIt lies across the base of metacarpal bones. It is formed mainly by radial aery and completed by deep branch of ulnar aery. Its branches are :-Three palmar metacarpal aeries on the II, III and IV palmar interossei muscles to join the digital branches of superficial palmar arch.Three perforating aeries :- Anastomose with dorsal metacarpal aeries.Recurrent branches :- Supply carpal bones and join palmar carpal arch.The deep palmar arch lies deep to the oblique head of adductor pollicis, long flexor tendon and lumbrical muscles and passes across the base of metacarpal and interossei.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: True about deep palmar arch ?, with the following options: A: Main contribution is by ulnar aery, B: Lie superficial to lumbricals, C: Gives three perforating branches, D: Gives four palmar metacarpal aeries ### Response: Deep palmar archIt lies across the base of metacarpal bones. It is formed mainly by radial aery and completed by deep branch of ulnar aery. Its branches are :-Three palmar metacarpal aeries on the II, III and IV palmar interossei muscles to join the digital branches of superficial palmar arch.Three perforating aeries :- Anastomose with dorsal metacarpal aeries.Recurrent branches :- Supply carpal bones and join palmar carpal arch.The deep palmar arch lies deep to the oblique head of adductor pollicis, long flexor tendon and lumbrical muscles and passes across the base of metacarpal and interossei. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Child knows his/her sex by the age of?, with the following options: A: 2 years, B: 3 years, C: 4 years, D: 5 years ### Response:

O.P. Ghai 7th ed, page 30

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Child knows his/her sex by the age of?, with the following options: A: 2 years, B: 3 years, C: 4 years, D: 5 years ### Response: O.P. Ghai 7th ed, page 30 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Epidemic typhus cause and vector is, with the following options: A: R. prowazki and louse, B: R. typhi and mite, C: R. conori and tick, D: R. akari and mite ### Response:

Epidemic Typhus Is a type of rickettsial disease of typhus group : Recrudence form of Epidemic typhus : Brill Zinsser Disease Was the 'most formidable rickettsial disease in past' Causative agent: R.prowazekii Vector : Louse (p.capitis,p.corporis) Mode of Transmission: (Not by Louse bite) Scratching and inoculation with infected louse faeces Crushing infected louse on body Inhalation of infected louse faeces or dust Clinical picture : Prolonged febrile illness, Vasculitis Drug of choice : Tetracycline Under International Health Regulations (IHRs), "Louse borne typhus is a disease under surveillance" Ref: Park 25th edition Pgno : 316

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Epidemic typhus cause and vector is, with the following options: A: R. prowazki and louse, B: R. typhi and mite, C: R. conori and tick, D: R. akari and mite ### Response: Epidemic Typhus Is a type of rickettsial disease of typhus group : Recrudence form of Epidemic typhus : Brill Zinsser Disease Was the 'most formidable rickettsial disease in past' Causative agent: R.prowazekii Vector : Louse (p.capitis,p.corporis) Mode of Transmission: (Not by Louse bite) Scratching and inoculation with infected louse faeces Crushing infected louse on body Inhalation of infected louse faeces or dust Clinical picture : Prolonged febrile illness, Vasculitis Drug of choice : Tetracycline Under International Health Regulations (IHRs), "Louse borne typhus is a disease under surveillance" Ref: Park 25th edition Pgno : 316 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 19 - year - old boy suffering from chronic Schizophrenia is put on haloperidol at the dose of 20 mg/day. A week after the initiation of medication the patient shows restlessness, fidgetiness, irritability and cannot sit still at one place. The most appropriate treatment strategy is:, with the following options: A: Increase in the dose of haloperidol, B: Addition of anticholinergic drug, C: Addition of beta blocker, D: Adding another antipsychotic drug ### Response:

The history here is suggestive of akathisia AKATHASIA It is a subjectively unpleasant state of inner restlessness where there is a strong desire to move Signs and symptoms: foot stamping when seated constantly crossing/uncrossing legs rocking from foot to foot constantly pacing up and down Prevalence: Higher prevalence with typical antipsychotics Among atypical antipsychotics, most prevalent withAripiprazole Treatment: Beta blockers like propranolol (DOC) Anticholinergics and benzodiazepines can also be used

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 19 - year - old boy suffering from chronic Schizophrenia is put on haloperidol at the dose of 20 mg/day. A week after the initiation of medication the patient shows restlessness, fidgetiness, irritability and cannot sit still at one place. The most appropriate treatment strategy is:, with the following options: A: Increase in the dose of haloperidol, B: Addition of anticholinergic drug, C: Addition of beta blocker, D: Adding another antipsychotic drug ### Response: The history here is suggestive of akathisia AKATHASIA It is a subjectively unpleasant state of inner restlessness where there is a strong desire to move Signs and symptoms: foot stamping when seated constantly crossing/uncrossing legs rocking from foot to foot constantly pacing up and down Prevalence: Higher prevalence with typical antipsychotics Among atypical antipsychotics, most prevalent withAripiprazole Treatment: Beta blockers like propranolol (DOC) Anticholinergics and benzodiazepines can also 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: In how many flaps is fetal skull opened during autopsy?, with the following options: A: 2, B: 3, C: 4, D: 5 ### Response:

Ans. is 'c' i.e., 4 In infants and fetuses, before skull ossification and suture closure is complete, the fontanelles can be separated and the skull opened in 4 flaps, in a "butterfly" manner.In newborn infants in whom sagittal sinus trauma or developmental abnormalities are suspected, the following alternative cranial opening preserves the critical anatomy.To preserve the superior sagittal sinus, dura is incised at lateral angles of the anterior fontanelle parallel to and approximately 1 cm lateral on both sides of the midline, preserving the superior sagittal sinus in between.Each of these incisions is continued anteriorly and posteriorly (into frontal and occipital bones) and laterally (into the parietal bones) to create two large bone flaps, each on a "hinge" of uncut parietal bone inferiorly.In adults, the saw line is made in slightly V - shaped direction - to remove the skull cap.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In how many flaps is fetal skull opened during autopsy?, with the following options: A: 2, B: 3, C: 4, D: 5 ### Response: Ans. is 'c' i.e., 4 In infants and fetuses, before skull ossification and suture closure is complete, the fontanelles can be separated and the skull opened in 4 flaps, in a "butterfly" manner.In newborn infants in whom sagittal sinus trauma or developmental abnormalities are suspected, the following alternative cranial opening preserves the critical anatomy.To preserve the superior sagittal sinus, dura is incised at lateral angles of the anterior fontanelle parallel to and approximately 1 cm lateral on both sides of the midline, preserving the superior sagittal sinus in between.Each of these incisions is continued anteriorly and posteriorly (into frontal and occipital bones) and laterally (into the parietal bones) to create two large bone flaps, each on a "hinge" of uncut parietal bone inferiorly.In adults, the saw line is made in slightly V - shaped direction - to remove the skull cap. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A patient had injury to right leg by road traffic accident and his leg was amputated. This is ?, with the following options: A: Disease, B: Disability, C: Impairment, D: Handicap ### Response:

Ans. is 'c' i.e., Impairment Any loss of anatomical structure (e.g. loss of leg in this question) is called as impairment. According to WHO definitions, Disease: Any abnormal condition of an individual that impairs function Impairment: Any loss or abnormality of psychological, physiological or anatomical structure or function Disability: (Because of impairment,) any restriction or inability to perform an activity in a range considered normal for a human being Handicap: A disadvantage for a given individual, resulting from an impairment/disability, that limits/prevents fulfillment of a role considered normal (depending on age, sex, social, cultural factors) for that individual For example, Event Classification Interpretation Accident Disease Impairs function of a person Loss of foot Impairment Loss of anatomical structure in the form of foot Cannot Walk Disability Walking is a normal routine daily activity of a human being Unemployed Handicap Loses out his job because he cannot walk, so cannot fulfill his role in the society, i.e, earning for his family members

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A patient had injury to right leg by road traffic accident and his leg was amputated. This is ?, with the following options: A: Disease, B: Disability, C: Impairment, D: Handicap ### Response: Ans. is 'c' i.e., Impairment Any loss of anatomical structure (e.g. loss of leg in this question) is called as impairment. According to WHO definitions, Disease: Any abnormal condition of an individual that impairs function Impairment: Any loss or abnormality of psychological, physiological or anatomical structure or function Disability: (Because of impairment,) any restriction or inability to perform an activity in a range considered normal for a human being Handicap: A disadvantage for a given individual, resulting from an impairment/disability, that limits/prevents fulfillment of a role considered normal (depending on age, sex, social, cultural factors) for that individual For example, Event Classification Interpretation Accident Disease Impairs function of a person Loss of foot Impairment Loss of anatomical structure in the form of foot Cannot Walk Disability Walking is a normal routine daily activity of a human being Unemployed Handicap Loses out his job because he cannot walk, so cannot fulfill his role in the society, i.e, earning for his family members ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vaccine that can be safely given during pregnancy are the following except-, with the following options: A: Tetanus, B: Influena, C: Rubella, D: Pneumpcoccus ### Response:

.vaccines containing live attenuated strains of viruses such as rubella are not administered during pregnancy duto the immunocompromised statesref:parks textbook,ed22,pg 122

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vaccine that can be safely given during pregnancy are the following except-, with the following options: A: Tetanus, B: Influena, C: Rubella, D: Pneumpcoccus ### Response: .vaccines containing live attenuated strains of viruses such as rubella are not administered during pregnancy duto the immunocompromised statesref:parks textbook,ed22,pg 122 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The fastest acting schizontocidal drug among the following is:, with the following options: A: Aemether, B: Mefloquine, C: Chloroquine, D: Proguanil ### Response:

Aemisinin derivatives like dihydroaemisinin, aeether and aemether etc. are fastest acting antimalarial drugs.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The fastest acting schizontocidal drug among the following is:, with the following options: A: Aemether, B: Mefloquine, C: Chloroquine, D: Proguanil ### Response: Aemisinin derivatives like dihydroaemisinin, aeether and aemether etc. are fastest acting antimalarial drugs. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is False about Red Cross emblem-, with the following options: A: It came into existence in 1863 in Geneva meet, B: The veical and horizontal lines are of equal lengths, C: It is used by members of UNO, D: Use of red cross symbol without permission of government of India is a punishable offence in India ### Response:

Ans. is `c' i.e., It is used by members of UNO Emblems of lin ernational Red Cross and Red Crescent Mo. merit o Emblems simply means symbols. o The emblems (symbols) of International Red Cross and Red Crescent Movement are to be placed on Armed Forces Medical Services (humanitarian & medical vehicles, and buildings) to protect them from military attack on the battlefield. o There are four such emblems :? 1. The Red cross The Red cross on white background was the original protection symbol declared at the 1864 Geneva convention. There is an unofficial agreement within the Red Cross and Red Crescent Movement that the shape of the cross should be a cross made up of 5 squares. (Horizontal and veical lines are equal). However, regardless of shape. any Red Cross on white background should be valid and must be recognized as a protection symbol in conflict. o Of the 186 national societies which are currently recognized by ICRC, 152 are using the Red Cross as their official organization emblem. 2. Red crescent Red crescent on white background is used by 33 of the 186 recognized societies world wide. 3. Red crystal (the third protocol emblem) o On 22 June 2006 the ICRC announced that the International Red Cross and Red Crescent Movement adopted the Red Crystal as additional emblem for use by the National societies. 4. Red Lion and Sun No longer in use o All these emblems (symbols) are under the Geneva conventions. kuthorimi users of emblems 3 The authorized users of emblems are ? 1) The armed forces medical services, their personnel units, installations and means of transpo. ii) !CRC (International cornmitte of Red Cross) iii) I FRC (International Federation of Red Cross & Red Crescent Socies) iv) National Red Cross Society. v) First Aid centers that offer totally free medical assistance & are authorized by National Red Cross / Red Crescent Society. Misuse of emblems o Misuse of emblems is prohibited under the 4 Geneva Conventions of 1949. o Under the Indian Law (Geneva conventions Act, 1962), the abuse of the emblems is a pubishable offence. The punishment is a fine of Rs. 500, besides the provision for forfeiture of the goods or vehicles on which the emblem has been used without authorization.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is False about Red Cross emblem-, with the following options: A: It came into existence in 1863 in Geneva meet, B: The veical and horizontal lines are of equal lengths, C: It is used by members of UNO, D: Use of red cross symbol without permission of government of India is a punishable offence in India ### Response: Ans. is `c' i.e., It is used by members of UNO Emblems of lin ernational Red Cross and Red Crescent Mo. merit o Emblems simply means symbols. o The emblems (symbols) of International Red Cross and Red Crescent Movement are to be placed on Armed Forces Medical Services (humanitarian & medical vehicles, and buildings) to protect them from military attack on the battlefield. o There are four such emblems :? 1. The Red cross The Red cross on white background was the original protection symbol declared at the 1864 Geneva convention. There is an unofficial agreement within the Red Cross and Red Crescent Movement that the shape of the cross should be a cross made up of 5 squares. (Horizontal and veical lines are equal). However, regardless of shape. any Red Cross on white background should be valid and must be recognized as a protection symbol in conflict. o Of the 186 national societies which are currently recognized by ICRC, 152 are using the Red Cross as their official organization emblem. 2. Red crescent Red crescent on white background is used by 33 of the 186 recognized societies world wide. 3. Red crystal (the third protocol emblem) o On 22 June 2006 the ICRC announced that the International Red Cross and Red Crescent Movement adopted the Red Crystal as additional emblem for use by the National societies. 4. Red Lion and Sun No longer in use o All these emblems (symbols) are under the Geneva conventions. kuthorimi users of emblems 3 The authorized users of emblems are ? 1) The armed forces medical services, their personnel units, installations and means of transpo. ii) !CRC (International cornmitte of Red Cross) iii) I FRC (International Federation of Red Cross & Red Crescent Socies) iv) National Red Cross Society. v) First Aid centers that offer totally free medical assistance & are authorized by National Red Cross / Red Crescent Society. Misuse of emblems o Misuse of emblems is prohibited under the 4 Geneva Conventions of 1949. o Under the Indian Law (Geneva conventions Act, 1962), the abuse of the emblems is a pubishable offence. The punishment is a fine of Rs. 500, besides the provision for forfeiture of the goods or vehicles on which the emblem has been used without authorization. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A child with an abdominal mass diagnosed of having Wilms tumour. The child may have all of the following features associated with Wilms tumour, EXCEPT:, with the following options: A: Aniridia, B: Hemihyperophy, C: Hypeension, D: Bilateral polycystic kidney ### Response:

Horseshoe kidney is associated with Wilms tumor not bilateral polycystic kidney. In a few children, Wilms tumor occurs in the setting of associated malformations or syndromes, including, Aniridia Hemihyperophy Genitourinary malformations Cryptorchidism Hypospadias Gonadal dysgenesis Pseudohermaphroditism Horseshoe kidney Beck-with-Wiedemann syndrome Denys-Drash syndrome WAGR syndrome (Wilms tumor, aniridia, ambiguous genitalia, mental retardation) Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A child with an abdominal mass diagnosed of having Wilms tumour. The child may have all of the following features associated with Wilms tumour, EXCEPT:, with the following options: A: Aniridia, B: Hemihyperophy, C: Hypeension, D: Bilateral polycystic kidney ### Response: Horseshoe kidney is associated with Wilms tumor not bilateral polycystic kidney. In a few children, Wilms tumor occurs in the setting of associated malformations or syndromes, including, Aniridia Hemihyperophy Genitourinary malformations Cryptorchidism Hypospadias Gonadal dysgenesis Pseudohermaphroditism Horseshoe kidney Beck-with-Wiedemann syndrome Denys-Drash syndrome WAGR syndrome (Wilms tumor, aniridia, ambiguous genitalia, mental retardation) Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Heart failure with preserved ejection firaction-, with the following options: A: Dilated cardiomyopathy, B: Restrictive cardiomyopathy, C: MI, D: Hypertension ### Response:

Ans. is 'b' i.e., Restrictive cardiomyopathy o Diastolic heart failure (DHF) is a clinical syndrome in which patients have:Symptoms and signs of heart failure (HF)Normal or near normal left ventricular (L Vi ejection fraction (EF)Normal or near normal L V volume,, and evidence of diastolic dysfunction (e.g., abnormal pattern ofL Vfilling and elected filling pressures).o By contrast, systolic heart failure (SHE) is characterized by increased L V volume and reduced EF.o Among all patients with HF, as many as half have a normal or near normal LVEF.o This condition has been termed "heart failure with normal ejection fraction " (HFNEF) or"heart failure with preserved ejection fraction " (HF-PEFEtiologies of Heart FailureDepressed Ejection Fraction (<40%)o Coronary artery diseaseMyocardial infarctionaMyocardial ischemiaaoChronic pressure overloadHypertensionaObstructive valvular diseaseao Chronic volume overloadRegurgitant valvular diseaseIntracardiac- (left-to-right) shuntingExtracardiac shuntingo Nonischemic dilated cardiomyopathyFamilial/genetic, disordersInfiltrative disorders3o Toxic/drug induced damageMetabolic disorder3Viralo Chagas diseaseo Disorders of rate and rhythmChronic tachyarrhythmiasChronic tachyarrhythmiasPreserved Ejection Fraction (>40-50%)o Pathologic hypertrophy# Primary (hypertrophic cardiomyopathies)o Agingo Restrictive cardiomyopathy# Infiltrative disorders (amyloidosis sarcoiodosis)o Fibrosiso Endomyocardial disordersPulmonary Heart DiseaseCor pulmonalePulmonary vascular disorders High-Output States# Metabolic disordersThyrotoxicosisNutritional disorders (beriberi)o Excessive blood-flow requirementsSystemic arteriovenous shuntingChronic anemia

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Heart failure with preserved ejection firaction-, with the following options: A: Dilated cardiomyopathy, B: Restrictive cardiomyopathy, C: MI, D: Hypertension ### Response: Ans. is 'b' i.e., Restrictive cardiomyopathy o Diastolic heart failure (DHF) is a clinical syndrome in which patients have:Symptoms and signs of heart failure (HF)Normal or near normal left ventricular (L Vi ejection fraction (EF)Normal or near normal L V volume,, and evidence of diastolic dysfunction (e.g., abnormal pattern ofL Vfilling and elected filling pressures).o By contrast, systolic heart failure (SHE) is characterized by increased L V volume and reduced EF.o Among all patients with HF, as many as half have a normal or near normal LVEF.o This condition has been termed "heart failure with normal ejection fraction " (HFNEF) or"heart failure with preserved ejection fraction " (HF-PEFEtiologies of Heart FailureDepressed Ejection Fraction (<40%)o Coronary artery diseaseMyocardial infarctionaMyocardial ischemiaaoChronic pressure overloadHypertensionaObstructive valvular diseaseao Chronic volume overloadRegurgitant valvular diseaseIntracardiac- (left-to-right) shuntingExtracardiac shuntingo Nonischemic dilated cardiomyopathyFamilial/genetic, disordersInfiltrative disorders3o Toxic/drug induced damageMetabolic disorder3Viralo Chagas diseaseo Disorders of rate and rhythmChronic tachyarrhythmiasChronic tachyarrhythmiasPreserved Ejection Fraction (>40-50%)o Pathologic hypertrophy# Primary (hypertrophic cardiomyopathies)o Agingo Restrictive cardiomyopathy# Infiltrative disorders (amyloidosis sarcoiodosis)o Fibrosiso Endomyocardial disordersPulmonary Heart DiseaseCor pulmonalePulmonary vascular disorders High-Output States# Metabolic disordersThyrotoxicosisNutritional disorders (beriberi)o Excessive blood-flow requirementsSystemic arteriovenous shuntingChronic anemia ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Apple–jelly nodules are seen in –, with the following options: A: Lupus vulgaris, B: DLE, C: Lichen planus, D: Psoriasis ### Response:

"Apple jelly nodules" : - Characterized by yellow-brown nodules with tiny darker granules. On probing, the nodules are soft jelly-like seen in cutaneous TB infection Lupus vulgaris.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Apple–jelly nodules are seen in –, with the following options: A: Lupus vulgaris, B: DLE, C: Lichen planus, D: Psoriasis ### Response: "Apple jelly nodules" : - Characterized by yellow-brown nodules with tiny darker granules. On probing, the nodules are soft jelly-like seen in cutaneous TB infection Lupus vulgaris. ### 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 for yellow fever EXCEPT, with the following options: A: Caused by vector aedes, B: Incubation period of 3-6 days, C: One attack gives life long immunity, D: Validity of vaccination certification begins immediately after vaccination ### Response:

Ans. (d) Validity of vaccination certification begins immediately after vaccinationRef : K. Park 23rd ed. /121, 283

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 for yellow fever EXCEPT, with the following options: A: Caused by vector aedes, B: Incubation period of 3-6 days, C: One attack gives life long immunity, D: Validity of vaccination certification begins immediately after vaccination ### Response: Ans. (d) Validity of vaccination certification begins immediately after vaccinationRef : K. Park 23rd ed. /121, 283 ### 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 characteristic features of treatment of iron deficiency anemia with oral iron supplements, except:, with the following options: A: If 200-300 mg elemental iron is consumed, about 50 mg is absorbed, B: The propoion of iron absorbed reduces as hemoglobin improves, C: The reticulocyte count should begin to increase in two weeks and peak in 4 weeks --this suggests good response to treatment, D: The treatment should be discontinued immediately once hemoglobin normalizes to prevent side effects of iron. ### Response:

A total of200mg given daily in three divided doses produces the maximal haemopoietic response. Iron therapy should be continued for 3-6 months after the correction of deficiency in order to replenish the iron stores. From medical pharmacology padmaja 4th edition page 328 and essential of medical pharmacology K D Tripati 7th edition page no 603

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 characteristic features of treatment of iron deficiency anemia with oral iron supplements, except:, with the following options: A: If 200-300 mg elemental iron is consumed, about 50 mg is absorbed, B: The propoion of iron absorbed reduces as hemoglobin improves, C: The reticulocyte count should begin to increase in two weeks and peak in 4 weeks --this suggests good response to treatment, D: The treatment should be discontinued immediately once hemoglobin normalizes to prevent side effects of iron. ### Response: A total of200mg given daily in three divided doses produces the maximal haemopoietic response. Iron therapy should be continued for 3-6 months after the correction of deficiency in order to replenish the iron stores. From medical pharmacology padmaja 4th edition page 328 and essential of medical pharmacology K D Tripati 7th edition page no 603 ### 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 adverse effects of aminoglycosides except:, with the following options: A: Nephrotoxicity, B: Ototoxicity, C: Neuromuscular blockade, D: Cholestatic jaundice ### Response:

Cholestatic jaundice is seen with usage of Erythromycin (a macrolide) not aminoglycosides.

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 adverse effects of aminoglycosides except:, with the following options: A: Nephrotoxicity, B: Ototoxicity, C: Neuromuscular blockade, D: Cholestatic jaundice ### Response: Cholestatic jaundice is seen with usage of Erythromycin (a macrolide) not aminoglycosides. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Cervical hostility is tested by following except :, with the following options: A: Spinbarkeit, B: Post coital test, C: Miller kuzrole test, D: Keller test ### Response:

Ans. is d i.e. Keller test As explained in question no 15, Post coital test and Miller kurzrok test can detect cervical hostility as noted by rotatory/shaky movement of the sperm in post coital test, or < 3 cm of penetration of cervical mucus in 30 minutes in miller kurzrok test. Spinbarkeit is basically a test for assessing ovulation :At the time of ovulation, the cervical mucus is thin and so profuse that the patient may notice a clear discharge, (called Normal ovulatory cascade). This ovulatory mucus has the propey of great elasticity and will withstand stretching up to a distance of over 10 cm. This phenomenon is called SPINBARKEIT, or thread test for oestrogen activity. Under the influence of progesterone after ovulation mucus becomes thick and opaque and breaks on stretching i.e. hostile for sperms Therefore, indirectly Spinbarkeit test can also detect cervical hostility.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Cervical hostility is tested by following except :, with the following options: A: Spinbarkeit, B: Post coital test, C: Miller kuzrole test, D: Keller test ### Response: Ans. is d i.e. Keller test As explained in question no 15, Post coital test and Miller kurzrok test can detect cervical hostility as noted by rotatory/shaky movement of the sperm in post coital test, or < 3 cm of penetration of cervical mucus in 30 minutes in miller kurzrok test. Spinbarkeit is basically a test for assessing ovulation :At the time of ovulation, the cervical mucus is thin and so profuse that the patient may notice a clear discharge, (called Normal ovulatory cascade). This ovulatory mucus has the propey of great elasticity and will withstand stretching up to a distance of over 10 cm. This phenomenon is called SPINBARKEIT, or thread test for oestrogen activity. Under the influence of progesterone after ovulation mucus becomes thick and opaque and breaks on stretching i.e. hostile for sperms Therefore, indirectly Spinbarkeit test can also detect cervical hostility. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A girl presented with severe hyperkalemia and peaked T waves on ECC. Most rapid way to decrease serum potassium level:, with the following options: A: Calcium gluconate IV, B: Oral resins, C: Insulin + glucose, D: Sodium bicarbonate ### Response:

Ans. c. Insulin + glucose Administering insulin and glucose are the most rapid way to decrease serum potassium level."Intravenous insulin is the fastest way to lower serum potassium levels.""Intravenous calcium gluconate is the first drug to he administered in a patient with hyperkalemia having ECG abnormalities. It stabilizes the myocardium immediately. It acts within minutes and is characterized by improvement in ECG appearance. "Complaints of muscle weakness, nausea, vomiting and fatigue and ECG showing tall peaked T waves, prolonged PR interval, wide QRS and absent P wave is suggestive of Hyperkalemia, Beta-agonists are used in the management of hyperkalemia, not the beta-blockers.ECG changesHypokalemiaHyperkalemia* ST depressionQ* Flattened or inverted T waveQ* Prominent U waveQ* Prolonged PR intervalQ* Rarely S-A blockEarly* Increased T wave amplitudeQ* Peaked T wavesQLater (with severe degrees of hyperkalemia)* Prolonged PR intervalQ* Prolonged QRS durationQ* AV conduction delayQ* Loss of P wavesQ* Sine wave patternQ* Ventricular fibrillation or asystoleQHyperkalemiaHyperkalemia is defined as plasma K+ conc. > 5.0 mmol/L, but every case of Hyperkalemia doesn't require treatment.The management strategy of Hyperkalemia depends upon:Plasma K+ concentrationAssociated muscular weaknessChanges on ECGTreatment of Hyperkalemia is required in following cases:Serum K+ >5 along with ECG manifestation of HyperkalemiaSerum K+ >6 (even when ECG manifestation are not present)In Hyperkalemia the treatment is directed atMinimizing membrane depolarizationRedistribution of potassium (shifting of K+ back into cells)Increased excretion of potassium* Administration of calcium in the form of calcium gluconate, decreases membrane excitabilityQ* Calcium directly reverses the effect of potassium on the cardiac conduction systemQ* Administering insulin and glucose* Alkali therapy with I.V. NaHCO3Q* Beta2 adrenergic agonistQ* (When administered parenterally or in nebulized form, beta2 adrenergic agonist promote cellular uptake of K+)Q* Cation exchange resinQ (Sodium polystyrene sulfonate)* Diuretics (Enhance K+ excretion)Q* Hemodialysis (Most effective and rapid way of lowering plasma K+ conc.)Q

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A girl presented with severe hyperkalemia and peaked T waves on ECC. Most rapid way to decrease serum potassium level:, with the following options: A: Calcium gluconate IV, B: Oral resins, C: Insulin + glucose, D: Sodium bicarbonate ### Response: Ans. c. Insulin + glucose Administering insulin and glucose are the most rapid way to decrease serum potassium level."Intravenous insulin is the fastest way to lower serum potassium levels.""Intravenous calcium gluconate is the first drug to he administered in a patient with hyperkalemia having ECG abnormalities. It stabilizes the myocardium immediately. It acts within minutes and is characterized by improvement in ECG appearance. "Complaints of muscle weakness, nausea, vomiting and fatigue and ECG showing tall peaked T waves, prolonged PR interval, wide QRS and absent P wave is suggestive of Hyperkalemia, Beta-agonists are used in the management of hyperkalemia, not the beta-blockers.ECG changesHypokalemiaHyperkalemia* ST depressionQ* Flattened or inverted T waveQ* Prominent U waveQ* Prolonged PR intervalQ* Rarely S-A blockEarly* Increased T wave amplitudeQ* Peaked T wavesQLater (with severe degrees of hyperkalemia)* Prolonged PR intervalQ* Prolonged QRS durationQ* AV conduction delayQ* Loss of P wavesQ* Sine wave patternQ* Ventricular fibrillation or asystoleQHyperkalemiaHyperkalemia is defined as plasma K+ conc. > 5.0 mmol/L, but every case of Hyperkalemia doesn't require treatment.The management strategy of Hyperkalemia depends upon:Plasma K+ concentrationAssociated muscular weaknessChanges on ECGTreatment of Hyperkalemia is required in following cases:Serum K+ >5 along with ECG manifestation of HyperkalemiaSerum K+ >6 (even when ECG manifestation are not present)In Hyperkalemia the treatment is directed atMinimizing membrane depolarizationRedistribution of potassium (shifting of K+ back into cells)Increased excretion of potassium* Administration of calcium in the form of calcium gluconate, decreases membrane excitabilityQ* Calcium directly reverses the effect of potassium on the cardiac conduction systemQ* Administering insulin and glucose* Alkali therapy with I.V. NaHCO3Q* Beta2 adrenergic agonistQ* (When administered parenterally or in nebulized form, beta2 adrenergic agonist promote cellular uptake of K+)Q* Cation exchange resinQ (Sodium polystyrene sulfonate)* Diuretics (Enhance K+ excretion)Q* Hemodialysis (Most effective and rapid way of lowering plasma K+ conc.)Q ### 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 changes occur in urinary system in pregnancy except :, with the following options: A: Increased GFR, B: Increased RBF, C: Hyperophy of bladder musculature, D: Increased activity of ureters ### Response:

URINARY SYSTEM: Kidney--There is dilatation of the ureter, renal pelvis and the calyces. The kidneys enlarge in length by 1 cm. RBF is increased by 50-75%, maximum by the 16 weeks and is maintained until 34 weeks. Thereafter it falls by 25%. Glomerular filtration rate (GFR) is increased by 50% all throughout pregnancy. Increased GFR causes reduction in maternal plasma levels of creatinine, blood urea nitrogen (BUN) and uric acid. Renal tubules fail to reabsorb glucose, uric acid, amino acids, water soluble vitamins and other substances completely. Ureter: Ureters become atonic due to high progesterone level. Dilatation of the ureter above the pelvic brim with stasis is marked on the right side specially in primigravidae. It is due to dextrorotation of the uterus pressing the right ureter against the pelvic brim and also due to pressure by the right ovarian vein which crosses the right ureter at right angle. The stasis is marked between 20-24 weeks. There is marked hyperophy of the muscle and the sheath of the ureter specially the pelvic pa probably due to estrogen. There is elongation, kinking and outward displacement of the ureters. Bladder: There is marked congestion with hyper-trophy of the muscles and elastic tissues of the wall. In late pregnancy, the bladder mucosa becomes edematous due to venous and lymphatic obstruction especially in primigravidae following early engagement. Increased frequency of micturition is noticed at 6-8 weeks of pregnancy which subsides after 12 weeks. It may be due to resetting of osmoregulation causing increased water intake and polyuria. In late pregnancy, frequency of micturition once more reappears due to pressure on the bladder as the presenting pa descends down the pelvis. Stress incontinence may be observed in late pregnancy due to urethral sphincter weakness. Reference: Dutta's Textbook of Obstetrics 7th edition page 54

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The following changes occur in urinary system in pregnancy except :, with the following options: A: Increased GFR, B: Increased RBF, C: Hyperophy of bladder musculature, D: Increased activity of ureters ### Response: URINARY SYSTEM: Kidney--There is dilatation of the ureter, renal pelvis and the calyces. The kidneys enlarge in length by 1 cm. RBF is increased by 50-75%, maximum by the 16 weeks and is maintained until 34 weeks. Thereafter it falls by 25%. Glomerular filtration rate (GFR) is increased by 50% all throughout pregnancy. Increased GFR causes reduction in maternal plasma levels of creatinine, blood urea nitrogen (BUN) and uric acid. Renal tubules fail to reabsorb glucose, uric acid, amino acids, water soluble vitamins and other substances completely. Ureter: Ureters become atonic due to high progesterone level. Dilatation of the ureter above the pelvic brim with stasis is marked on the right side specially in primigravidae. It is due to dextrorotation of the uterus pressing the right ureter against the pelvic brim and also due to pressure by the right ovarian vein which crosses the right ureter at right angle. The stasis is marked between 20-24 weeks. There is marked hyperophy of the muscle and the sheath of the ureter specially the pelvic pa probably due to estrogen. There is elongation, kinking and outward displacement of the ureters. Bladder: There is marked congestion with hyper-trophy of the muscles and elastic tissues of the wall. In late pregnancy, the bladder mucosa becomes edematous due to venous and lymphatic obstruction especially in primigravidae following early engagement. Increased frequency of micturition is noticed at 6-8 weeks of pregnancy which subsides after 12 weeks. It may be due to resetting of osmoregulation causing increased water intake and polyuria. In late pregnancy, frequency of micturition once more reappears due to pressure on the bladder as the presenting pa descends down the pelvis. Stress incontinence may be observed in late pregnancy due to urethral sphincter weakness. Reference: Dutta's Textbook of Obstetrics 7th edition page 54 ### 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 hallucinogen is considered as angel dust?, with the following options: A: LSD, B: Phencyclidine, C: Heroin, D: Mescaline ### Response:

PCP works primarily as an NMDA receptor antagonist Sma name for phencyclidine is angel dust which is a hallucinogen Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 330-336

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 hallucinogen is considered as angel dust?, with the following options: A: LSD, B: Phencyclidine, C: Heroin, D: Mescaline ### Response: PCP works primarily as an NMDA receptor antagonist Sma name for phencyclidine is angel dust which is a hallucinogen Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 330-336 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which drug of anaesthetics causes hallucination –, with the following options: A: Ketamine, B: Trilene, C: Halothane, D: Trichloroethylene ### Response:

Ketamine causes emergence reaction (emergence delirium) and hallucination.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which drug of anaesthetics causes hallucination –, with the following options: A: Ketamine, B: Trilene, C: Halothane, D: Trichloroethylene ### Response: Ketamine causes emergence reaction (emergence delirium) and hallucination. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Tentative cut is indicative of -, with the following options: A: Homicide, B: Accidental, C: Suicidal, D: Fall from height ### Response:

Hesitation cuts (Tentative cuts or trial cuts) are characteristic features off suicidal attempt.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Tentative cut is indicative of -, with the following options: A: Homicide, B: Accidental, C: Suicidal, D: Fall from height ### Response: Hesitation cuts (Tentative cuts or trial cuts) are characteristic features off suicidal attempt. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In a 6-year-old child with burns involving the whole of head and trunk, estimated body surface area of burns is:, with the following options: A: 44%, B: 52%, C: 55%, D: 58% ### Response:

Ans. (a) 44%6 year old child:Apply Berkow formula:* Head and Trunk =13% for head +13% for anterior trunk +13% for posterior trunk +2% neck* Total =41% - nearby answer =40%

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In a 6-year-old child with burns involving the whole of head and trunk, estimated body surface area of burns is:, with the following options: A: 44%, B: 52%, C: 55%, D: 58% ### Response: Ans. (a) 44%6 year old child:Apply Berkow formula:* Head and Trunk =13% for head +13% for anterior trunk +13% for posterior trunk +2% neck* Total =41% - nearby answer =40% ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Myasthenia gravis is most commonly associated with which of the following?, with the following options: A: Thymoma, B: Thymic carcinoma, C: Thymic hyperplasia, D: Lymphoma ### Response:

Myasthenia gravis Autoimmune disease with fluctuating muscle weakness that is caused by autoantibodies that target the neuromuscular junction. About 85% of patients have autoantibodies against post-synaptic ACh receptors, while most of the remaining patients have antibodies against the sarcolemmal protein muscle-specific receptor tyrosine kinase. C/F: - Ptosis or diplopia (Weakness in extraocular muscle) There is a strong association between pathogenic anti-ACh receptor autoantibodies and thymic abnormalities. Approximately 10% of patients with myasthenia gravis have a thymoma, a tumour of thymic epithelial cells. An additional 30% of patients (and paicularly young patients) have a different thymic abnormality called thymic hyperplasia. Acetylcholinesterase inhibitors that increase the half-life of ACh are the first line of treatment.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Myasthenia gravis is most commonly associated with which of the following?, with the following options: A: Thymoma, B: Thymic carcinoma, C: Thymic hyperplasia, D: Lymphoma ### Response: Myasthenia gravis Autoimmune disease with fluctuating muscle weakness that is caused by autoantibodies that target the neuromuscular junction. About 85% of patients have autoantibodies against post-synaptic ACh receptors, while most of the remaining patients have antibodies against the sarcolemmal protein muscle-specific receptor tyrosine kinase. C/F: - Ptosis or diplopia (Weakness in extraocular muscle) There is a strong association between pathogenic anti-ACh receptor autoantibodies and thymic abnormalities. Approximately 10% of patients with myasthenia gravis have a thymoma, a tumour of thymic epithelial cells. An additional 30% of patients (and paicularly young patients) have a different thymic abnormality called thymic hyperplasia. Acetylcholinesterase inhibitors that increase the half-life of ACh are the first line of treatment. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: First clinical feature of cerebello-pontine angle tumor is ?, with the following options: A: Reduced lacrimation, B: Loss of corneal reflex, C: Hoarseness of voice, D: Exaggerated tendon reflexes ### Response:

Answer- B. Loss of corneal reflexAbsent corneal reflex is the earliest sign of cerebellopontine (CP) angle tumors like acoustic neuroma.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: First clinical feature of cerebello-pontine angle tumor is ?, with the following options: A: Reduced lacrimation, B: Loss of corneal reflex, C: Hoarseness of voice, D: Exaggerated tendon reflexes ### Response: Answer- B. Loss of corneal reflexAbsent corneal reflex is the earliest sign of cerebellopontine (CP) angle tumors like acoustic neuroma. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: What disappears first in post mortem rigidity -, with the following options: A: Eyelids, B: Neck, C: Lower limbs, D: Upper limbs ### Response:

Rigor mortis passes off in same order in which it has appeared. Thus upper eyelid is the first voluntary muscles, from which it disappears.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: What disappears first in post mortem rigidity -, with the following options: A: Eyelids, B: Neck, C: Lower limbs, D: Upper limbs ### Response: Rigor mortis passes off in same order in which it has appeared. Thus upper eyelid is the first voluntary muscles, from which it disappears. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Commonest complication of CSOM is, with the following options: A: Subperiosteal abscess, B: Mastoiditis, C: Brain abscess, D: Meningitis ### Response:

50% of brain abscesses in adults and 25% in children are otogenic in origin. In adults, an abscess usually follows CSOM with cholesteatoma. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 90)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Commonest complication of CSOM is, with the following options: A: Subperiosteal abscess, B: Mastoiditis, C: Brain abscess, D: Meningitis ### Response: 50% of brain abscesses in adults and 25% in children are otogenic in origin. In adults, an abscess usually follows CSOM with cholesteatoma. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 90) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 54-year-old woman with rheumatoid arthritis presents with a 2-year history of dry eyes and dry mouth. Physical examination confirms xerostomia (dry mouth) and xerophthalmia (dry eyes) and reveals enlarged lacrimal glands bilaterally. Histologic examination of the lacrimal glands would likely show an infiltrate of which of the following inflammatory cell types?, with the following options: A: Fibroblasts, B: Lymphocytes, C: Macrophages, D: Mast cells ### Response:

This patient has Sjogren (sicca) syndrome, an autoimmune disease characterized by an intense lymphocytic infiltration of the salivary and lacrimal glands. Patients develop xerostomia and xerophthalmia. The other choices are not characteristic of autoimmune disease.Diagnosis: Sjogren syndrome

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 54-year-old woman with rheumatoid arthritis presents with a 2-year history of dry eyes and dry mouth. Physical examination confirms xerostomia (dry mouth) and xerophthalmia (dry eyes) and reveals enlarged lacrimal glands bilaterally. Histologic examination of the lacrimal glands would likely show an infiltrate of which of the following inflammatory cell types?, with the following options: A: Fibroblasts, B: Lymphocytes, C: Macrophages, D: Mast cells ### Response: This patient has Sjogren (sicca) syndrome, an autoimmune disease characterized by an intense lymphocytic infiltration of the salivary and lacrimal glands. Patients develop xerostomia and xerophthalmia. The other choices are not characteristic of autoimmune disease.Diagnosis: Sjogren syndrome ### 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 Eustachian tube -, with the following options: A: Length is 36 mm in adults and 1.6 mm to 3 mm in children, B: Higher elastin content in adults, C: Ventilatory function of ear better developed in infants, D: More horizontal in adults ### Response:

“Eustachian tube serves to ventilate the middle ear and exchange nasopharyngeal air in the middle ear. In children, ET is relatively narrow. It is prone to obstructionQ when mucosa swell in response to infection or allergic challenge and it results in middle ear effusion”

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: True about Eustachian tube -, with the following options: A: Length is 36 mm in adults and 1.6 mm to 3 mm in children, B: Higher elastin content in adults, C: Ventilatory function of ear better developed in infants, D: More horizontal in adults ### Response: “Eustachian tube serves to ventilate the middle ear and exchange nasopharyngeal air in the middle ear. In children, ET is relatively narrow. It is prone to obstructionQ when mucosa swell in response to infection or allergic challenge and it results in middle ear effusion” ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A boy complained of unprovoked bite by a local dog in the community. The dog was later caught by the local animal authorities and appeared to the healthy. The most appropriate course of action would be:, with the following options: A: Give post-exposure prophylaxis to the bitten person with cell-culture derived vaccine, B: Withhold vaccination, keep the dog under observation for ten days for signs of rabies, C: Test the dog for rabies antibodies, D: Immediately carry out euthanasia of the dog ### Response:

The boy should be treated irrespective of the condition of the dog with PEP including vaccination and local wound treatment, Immunoglobulins may be used in Category 3 bite. The dog should be observed for 10 days, and if the dog remains healthy throughout the period, PEP may be discontinued. However, PEP should NOT be withheld.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A boy complained of unprovoked bite by a local dog in the community. The dog was later caught by the local animal authorities and appeared to the healthy. The most appropriate course of action would be:, with the following options: A: Give post-exposure prophylaxis to the bitten person with cell-culture derived vaccine, B: Withhold vaccination, keep the dog under observation for ten days for signs of rabies, C: Test the dog for rabies antibodies, D: Immediately carry out euthanasia of the dog ### Response: The boy should be treated irrespective of the condition of the dog with PEP including vaccination and local wound treatment, Immunoglobulins may be used in Category 3 bite. The dog should be observed for 10 days, and if the dog remains healthy throughout the period, PEP may be discontinued. However, PEP should NOT be withheld. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In disaster management all are true except-, with the following options: A: Mitigation before a disaster strikes, B: Response in pre-disaster phase, C: Yellow color is for medium priority, D: Gastroenteritis is commonest infection after disaster ### Response:

Disaster management Management sequence of a sudden-onset disaster is as follows:- a) Risk reduction phase before a disaster strikes It includes:- Mitigation: Measures designed either to prevent hazards from causing emergency or to lessen the likely effect of emergencies. Preparedness: To ensure that appropriate systems, procedures and resources are in place to provide prompt effective assistance to disaster victims. b) Disaster Impact Most injuries are sustained during the impact, and thus greatest need for emergency care occurs in first few hours. The management can be divided into Search, rescue and first aid: Most immediate help comes from uninjured survivors. Field care: As many injured patients come simultaneously, emergency services should be proper in terms of priorty and numbers of facilities. Triage: Triage consists of classifying the injured on the basis of severity of injuries and the likely hood of their survival with prompt medical intervention. The most common triage classification system used internationally is four colour code system i) Red → High priority treatment or transfer ii) Yellow → Medium priority iii) Green → Ambulatory patients iv) Black → Dead or moribund patients 4. Tagging : All patients should be identified with tags. 5. Identification of dead : Proper respect to dead is of great importance. c) Recovery phase after disaster  It includes :- Response : Response starts with disaster impact and extends in recovery phase. Rheabilitation and reconstruction : These should lead to restoration of pre-disaster condition The ‘control room’ is nodal center in terms of disaster management. The diseases common after a disaster are: Gastroenteritis (most common), acute respiratory infections (pneumonia), leptospirosis, rabies, equine encephalitis and rickettsiosis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In disaster management all are true except-, with the following options: A: Mitigation before a disaster strikes, B: Response in pre-disaster phase, C: Yellow color is for medium priority, D: Gastroenteritis is commonest infection after disaster ### Response: Disaster management Management sequence of a sudden-onset disaster is as follows:- a) Risk reduction phase before a disaster strikes It includes:- Mitigation: Measures designed either to prevent hazards from causing emergency or to lessen the likely effect of emergencies. Preparedness: To ensure that appropriate systems, procedures and resources are in place to provide prompt effective assistance to disaster victims. b) Disaster Impact Most injuries are sustained during the impact, and thus greatest need for emergency care occurs in first few hours. The management can be divided into Search, rescue and first aid: Most immediate help comes from uninjured survivors. Field care: As many injured patients come simultaneously, emergency services should be proper in terms of priorty and numbers of facilities. Triage: Triage consists of classifying the injured on the basis of severity of injuries and the likely hood of their survival with prompt medical intervention. The most common triage classification system used internationally is four colour code system i) Red → High priority treatment or transfer ii) Yellow → Medium priority iii) Green → Ambulatory patients iv) Black → Dead or moribund patients 4. Tagging : All patients should be identified with tags. 5. Identification of dead : Proper respect to dead is of great importance. c) Recovery phase after disaster  It includes :- Response : Response starts with disaster impact and extends in recovery phase. Rheabilitation and reconstruction : These should lead to restoration of pre-disaster condition The ‘control room’ is nodal center in terms of disaster management. The diseases common after a disaster are: Gastroenteritis (most common), acute respiratory infections (pneumonia), leptospirosis, rabies, equine encephalitis and rickettsiosis. ### 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 somatization disorder except:, with the following options: A: Maintain sick role, B: 4-Pain symptoms, C: 1-Sexual symptom, D: 1-Pseudo neurological symptom ### Response:

Ans:A-Maintain sick roleSomatic symptom disorder (SSD formerly known as "somatization disorder" or "somatoform disorder") is a form of mental illness that causes one or more bodily symptoms, including pain.The symptoms may or may not be traceable to a physical cause including general medical conditions, other mental illnesses, or substance abuse. But regardless, they cause excessive and dispropoionate levels of distress.The symptoms can involve one or more different organs and body systems, such as:PainNeurologic problemsGastrointestinal complaintsSexual symptomsMany people who have SSD will also have an anxiety disorder.People with SSD are not faking their symptoms. The distress they experience from pain and other problems they experience are real, regardless of whether or not a physical explanation can be found. And the distress from symptoms significantly affects daily functioning.

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 somatization disorder except:, with the following options: A: Maintain sick role, B: 4-Pain symptoms, C: 1-Sexual symptom, D: 1-Pseudo neurological symptom ### Response: Ans:A-Maintain sick roleSomatic symptom disorder (SSD formerly known as "somatization disorder" or "somatoform disorder") is a form of mental illness that causes one or more bodily symptoms, including pain.The symptoms may or may not be traceable to a physical cause including general medical conditions, other mental illnesses, or substance abuse. But regardless, they cause excessive and dispropoionate levels of distress.The symptoms can involve one or more different organs and body systems, such as:PainNeurologic problemsGastrointestinal complaintsSexual symptomsMany people who have SSD will also have an anxiety disorder.People with SSD are not faking their symptoms. The distress they experience from pain and other problems they experience are real, regardless of whether or not a physical explanation can be found. And the distress from symptoms significantly affects daily functioning. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Aerial supply to middle l/3rd of vagina is by ?, with the following options: A: Internal pudendal aery, B: Uterine aery, C: Inferior vesical aery, D: Middle rectal aery ### Response:

Ans. is 'c' i.e., Inferior vesical aeryAerial supply of vaginaVaginal branch of internal iliac (main supply)Cervicovaginal branch of uterine aery (in upper pa).Middle rectal and internal pudendal aeries (in lower pa).Inferiorvesical aery (in middle 3rd).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Aerial supply to middle l/3rd of vagina is by ?, with the following options: A: Internal pudendal aery, B: Uterine aery, C: Inferior vesical aery, D: Middle rectal aery ### Response: Ans. is 'c' i.e., Inferior vesical aeryAerial supply of vaginaVaginal branch of internal iliac (main supply)Cervicovaginal branch of uterine aery (in upper pa).Middle rectal and internal pudendal aeries (in lower pa).Inferiorvesical aery (in middle 3rd). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Drug of choice for pregnancy induced hypertension is:, with the following options: A: Methyl dopa, B: Atenolol, C: Nitroprusside, D: Enalapril ### Response:

Ans. (A) Methyl dopa(Ref: Goodman Gilman 12th/e p773, 774; Katzung 12th/e p176)Alpha methyl dopa is drug of choice for pregnancy induced hypertension. However, these days labetalol is preferred for this indication.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Drug of choice for pregnancy induced hypertension is:, with the following options: A: Methyl dopa, B: Atenolol, C: Nitroprusside, D: Enalapril ### Response: Ans. (A) Methyl dopa(Ref: Goodman Gilman 12th/e p773, 774; Katzung 12th/e p176)Alpha methyl dopa is drug of choice for pregnancy induced hypertension. However, these days labetalol is preferred for this indication. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: When there is no other source of glucose, liver and muscle glycogen would be exhausted after, with the following options: A: 12 hours, B: 18 hours, C: 24 hours, D: 36 hours ### Response:

Were there no other source of glucose, liver and muscle glycogen would be exhausted after about 18 hours of fasting. As fasting becomes more prolonged, so an increasing amount of the amino acids released as a result of protein catabolism is utilized in the liver and kidneys for gluconeogenesis. Reference: Harper; 30th edition; Chapter 14; Page no: 149

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: When there is no other source of glucose, liver and muscle glycogen would be exhausted after, with the following options: A: 12 hours, B: 18 hours, C: 24 hours, D: 36 hours ### Response: Were there no other source of glucose, liver and muscle glycogen would be exhausted after about 18 hours of fasting. As fasting becomes more prolonged, so an increasing amount of the amino acids released as a result of protein catabolism is utilized in the liver and kidneys for gluconeogenesis. Reference: Harper; 30th edition; Chapter 14; Page no: 149 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Transition from G2 to M phase of the ceil cycle is controlled by, with the following options: A: Retinoblastoma gene product, B: p53 protein, C: CyclinE, D: CyclinB ### Response:

. CyclinB

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Transition from G2 to M phase of the ceil cycle is controlled by, with the following options: A: Retinoblastoma gene product, B: p53 protein, C: CyclinE, D: CyclinB ### Response: . CyclinB ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Frieberg's disease involve -, with the following options: A: Tibial tuberosity, B: Calcaneal tuberosity, C: 2nd metatarsal, D: 5th metarasal ### Response:

*Frieberg's disease is osteochondritis of 2nd metatarsal head. Ref: Appley's 9th/e p.723

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Frieberg's disease involve -, with the following options: A: Tibial tuberosity, B: Calcaneal tuberosity, C: 2nd metatarsal, D: 5th metarasal ### Response: *Frieberg's disease is osteochondritis of 2nd metatarsal head. Ref: Appley's 9th/e p.723 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Disc edema is not seen in:, with the following options: A: Retro bulbar neuritis, B: Papillitis, C: Papilledema, D: Optic nerve glioma ### Response:

Retro bulbar neuritis REF: Neuro-ophthalmology: the practical guide, By Leonard A. Levin page 101 Optic Disc Edema: Possible diagnostic consideration of appearance of optic disc edema is to determine whether the disc edema is pathological or just the disc itself is congenitally elevated (Pseudopapilledema). A reliable indicator of Pseudopapilledema is the presence of anomalous vessels on the disc. Now if disc is truly swollen then its turn to decide, it is due to increased ICT (papilledema) or any other cause of disc edema. Unilateral Visual Increased Anomalous Broad category Examples or Bilateral function ICT vessels Generally bilateral Normal No Yes Pseudopapilledema Pseudopapilledema (aka-Optic Disc Drusen- congenital & asymptomatic) Bilateral Normal Yes No Papilledema Papilledema Either Normal No No Disc edema with preserved vision Diabetic papillopathy Aerial hypeension Papillophlebitis Either Abnormal No No Disc edema with abnormal vision Optic neuritis (Papillitis) Neuroretinitis Optic nerve tumors Optic nerve glioma Optic nerve sheath meningioma Anterior ischemic optic neuropathy

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Disc edema is not seen in:, with the following options: A: Retro bulbar neuritis, B: Papillitis, C: Papilledema, D: Optic nerve glioma ### Response: Retro bulbar neuritis REF: Neuro-ophthalmology: the practical guide, By Leonard A. Levin page 101 Optic Disc Edema: Possible diagnostic consideration of appearance of optic disc edema is to determine whether the disc edema is pathological or just the disc itself is congenitally elevated (Pseudopapilledema). A reliable indicator of Pseudopapilledema is the presence of anomalous vessels on the disc. Now if disc is truly swollen then its turn to decide, it is due to increased ICT (papilledema) or any other cause of disc edema. Unilateral Visual Increased Anomalous Broad category Examples or Bilateral function ICT vessels Generally bilateral Normal No Yes Pseudopapilledema Pseudopapilledema (aka-Optic Disc Drusen- congenital & asymptomatic) Bilateral Normal Yes No Papilledema Papilledema Either Normal No No Disc edema with preserved vision Diabetic papillopathy Aerial hypeension Papillophlebitis Either Abnormal No No Disc edema with abnormal vision Optic neuritis (Papillitis) Neuroretinitis Optic nerve tumors Optic nerve glioma Optic nerve sheath meningioma Anterior ischemic optic neuropathy ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The given instrument is used for harvesting the graft from healthy area in split skin thickness graft. What is this called?, with the following options: A: Humby knife, B: Silvers knife, C: Dermatome, D: Catlin amputating knife ### Response:

Ans. A. Humby knife* This is a "Humby" skin-grafting knife, formerly owned by Sir Edward "Weary"Dunlop, and made in 1950s.Silver's knifeBrown dermatome

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The given instrument is used for harvesting the graft from healthy area in split skin thickness graft. What is this called?, with the following options: A: Humby knife, B: Silvers knife, C: Dermatome, D: Catlin amputating knife ### Response: Ans. A. Humby knife* This is a "Humby" skin-grafting knife, formerly owned by Sir Edward "Weary"Dunlop, and made in 1950s.Silver's knifeBrown dermatome ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: According to disabilities ACT 1995. Seventh disability is usually refferred to as ?, with the following options: A: Neurological abnormality, B: Mental illness, C: Substance abuse, D: Disability due to road traffic accident ### Response:

Mental illness According to disabilities act 1995, the disabilities are:- i) Blindness ii) Low vision iii) Leprosy cured iv) Hearing impairment v) Locomotor disability vi) Mental retardation vii) Mental illness

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: According to disabilities ACT 1995. Seventh disability is usually refferred to as ?, with the following options: A: Neurological abnormality, B: Mental illness, C: Substance abuse, D: Disability due to road traffic accident ### Response: Mental illness According to disabilities act 1995, the disabilities are:- i) Blindness ii) Low vision iii) Leprosy cured iv) Hearing impairment v) Locomotor disability vi) Mental retardation vii) Mental illness ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Sprinter gets its immediate energy from -, with the following options: A: Glycogen, B: Fatty acid, C: Creatine phosphate, D: None ### Response:

Ans. is 'c' i.e., Creatine phosphate Source of energy for muscular activityo The immediate source of energy for all muscle contraction is ATP, followed immediately by creatine phosphate6. In stemous exercise ATP store is sufficient only for 1-2 seconds and creatine phosphate for another 5-7 seconds. Thus, energy rich phosphagen stores (ATP and creatine phosphate) permit severe muscle contraction for 8-10 seconds only. After this, energy is obtained from the metabolism of stored glycogen or from circulating glucose and free fatty acids, depending upon the availability- of oxygen. Energy source during in exercise can be summarized by : -Short burst of intense activity (e.g., 100 meter sprint or weight lifting) : - All energy comes from ATP and creatine phosphateQ. Breakdown of these compound is an anaerobic processesQ.Little longer intense exercise (e.g., 200 m eter sprint or 100 meter swim): - Besides ATP and creatine phosphate, glycogen is metabolised by anerobic6 glycolytic pathways to provide a ready source of energy. So, muscle work is anaerobic.in) Longer duration exercise (e.g., jogging, marathan run) : - The muscle w ork is aerobic and energy comes from aerobic utilization of glucose and free fatty acids. More glucose is utilized at the initial stage, but as the exercise is prolonged, free fatty acids become the predominant fuelQ.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Sprinter gets its immediate energy from -, with the following options: A: Glycogen, B: Fatty acid, C: Creatine phosphate, D: None ### Response: Ans. is 'c' i.e., Creatine phosphate Source of energy for muscular activityo The immediate source of energy for all muscle contraction is ATP, followed immediately by creatine phosphate6. In stemous exercise ATP store is sufficient only for 1-2 seconds and creatine phosphate for another 5-7 seconds. Thus, energy rich phosphagen stores (ATP and creatine phosphate) permit severe muscle contraction for 8-10 seconds only. After this, energy is obtained from the metabolism of stored glycogen or from circulating glucose and free fatty acids, depending upon the availability- of oxygen. Energy source during in exercise can be summarized by : -Short burst of intense activity (e.g., 100 meter sprint or weight lifting) : - All energy comes from ATP and creatine phosphateQ. Breakdown of these compound is an anaerobic processesQ.Little longer intense exercise (e.g., 200 m eter sprint or 100 meter swim): - Besides ATP and creatine phosphate, glycogen is metabolised by anerobic6 glycolytic pathways to provide a ready source of energy. So, muscle work is anaerobic.in) Longer duration exercise (e.g., jogging, marathan run) : - The muscle w ork is aerobic and energy comes from aerobic utilization of glucose and free fatty acids. More glucose is utilized at the initial stage, but as the exercise is prolonged, free fatty acids become the predominant fuelQ. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Fever & hemorrhagic rash are seen in ail except:, with the following options: A: Dengu fever, B: Lassa fever, C: Rift Valley fever, D: Sand fly fever ### Response:

Ans: D (Sand,.) [Ref: Ananthanarayan 8th/514.518-19; Harrison 18th/l50,1629; Medical microbiology by Greenwood 16 th /4961The viral HF syndrome is a constellation of findings based on vascular instability and decreased vascular integrity. An assault, direct or indirect, on the microvasculature leads to increased permeability and (particularly when platelet function is decreased) to actual disruption and local hemorrhage"Dengue (breakbone fever) Q is a mosquito-borne infection caused by a flavivirus that is characterized by fever, severe headache, muscle and joint pain, nausea and vomiting, eye pain, and rash"-Harrison 18th/1632"Lassa fever: The disease is characterized by very high fever, mouth ulcers, severe muscle aches, skin rash with hemorrhages, pneumonia, and heart and kidney damage"- Harrison 18th/1628Viral hemorrhagic feverArboviruses and arenavirusesPetechial rash Residence in or travel to endemic areas or other virus exposureTriad of fever, shock, hemorrhage from mucosa or gastrointestinal tractTable (Harrison 18th/1629): Viral Hemorrhagic Fever (HF) Syndromes and Their DistributionDiseaseIncubation Period, DaysCase-Infection RatioCase-Fatality Rate, %Geographic RangeTarget PopulationLasso fever-5-16Mild infections probably common15West AfricaAll ages, both sexesRift Valley fever2-5~1:100a~50Sub-Saharan Africa, Madagascar. EgyptAll ages, both sexes; more often diagnosed in men; preexisting liver disease may predisposeCrimean-Congo HF3-12>1:515-30Africa, Middle East, Turkey, Balkans, southern region of former Soviet Union, western ChinaAll ages, both sexes: men more exposed in some settingsYellow fever3-61:2-1:2020Africa, South AmericaAh ages, both sexes; adults more exposed in jungle setting; preexisting flavivirus immunity may cross-protectDengue HF/dengue shock syndrome2-7Nonimmune, 1:10,000; heterologous immune, 1:100<1 with supportive treatmentTropics and subtropics worldwidePredominantly children: previous heterologous dengue infection predisposes to HF

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Fever & hemorrhagic rash are seen in ail except:, with the following options: A: Dengu fever, B: Lassa fever, C: Rift Valley fever, D: Sand fly fever ### Response: Ans: D (Sand,.) [Ref: Ananthanarayan 8th/514.518-19; Harrison 18th/l50,1629; Medical microbiology by Greenwood 16 th /4961The viral HF syndrome is a constellation of findings based on vascular instability and decreased vascular integrity. An assault, direct or indirect, on the microvasculature leads to increased permeability and (particularly when platelet function is decreased) to actual disruption and local hemorrhage"Dengue (breakbone fever) Q is a mosquito-borne infection caused by a flavivirus that is characterized by fever, severe headache, muscle and joint pain, nausea and vomiting, eye pain, and rash"-Harrison 18th/1632"Lassa fever: The disease is characterized by very high fever, mouth ulcers, severe muscle aches, skin rash with hemorrhages, pneumonia, and heart and kidney damage"- Harrison 18th/1628Viral hemorrhagic feverArboviruses and arenavirusesPetechial rash Residence in or travel to endemic areas or other virus exposureTriad of fever, shock, hemorrhage from mucosa or gastrointestinal tractTable (Harrison 18th/1629): Viral Hemorrhagic Fever (HF) Syndromes and Their DistributionDiseaseIncubation Period, DaysCase-Infection RatioCase-Fatality Rate, %Geographic RangeTarget PopulationLasso fever-5-16Mild infections probably common15West AfricaAll ages, both sexesRift Valley fever2-5~1:100a~50Sub-Saharan Africa, Madagascar. EgyptAll ages, both sexes; more often diagnosed in men; preexisting liver disease may predisposeCrimean-Congo HF3-12>1:515-30Africa, Middle East, Turkey, Balkans, southern region of former Soviet Union, western ChinaAll ages, both sexes: men more exposed in some settingsYellow fever3-61:2-1:2020Africa, South AmericaAh ages, both sexes; adults more exposed in jungle setting; preexisting flavivirus immunity may cross-protectDengue HF/dengue shock syndrome2-7Nonimmune, 1:10,000; heterologous immune, 1:100<1 with supportive treatmentTropics and subtropics worldwidePredominantly children: previous heterologous dengue infection predisposes to HF ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vascular sign of narath is seen in-, with the following options: A: Dislocation of hip, B: Dislocation of knee, C: Dislocation of elbow, D: Dislocation of shoulder ### Response:

Vascular sign of Narath *Normally femoral pulse is felt in the groin against head of the femur. *In posterior dislocation of hip the vessels fall back unsuppoed, so femoral aerial pulsation, which isn't felt against the head of the femur will be feeble or even, may not be palpable. Ref: Textbook of Ohopaedics by kotwal p.25

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Vascular sign of narath is seen in-, with the following options: A: Dislocation of hip, B: Dislocation of knee, C: Dislocation of elbow, D: Dislocation of shoulder ### Response: Vascular sign of Narath *Normally femoral pulse is felt in the groin against head of the femur. *In posterior dislocation of hip the vessels fall back unsuppoed, so femoral aerial pulsation, which isn't felt against the head of the femur will be feeble or even, may not be palpable. Ref: Textbook of Ohopaedics by kotwal p.25 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Balthazar scoring system is used for?, with the following options: A: Acute Pancreatitis, B: Acute Appendicitis, C: Acute Cholecystitis, D: Cholangitis ### Response:

ANSWER: (A) Acute PancreatitisREF: REF: Schwartz 9th ed chapter 33, Sabiston 18th ed chapter 55, The Washington Manual of Critical Care by Marin Kollef page 418See "ASSESSMENT OF SEVERITY OF PANCREATITIS" in Surgery 2012 Session 2

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Balthazar scoring system is used for?, with the following options: A: Acute Pancreatitis, B: Acute Appendicitis, C: Acute Cholecystitis, D: Cholangitis ### Response: ANSWER: (A) Acute PancreatitisREF: REF: Schwartz 9th ed chapter 33, Sabiston 18th ed chapter 55, The Washington Manual of Critical Care by Marin Kollef page 418See "ASSESSMENT OF SEVERITY OF PANCREATITIS" in Surgery 2012 Session 2 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: EDD ( Expected Date of Delivery) is calculated by:, with the following options: A: Young's rule, B: Naegele's formula, C: Cardiff Formula, D: Hadlock Formula ### Response:

Expected date of delivery is calculated by - Naegele's formula From the 1st day of last menstrual cycle - 9 months + 7 days

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: EDD ( Expected Date of Delivery) is calculated by:, with the following options: A: Young's rule, B: Naegele's formula, C: Cardiff Formula, D: Hadlock Formula ### Response: Expected date of delivery is calculated by - Naegele's formula From the 1st day of last menstrual cycle - 9 months + 7 days ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Greenstick/ Nightstick fractures are seen in -, with the following options: A: Children, B: Elderly, C: Young adults, D: Common in all age groups ### Response:

Ans. is 'a' i.e., Children Greenstick fractureso A greenstick fracture is an incomplete transverse fracture pattern seen in childreno Greenstick fractures occur when an injuring force applied to a bone exceeds the limits of elasticity of the bone. This results in the bone's bending to the point of bony disruption and fracture on the side opposite to the applied forceo However, a green-stick fracture is an incomplete fracture, in which the compressed cortex and periosteum remain intact.o Greenstick fractures of radius-ulna are common fractures in children and often result from a fall on a outstretched hands.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Greenstick/ Nightstick fractures are seen in -, with the following options: A: Children, B: Elderly, C: Young adults, D: Common in all age groups ### Response: Ans. is 'a' i.e., Children Greenstick fractureso A greenstick fracture is an incomplete transverse fracture pattern seen in childreno Greenstick fractures occur when an injuring force applied to a bone exceeds the limits of elasticity of the bone. This results in the bone's bending to the point of bony disruption and fracture on the side opposite to the applied forceo However, a green-stick fracture is an incomplete fracture, in which the compressed cortex and periosteum remain intact.o Greenstick fractures of radius-ulna are common fractures in children and often result from a fall on a outstretched hands. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Best time for hearing assessment in an infant -, with the following options: A: 1st month of life, B: 3-6 months, C: 6-9 months, D: 9-12 months ### Response:

Ans. is 'a' i.e., 1st month of lifeo The American Academy of Pediatrics (AAP), Joint Committee on Infant hearing (2007), has recommended that all newborn infants be screened for hearing impairment either as neonate or before 1 month of age and that those infants who fail newborn screening have an audiologic examination to varifv hearing loss before age of 3 months.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Best time for hearing assessment in an infant -, with the following options: A: 1st month of life, B: 3-6 months, C: 6-9 months, D: 9-12 months ### Response: Ans. is 'a' i.e., 1st month of lifeo The American Academy of Pediatrics (AAP), Joint Committee on Infant hearing (2007), has recommended that all newborn infants be screened for hearing impairment either as neonate or before 1 month of age and that those infants who fail newborn screening have an audiologic examination to varifv hearing loss before age of 3 months. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The maximum number of death in children occur in following age group -, with the following options: A: 2-5 years, B: 1-2 years, C: first 7 days, D: 6 months - 12 months ### Response:

Ans. is 'c' i.e., First 7 days

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The maximum number of death in children occur in following age group -, with the following options: A: 2-5 years, B: 1-2 years, C: first 7 days, D: 6 months - 12 months ### Response: Ans. is 'c' i.e., First 7 days ### 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: Monocytes, C: Macrophages, D: Plasma cells ### Response:

*Multiple myeloma is plasma cells disorder. These plasma cells may have intracytoplasmic inclusion called as Russel bodies and intranuclear inclusions called as Dutcher bodies.

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: Monocytes, C: Macrophages, D: Plasma cells ### Response: *Multiple myeloma is plasma cells disorder. These plasma cells may have intracytoplasmic inclusion called as Russel bodies and intranuclear inclusions called as Dutcher bodies. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The most severe form of Ehler Danlos syndrome is, with the following options: A: Type 1, B: Type 8, C: Type 4, D: Type 2 ### Response:

Ehlers danlos syndrome *A genetic defect in the synthesis of fibrillar collagen*Of all the types, type IV (vascular type) is the most severe form as it involves internal organs*Common type - Type VI (kyphoscoliosis type) caused due to a defect in lysyl hydroxylase*Type VII - defect in type 1 collagen*Type IV - Defect in type 3 collagen*Type I and II - Defect in type 5 collagen ( Ref: Robbins 8/e p146)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The most severe form of Ehler Danlos syndrome is, with the following options: A: Type 1, B: Type 8, C: Type 4, D: Type 2 ### Response: Ehlers danlos syndrome *A genetic defect in the synthesis of fibrillar collagen*Of all the types, type IV (vascular type) is the most severe form as it involves internal organs*Common type - Type VI (kyphoscoliosis type) caused due to a defect in lysyl hydroxylase*Type VII - defect in type 1 collagen*Type IV - Defect in type 3 collagen*Type I and II - Defect in type 5 collagen ( Ref: Robbins 8/e p146) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 32-year-old man presents with abdominal pain. On examination, he is noted to have pigmented spots in the buccal region. He is diagnosed to have Peutz-Jeghers syndrome, which also results in what? SELECT ONE., with the following options: A: Optic neuroma, B: Constricted pupil, C: Cerebellar dysfunction, D: Hamartomatous polyps in the small intestine ### Response:

In Peutz-Jegher syndrome, pigmented melanin spots are found in the buccal and perineal region. The lesions are flat and greenish black in the buccal region and remain after puberty. Pigmentation is found inside the mouth, nostrils, palms, and feet. Usually at about 20-30 years of age, hamartomatous polyps are found in the small intestine, but other parts of the alimentary tract may also be involved. Adenocarcinoma develops in 23% of patients.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 32-year-old man presents with abdominal pain. On examination, he is noted to have pigmented spots in the buccal region. He is diagnosed to have Peutz-Jeghers syndrome, which also results in what? SELECT ONE., with the following options: A: Optic neuroma, B: Constricted pupil, C: Cerebellar dysfunction, D: Hamartomatous polyps in the small intestine ### Response: In Peutz-Jegher syndrome, pigmented melanin spots are found in the buccal and perineal region. The lesions are flat and greenish black in the buccal region and remain after puberty. Pigmentation is found inside the mouth, nostrils, palms, and feet. Usually at about 20-30 years of age, hamartomatous polyps are found in the small intestine, but other parts of the alimentary tract may also be involved. Adenocarcinoma develops in 23% of patients. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: pH of polycarboxylate liquid is:, with the following options: A: 5, B: 7, C: 8, D: 1.7 ### Response:

Biocompatibility Pulpal response is classified as mild. Despite the initial acidic nature of polycarboxylate cement, the pH of the liquid is 1.0-1.07 and that of freshly mixed cement is 3.0-4.0. After 24 hours, pH of the cement is 5.0-6.0. They are less irritant than zinc phosphate cement because: The liquid is rapidly neutralized by the powder. The pH of polycarboxylate cement rises more rapidly than that of zinc phosphate. Penetration of polyacrylic acid into the dentinal tubules is less because of its higher molecular weight and larger size. The histological reactions are similar to zinc oxide eugenol cements but more reparative dentine is observed with polycarboxylate. Ref: Manappalil P;97

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: pH of polycarboxylate liquid is:, with the following options: A: 5, B: 7, C: 8, D: 1.7 ### Response: Biocompatibility Pulpal response is classified as mild. Despite the initial acidic nature of polycarboxylate cement, the pH of the liquid is 1.0-1.07 and that of freshly mixed cement is 3.0-4.0. After 24 hours, pH of the cement is 5.0-6.0. They are less irritant than zinc phosphate cement because: The liquid is rapidly neutralized by the powder. The pH of polycarboxylate cement rises more rapidly than that of zinc phosphate. Penetration of polyacrylic acid into the dentinal tubules is less because of its higher molecular weight and larger size. The histological reactions are similar to zinc oxide eugenol cements but more reparative dentine is observed with polycarboxylate. Ref: Manappalil P;97 ### 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 chromosomal defect is:, with the following options: A: Down's, B: Turner, C: Edward, D: Patau ### Response:

Ans: a (Downs) Ref: Robbins, 7th ed, p. 175Down's syndrome is the most common of the chromosome disorders and a major cause of mental retardation.Cytogenetic abnormalityNon disjunction (MC) = 95%Translocation (robertsonian) = 4 %Mosaicism = 1%Increased maternal age is the main risk factor .Translocation carriers carry high recurrence risk.Clinical features:Cardiac - endocardial cushion defect (MC)HypotoniaGIT - duodenal atresia, TEF, IHPS, Hirschprung disease, annular pancreasMental retardationShort statureMusculoskeletal system - atlantoaxial dislocationMicrocephaly/ brachycephalyRespiratory - recurrent aspiration pneumoniaOpen AFEndocrine - primary gonadal defect, hypothyroidismOblique palpebral fissureHaematopoietic - increased ALL and AMLBmshfield spot. But AML has a betterprognosis than normal individualsDepressed nasal bridgesLow set earsCNS alzhiemers in patients older than 40 yearsShort neck Simian crease,clinodactyly Sandal gap between 1st and 2nd toes Kennedy crease

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common chromosomal defect is:, with the following options: A: Down's, B: Turner, C: Edward, D: Patau ### Response: Ans: a (Downs) Ref: Robbins, 7th ed, p. 175Down's syndrome is the most common of the chromosome disorders and a major cause of mental retardation.Cytogenetic abnormalityNon disjunction (MC) = 95%Translocation (robertsonian) = 4 %Mosaicism = 1%Increased maternal age is the main risk factor .Translocation carriers carry high recurrence risk.Clinical features:Cardiac - endocardial cushion defect (MC)HypotoniaGIT - duodenal atresia, TEF, IHPS, Hirschprung disease, annular pancreasMental retardationShort statureMusculoskeletal system - atlantoaxial dislocationMicrocephaly/ brachycephalyRespiratory - recurrent aspiration pneumoniaOpen AFEndocrine - primary gonadal defect, hypothyroidismOblique palpebral fissureHaematopoietic - increased ALL and AMLBmshfield spot. But AML has a betterprognosis than normal individualsDepressed nasal bridgesLow set earsCNS alzhiemers in patients older than 40 yearsShort neck Simian crease,clinodactyly Sandal gap between 1st and 2nd toes Kennedy crease ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Botulism is a disease of: -, with the following options: A: Neural transmission caused by the toxin of the bacterium Clostridium botulinum, B: Muscular transmission caused by the toxin of the bacterium Clostridium botulinum, C: Neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum, D: Non neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum ### Response:

Neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum leads to botulism. C. botulinum produces powerful neurotoxin 'botulinum toxin'(BT). Botulinum toxin is absorbed from the gut, enters the blood circulation, and binds to receptors of presynaptic membranes of motor neurons of PNS and cranial nerves. The toxin does not cross the blood brain barrier or affect the central nervous system. Botulinum toxins act by blocking the release of acetylcholine at synapses and neuromuscular junction- resulting in lack of muscle contraction and flaccid paralysis. C/F - Flaccid ,symmetrical cranial nerve palsy -blurred vision, loss of pupilary reflexes. Symmetrical flaccid descending motor paralysis - Quadriparesis.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Botulism is a disease of: -, with the following options: A: Neural transmission caused by the toxin of the bacterium Clostridium botulinum, B: Muscular transmission caused by the toxin of the bacterium Clostridium botulinum, C: Neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum, D: Non neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum ### Response: Neuromuscular transmission caused by the toxin of the bacterium Clostridium botulinum leads to botulism. C. botulinum produces powerful neurotoxin 'botulinum toxin'(BT). Botulinum toxin is absorbed from the gut, enters the blood circulation, and binds to receptors of presynaptic membranes of motor neurons of PNS and cranial nerves. The toxin does not cross the blood brain barrier or affect the central nervous system. Botulinum toxins act by blocking the release of acetylcholine at synapses and neuromuscular junction- resulting in lack of muscle contraction and flaccid paralysis. C/F - Flaccid ,symmetrical cranial nerve palsy -blurred vision, loss of pupilary reflexes. Symmetrical flaccid descending motor paralysis - Quadriparesis. ### 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 cestodes EXCEPT, with the following options: A: Treponema pallidum, B: Echinococcus, C: Taenia solium, D: Taenia saginata ### Response:

Ref: Harrisons 19th ed. pg. 1146; table 245e1* Cestodes are helminthes. Example of cestodes:CestodesIntermediate hostDefinitive hostTaenia soliumPigManTaenia saginataBeefManEchinococcus granulosusMan, camels and sheepDogEchinococcus multilocularisRodents and humansFoxes, dogs and catsH. nanaManManD. latumCyclops, fresh water fishManNote: Treponema pallidum is a spirochete

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: All are cestodes EXCEPT, with the following options: A: Treponema pallidum, B: Echinococcus, C: Taenia solium, D: Taenia saginata ### Response: Ref: Harrisons 19th ed. pg. 1146; table 245e1* Cestodes are helminthes. Example of cestodes:CestodesIntermediate hostDefinitive hostTaenia soliumPigManTaenia saginataBeefManEchinococcus granulosusMan, camels and sheepDogEchinococcus multilocularisRodents and humansFoxes, dogs and catsH. nanaManManD. latumCyclops, fresh water fishManNote: Treponema pallidum is a spirochete ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not a feature of red infarction? September 2010, with the following options: A: Venous occlusion, B: Occurs in organs having dual circulation, C: Occurs in solid organs, D: Occurs in previously congested tissues ### Response:

Ans. C: Occurs in solid organsRed infarctions (hemorrhagic infarcts), generally affect the lungs or other loose organs (testis, ovary, small intestines). The occlusion consists more of red blood cells and fibrin strands.Characteristics of red infarcts include: occlusion of a vein; loose tissues that allow blood to collect in the infarcted zone; tissues with a dual circulatory system (lung, small intestines); tissues previously congested from sluggish venous outflow; and reperfusion (injury) of previously ischemic tissue that is associated with reperfusion-related diseases such as - Myocardial infarction, stroke (cerebral infarction), shock-resuscitation, replantation surgery, frostbite, burns and organ transplantation.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following is not a feature of red infarction? September 2010, with the following options: A: Venous occlusion, B: Occurs in organs having dual circulation, C: Occurs in solid organs, D: Occurs in previously congested tissues ### Response: Ans. C: Occurs in solid organsRed infarctions (hemorrhagic infarcts), generally affect the lungs or other loose organs (testis, ovary, small intestines). The occlusion consists more of red blood cells and fibrin strands.Characteristics of red infarcts include: occlusion of a vein; loose tissues that allow blood to collect in the infarcted zone; tissues with a dual circulatory system (lung, small intestines); tissues previously congested from sluggish venous outflow; and reperfusion (injury) of previously ischemic tissue that is associated with reperfusion-related diseases such as - Myocardial infarction, stroke (cerebral infarction), shock-resuscitation, replantation surgery, frostbite, burns and organ transplantation. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Acute corneal hydrops is seen in: September 2009, with the following options: A: Cornael dystrophy, B: Anterior staphyloma, C: Interstitial keaitis, D: Keratoconus ### Response:

Ans. D: KeratoconusCorneal hydrops is an uncommon complication seen in patients with keratoconus.It is characterized by significant corneal edema resulting from a spontaneous rupture in Descemet's membrane.Clinical findings include dense stromal and epithelial edema with corneal protrusion, possible conjunctival hyperemia and irregular epithelium secondary to microcystic edema.The location and area of the involved cornea is variable

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Acute corneal hydrops is seen in: September 2009, with the following options: A: Cornael dystrophy, B: Anterior staphyloma, C: Interstitial keaitis, D: Keratoconus ### Response: Ans. D: KeratoconusCorneal hydrops is an uncommon complication seen in patients with keratoconus.It is characterized by significant corneal edema resulting from a spontaneous rupture in Descemet's membrane.Clinical findings include dense stromal and epithelial edema with corneal protrusion, possible conjunctival hyperemia and irregular epithelium secondary to microcystic edema.The location and area of the involved cornea is variable ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 24 year old man gets married with 14 year old female. Having sex with her will be considered rape because :, with the following options: A: No consent taken from wife, B: Wife age < 14 year, C: Wife age < 15 year, D: Wife age < 17 year ### Response:

C i.e. Wife age < 15 years

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A 24 year old man gets married with 14 year old female. Having sex with her will be considered rape because :, with the following options: A: No consent taken from wife, B: Wife age < 14 year, C: Wife age < 15 year, D: Wife age < 17 year ### Response: C i.e. Wife age < 15 years ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Gamma waves of REM sleep in sleep cycle are associated with -, with the following options: A: Intense attention, B: Subconscious thinking, C: Deep subconscious thinking, D: Deep sleep ### Response:

Ans is 'a' i.e. Intense attention "Beta and gamma waves (20-80Hz) occur spontaneously during REM sleep and waking and are evoked by intense attention, conditioned responses, tasks requiring fine movements and sensory stimuli." - The Neuroscience of Sleep, p.24 EEG rhythms (Berger's rhythm) and sleep wake cycle 1) Alpha rhythm: - In adult humans who are awake but at rest with mind wandering and the eye closed, a-rhythm is prominent. It is a regular rhythm with a frequency of 8-13 Hz and amplitude of 50-100 m V. It is most marked in parietal and occipital lobe. It is associated with decreased level of attention, i.e., person is awake but has decreased attention (relaxed) - Person is thinking but with decreased attention (subconscious thinking). 2) Beta rhythm:- When attention is focused on something, the alpha rhythm is replaced by Beta rhythm. It is an irregular 13-30 Hz low voltage activity. It is most evident on frontal lobe and occurs when patient is fully awake and alert. Therefore this replacement of beta rhythm for alpha rhythm is called arousal or alerting response or alpha block. This phenomenon can be produced by any form of sensor stimulation or mental concentration such as solving arithmetic problems. Person is thinking with a maximum concentration - Conscious thinking. 3) Theta rhythm:- When person with alpha rhythm becomes slightly more relaxed (as occurs when there is transition from wakefullness to sleep, i.e., stage 1 of NREM), alpha rhythm is replaced by theta rhythm. Thinking is present but with even less attentiveness than which was present in alpha rhythm stage (Deep subcsoncious thinking). Two types of theta rhythm have been described:- i) Hippocampal (occurs in mammals other than men, i.e., cat dogs, etc). ii) Cortical (occurs in men). 4) Delta rhythm:- It is present when the person is in deep sleep (NREM stage 3 & 4) and there is no thinking.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Gamma waves of REM sleep in sleep cycle are associated with -, with the following options: A: Intense attention, B: Subconscious thinking, C: Deep subconscious thinking, D: Deep sleep ### Response: Ans is 'a' i.e. Intense attention "Beta and gamma waves (20-80Hz) occur spontaneously during REM sleep and waking and are evoked by intense attention, conditioned responses, tasks requiring fine movements and sensory stimuli." - The Neuroscience of Sleep, p.24 EEG rhythms (Berger's rhythm) and sleep wake cycle 1) Alpha rhythm: - In adult humans who are awake but at rest with mind wandering and the eye closed, a-rhythm is prominent. It is a regular rhythm with a frequency of 8-13 Hz and amplitude of 50-100 m V. It is most marked in parietal and occipital lobe. It is associated with decreased level of attention, i.e., person is awake but has decreased attention (relaxed) - Person is thinking but with decreased attention (subconscious thinking). 2) Beta rhythm:- When attention is focused on something, the alpha rhythm is replaced by Beta rhythm. It is an irregular 13-30 Hz low voltage activity. It is most evident on frontal lobe and occurs when patient is fully awake and alert. Therefore this replacement of beta rhythm for alpha rhythm is called arousal or alerting response or alpha block. This phenomenon can be produced by any form of sensor stimulation or mental concentration such as solving arithmetic problems. Person is thinking with a maximum concentration - Conscious thinking. 3) Theta rhythm:- When person with alpha rhythm becomes slightly more relaxed (as occurs when there is transition from wakefullness to sleep, i.e., stage 1 of NREM), alpha rhythm is replaced by theta rhythm. Thinking is present but with even less attentiveness than which was present in alpha rhythm stage (Deep subcsoncious thinking). Two types of theta rhythm have been described:- i) Hippocampal (occurs in mammals other than men, i.e., cat dogs, etc). ii) Cortical (occurs in men). 4) Delta rhythm:- It is present when the person is in deep sleep (NREM stage 3 & 4) and there is no thinking. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Antenatal suppo is not delivered by, with the following options: A: Anganwadi worker, B: Female Health worker, C: Health supervisor female, D: Traditional bih Attendant ### Response:

The special category of &;maternal and child health worker&; at peripheral level is gradually being phased out. A wide range of workers is now considered necessary for maternal and child health work. They include1) Professionals: Specialists2) Field workers: Multi-purpose workers, Health guides, Dais (traditional bih attendants), balsevikas, Anganwadi workers, ASHA3) Members of women organisations.Park23rd edition pg: 556

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Antenatal suppo is not delivered by, with the following options: A: Anganwadi worker, B: Female Health worker, C: Health supervisor female, D: Traditional bih Attendant ### Response: The special category of &;maternal and child health worker&; at peripheral level is gradually being phased out. A wide range of workers is now considered necessary for maternal and child health work. They include1) Professionals: Specialists2) Field workers: Multi-purpose workers, Health guides, Dais (traditional bih attendants), balsevikas, Anganwadi workers, ASHA3) Members of women organisations.Park23rd edition pg: 556 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Schedule-3 of MCI includes -, with the following options: A: MBBS degree of indian universities, B: DNB degree, C: Diploma of CPS, D: MBBS degree of foreign universities ### Response:

Ans. is 'c' i.e., Diploma of CPS Schedules of MCI Acto MCI was established in 1934 and MCI act was revised in 1956,1964,1993,1999, and 2002. The schedules of MCI includes list of medical degrees recognized by MCI :-Schedule 1Includes list of recognised degrees awarded by Indian universities7^(tm)5 ll) and also DNB awardedby National Board of Examination, New Delhi.Schedule 2 Includes list of recognized medical degrees awarded by foreign universities^7^.Schedule 3 Includes list of medical qualifications awarded by Indian or foreign boards or societies, but are notincluded in schedule 1 or 2. It has two partsPart I: Includes list of recognized degrees other than MBBS awarded by Indian Societies and Boards, e.g LMPand diploma of CPS.Part II: Includes list of recognized degrees other than MBBS awarded by Foreign Societies and Boards.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Schedule-3 of MCI includes -, with the following options: A: MBBS degree of indian universities, B: DNB degree, C: Diploma of CPS, D: MBBS degree of foreign universities ### Response: Ans. is 'c' i.e., Diploma of CPS Schedules of MCI Acto MCI was established in 1934 and MCI act was revised in 1956,1964,1993,1999, and 2002. The schedules of MCI includes list of medical degrees recognized by MCI :-Schedule 1Includes list of recognised degrees awarded by Indian universities7^(tm)5 ll) and also DNB awardedby National Board of Examination, New Delhi.Schedule 2 Includes list of recognized medical degrees awarded by foreign universities^7^.Schedule 3 Includes list of medical qualifications awarded by Indian or foreign boards or societies, but are notincluded in schedule 1 or 2. It has two partsPart I: Includes list of recognized degrees other than MBBS awarded by Indian Societies and Boards, e.g LMPand diploma of CPS.Part II: Includes list of recognized degrees other than MBBS awarded by Foreign Societies and Boards. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Primordial prevention is done in population -, with the following options: A: With risk factors, B: Without risk factors, C: Whole population with low prevalence of disease, D: Population with disease ### Response:

In primordial prevention, action is taken prior to emergence of risk factor, i.e. action is taken in population which has not developed risk factor.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Primordial prevention is done in population -, with the following options: A: With risk factors, B: Without risk factors, C: Whole population with low prevalence of disease, D: Population with disease ### Response: In primordial prevention, action is taken prior to emergence of risk factor, i.e. action is taken in population which has not developed risk factor. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The most important prognostic factor in carcinoma breast is:, with the following options: A: Size of tumour, B: Skin involvement, C: Involvement of muscles, D: Axillary gland involvement ### Response:

Ans: d (Axillary gland involvement)Ref: Patho Robbins, 7th ed, p. 1146 & 6th ed, p. 115, Schwartz surgery, 7th ed, p. 558, Bailey & Love, 24th ed, p. 839 & 23rd ed, p. 765

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The most important prognostic factor in carcinoma breast is:, with the following options: A: Size of tumour, B: Skin involvement, C: Involvement of muscles, D: Axillary gland involvement ### Response: Ans: d (Axillary gland involvement)Ref: Patho Robbins, 7th ed, p. 1146 & 6th ed, p. 115, Schwartz surgery, 7th ed, p. 558, Bailey & Love, 24th ed, p. 839 & 23rd ed, p. 765 ### 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 seen in this patient of Grave disease?, with the following options: A: Chemosis, B: Kocher sign, C: Von Graefe sign, D: Stellwag sign ### Response:

Ans. B. Kocher signFollowing Eye signs are seen in all cases of hyperthyroid.a. Wide staring appearance (Kocher Sign)b. Upper Lid retraction (Dalrymple sign),c. lid lag with down gaze (Von Graefe sign).d. Decreased blinking (Stellwag sign)(All these features are due to sympathetic over stimulation causing levator palpebrae superioris contraction.)Following Eye signs are seen only in Grave disease.a. Chemosis'b. Exophthalmosc. Corneal ulcerationd. Ophthalmoplegiae. Papilledemaf. Diplopia (diplopia results, typically when patient looks up and laterally)(PROPTOSIS occur due to GLYCOSAMINOGLUCAN deposit)

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 seen in this patient of Grave disease?, with the following options: A: Chemosis, B: Kocher sign, C: Von Graefe sign, D: Stellwag sign ### Response: Ans. B. Kocher signFollowing Eye signs are seen in all cases of hyperthyroid.a. Wide staring appearance (Kocher Sign)b. Upper Lid retraction (Dalrymple sign),c. lid lag with down gaze (Von Graefe sign).d. Decreased blinking (Stellwag sign)(All these features are due to sympathetic over stimulation causing levator palpebrae superioris contraction.)Following Eye signs are seen only in Grave disease.a. Chemosis'b. Exophthalmosc. Corneal ulcerationd. Ophthalmoplegiae. Papilledemaf. Diplopia (diplopia results, typically when patient looks up and laterally)(PROPTOSIS occur due to GLYCOSAMINOGLUCAN deposit) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following actions are caused by 2-4-diinitrophenol?, with the following options: A: Inhibition of ATP synthase, B: Inhibition of electron transpo, C: Uncoupling of oxidation and phosphorylation, D: Accumulation of ATP ### Response:

2,4-dinitrophenol and valinomycin are two uncouplers which inhibit oxidative phosphorylation. 2,4-dinitrophenol is a potent uncoupler even in low concentrations by dissolving itself in the bi-lipid core of the inner cell membrane. Ref: Harper's Illustrated Biochemistry 27th/107; Biochemistry 3E By S C Rastogi, 2010, Page 224.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which of the following actions are caused by 2-4-diinitrophenol?, with the following options: A: Inhibition of ATP synthase, B: Inhibition of electron transpo, C: Uncoupling of oxidation and phosphorylation, D: Accumulation of ATP ### Response: 2,4-dinitrophenol and valinomycin are two uncouplers which inhibit oxidative phosphorylation. 2,4-dinitrophenol is a potent uncoupler even in low concentrations by dissolving itself in the bi-lipid core of the inner cell membrane. Ref: Harper's Illustrated Biochemistry 27th/107; Biochemistry 3E By S C Rastogi, 2010, Page 224. ### 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 are indications of TURP for BHP? 1. Prostatism 2.Acute retention of urine 3. Haematuria 4.Complications like hydronephrosis, with the following options: A: 1,2 and 3, B: 2,3 and 4, C: 1,2 and 4, D: 1,2,3 and 4 ### Response:

Indications for surgery in BPH Prostatism (frequncy,urgency,dysuria) Acute rention of urine Chronic retention of urine with residue more than 200ml Haematuria Complications like hydroureter , hydronephrosis , stone formation , bladder changes etc ref- srb's manual of surgery 5e p 1045

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 are indications of TURP for BHP? 1. Prostatism 2.Acute retention of urine 3. Haematuria 4.Complications like hydronephrosis, with the following options: A: 1,2 and 3, B: 2,3 and 4, C: 1,2 and 4, D: 1,2,3 and 4 ### Response: Indications for surgery in BPH Prostatism (frequncy,urgency,dysuria) Acute rention of urine Chronic retention of urine with residue more than 200ml Haematuria Complications like hydroureter , hydronephrosis , stone formation , bladder changes etc ref- srb's manual of surgery 5e p 1045 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In classic Barret's, the length of columnar epithelium in distal oesophagus is, with the following options: A: >1cm, B: >2cm, C: >3cm, D: >4cm ### Response:

Classic Barrett's (>= 3cm columnar epithelium);Sho-segment Barrett's (<3 cm of columnar epithelium);Cardia metaplasia (intestinal metaplasia at the oesophagogastric junction without any macroscopic change at endoscopy).The relative risk of cancer rises with increasing length of abnormal mucosa.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: In classic Barret's, the length of columnar epithelium in distal oesophagus is, with the following options: A: >1cm, B: >2cm, C: >3cm, D: >4cm ### Response: Classic Barrett's (>= 3cm columnar epithelium);Sho-segment Barrett's (<3 cm of columnar epithelium);Cardia metaplasia (intestinal metaplasia at the oesophagogastric junction without any macroscopic change at endoscopy).The relative risk of cancer rises with increasing length of abnormal mucosa. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Secondary osteosarcoma are associated with, with the following options: A: Paget's disease, B: Osteogenesis imperfecta, C: Melhoreostosis, D: Ankylosing spondilitis ### Response:

Answer- A. Paget's diseaseCauses of secondary osteosarcomaPagets DiseaseFibrous dysplasiaEnchondromatosisHereditary multiple exostosisRadiationChronicosteomyelitisBone infarction

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Secondary osteosarcoma are associated with, with the following options: A: Paget's disease, B: Osteogenesis imperfecta, C: Melhoreostosis, D: Ankylosing spondilitis ### Response: Answer- A. Paget's diseaseCauses of secondary osteosarcomaPagets DiseaseFibrous dysplasiaEnchondromatosisHereditary multiple exostosisRadiationChronicosteomyelitisBone infarction ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A female married to a normal male but her father had vitamin D resistant rickets. So what are the chances that her childrens will be colour blind:March 2013, with the following options: A: 0%, B: 50%, C: 75%, D: 100% ### Response:

Ans. B i.e. 50%X-linked dominant are transmitted by an affected heterozygous female to half her sons and half her daughters and by an affected male parent to all his daughters but none of his sons, if the female parent is unaffected.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A female married to a normal male but her father had vitamin D resistant rickets. So what are the chances that her childrens will be colour blind:March 2013, with the following options: A: 0%, B: 50%, C: 75%, D: 100% ### Response: Ans. B i.e. 50%X-linked dominant are transmitted by an affected heterozygous female to half her sons and half her daughters and by an affected male parent to all his daughters but none of his sons, if the female parent is unaffected. ### 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 organism causing meningitis in a 1 year old child, with the following options: A: Streptococcus pneumoniae, B: H. influenza, C: Listeria, D: Neisseria meningitidIs ### Response:

Streptococcus pneumonia is the most common organism causes meningitis even in the 1 year old child. Reference: GHAI Essential pediatrics, 8th edition

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Most common organism causing meningitis in a 1 year old child, with the following options: A: Streptococcus pneumoniae, B: H. influenza, C: Listeria, D: Neisseria meningitidIs ### Response: Streptococcus pneumonia is the most common organism causes meningitis even in the 1 year old child. Reference: GHAI Essential pediatrics, 8th edition ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A bodybuilder starts eating raw egg for protein. He used develop fatigue on moderate exercise. The doctor prescribes a vitamin. Which enzyme is deficient in him?, with the following options: A: Glucose 6 Phosphatase, B: Pyruvate Carboxylase, C: PEPCK, D: Glycogen Phosphorylase ### Response:

Ans. (b) Pyruvate CarboxylaseRef: Harpers Biochemistry 30th Ed; Page No- 560* Raw egg contains Avidin, it is antagonist of Biotin.* Eating raw egg is harmful because of Avidin present in raw egg inhibit biotin.* Affinity of Avidin to Biotin is stronger than most of the Antigen antibody reaction.* So doctor only prescribe Biotin.* ELISA test and Labeling of DNA test are used.* Why do u need biotin? Because biotin is the mother of all carboxylation reaction.* Only one carboxylase given in options, so option B will be the best answer.Note* Streptavidin is also biotin antagonist. It is purified from Streptomyces Avidin. Bind 4 molecule of biotin.Coenzyme role of BiotinBiotin dependent carboxylation reaction* Pyruvate carboxylase: pyruvate (3C)- oxaloacetate (4C)* Acetyl-CoA carboxylase: acetyl-CoA (2C)- malonyl-CoA (3C)* Propionyl-CoA carboxylase: propionyl-CoA(3C)- methylmalonyl-CoA(4C)* Methyl Crotonyl CoA Carboxylase.Biotin Independent carboxylation reaction* Malic enzyme (Pyruvate to Malate)* Carbamoyl phosphate Synthetases -I & II* Gamma Carboxylation (Vitamin K dependent)* Addition of CO2 tC6 in purine ring (AIR Carboxylase)Extra MileCoenzyme Role of Vitamin B complex Thiamine* Pyruvate dehydrogenase (links glycolysis to TCA cycle)* a-ketoglutarate dehydrogenase (TCA cycle)* Transketolase (HMP shunt)* Branched-chain ketoacid dehydrogenaseRiboflavin* Component of flavins FAD and FMN, used as cofactors in redox reactions, eg, the succinate dehydrogenase reaction in the TCA cycleNiacin* NAD+ linked Enzymes# Lactate dehydrogenase# Pyruvate dehydrogenase# a-ketoglutarate dehydrogenase# Isocitrate dehydrogenase# Malate dehydrogenase# Glutamate dehydrogenase# Glyceraldehyde 3 phosphate dehydrogenase* NADPH generating reaction# Glucose 6 phosphate dehydrogenase in HMP shunt pathway# 6 phospho Gluconate Dehydrogenase in HMP shunt pathway# Malic enzyme (NADP Malate Dehydrogenase)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A bodybuilder starts eating raw egg for protein. He used develop fatigue on moderate exercise. The doctor prescribes a vitamin. Which enzyme is deficient in him?, with the following options: A: Glucose 6 Phosphatase, B: Pyruvate Carboxylase, C: PEPCK, D: Glycogen Phosphorylase ### Response: Ans. (b) Pyruvate CarboxylaseRef: Harpers Biochemistry 30th Ed; Page No- 560* Raw egg contains Avidin, it is antagonist of Biotin.* Eating raw egg is harmful because of Avidin present in raw egg inhibit biotin.* Affinity of Avidin to Biotin is stronger than most of the Antigen antibody reaction.* So doctor only prescribe Biotin.* ELISA test and Labeling of DNA test are used.* Why do u need biotin? Because biotin is the mother of all carboxylation reaction.* Only one carboxylase given in options, so option B will be the best answer.Note* Streptavidin is also biotin antagonist. It is purified from Streptomyces Avidin. Bind 4 molecule of biotin.Coenzyme role of BiotinBiotin dependent carboxylation reaction* Pyruvate carboxylase: pyruvate (3C)- oxaloacetate (4C)* Acetyl-CoA carboxylase: acetyl-CoA (2C)- malonyl-CoA (3C)* Propionyl-CoA carboxylase: propionyl-CoA(3C)- methylmalonyl-CoA(4C)* Methyl Crotonyl CoA Carboxylase.Biotin Independent carboxylation reaction* Malic enzyme (Pyruvate to Malate)* Carbamoyl phosphate Synthetases -I & II* Gamma Carboxylation (Vitamin K dependent)* Addition of CO2 tC6 in purine ring (AIR Carboxylase)Extra MileCoenzyme Role of Vitamin B complex Thiamine* Pyruvate dehydrogenase (links glycolysis to TCA cycle)* a-ketoglutarate dehydrogenase (TCA cycle)* Transketolase (HMP shunt)* Branched-chain ketoacid dehydrogenaseRiboflavin* Component of flavins FAD and FMN, used as cofactors in redox reactions, eg, the succinate dehydrogenase reaction in the TCA cycleNiacin* NAD+ linked Enzymes# Lactate dehydrogenase# Pyruvate dehydrogenase# a-ketoglutarate dehydrogenase# Isocitrate dehydrogenase# Malate dehydrogenase# Glutamate dehydrogenase# Glyceraldehyde 3 phosphate dehydrogenase* NADPH generating reaction# Glucose 6 phosphate dehydrogenase in HMP shunt pathway# 6 phospho Gluconate Dehydrogenase in HMP shunt pathway# Malic enzyme (NADP Malate Dehydrogenase) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Angle between nasal septum and lower border of upper lateral cailage is ____, with the following options: A: 40 0, B: 60 0, C: 500, D: 15 0 ### Response:

- Angle between the nasal septum and lower border of upper lateral cailage is generally > 10-15deg The internal nasal valve, in normal development, is thenarrowest poion of the nasal cavity and is bounded bythe septum medially, caudal edge of the upper lateral cailage and head of the inferior turbinate laterally and nasalfloor inferiorly. The apex of the internalnasal valve is approximately 10-15 degrees in Caucasiansand wider in non-Caucasian populations.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Angle between nasal septum and lower border of upper lateral cailage is ____, with the following options: A: 40 0, B: 60 0, C: 500, D: 15 0 ### Response: - Angle between the nasal septum and lower border of upper lateral cailage is generally > 10-15deg The internal nasal valve, in normal development, is thenarrowest poion of the nasal cavity and is bounded bythe septum medially, caudal edge of the upper lateral cailage and head of the inferior turbinate laterally and nasalfloor inferiorly. The apex of the internalnasal valve is approximately 10-15 degrees in Caucasiansand wider in non-Caucasian populations. ### 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 conditions produce a seborrheic dermatitis like lesions in an infant?, with the following options: A: Langerhan cell histiocytosis, B: Juvenile xanthogranuloma, C: Multicentric histiocytosis, D: Erdheim Chester disease ### Response:

All the above mentioned optionscare disorders of histiocytes. In langerhan cell histiocytosis, bone, lymph node and skin are the most frequently affected sytems. The most characteristic presentation is with scalp involvement. which is erythematous with greasy scales, looking very like seborrheic dermatitis. S100 Paraffin, peanut agglutinin, Placental alkaline phosphatase are the common used immunological markers.

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 conditions produce a seborrheic dermatitis like lesions in an infant?, with the following options: A: Langerhan cell histiocytosis, B: Juvenile xanthogranuloma, C: Multicentric histiocytosis, D: Erdheim Chester disease ### Response: All the above mentioned optionscare disorders of histiocytes. In langerhan cell histiocytosis, bone, lymph node and skin are the most frequently affected sytems. The most characteristic presentation is with scalp involvement. which is erythematous with greasy scales, looking very like seborrheic dermatitis. S100 Paraffin, peanut agglutinin, Placental alkaline phosphatase are the common used immunological markers. ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which is not an indication of thoracotomy -, with the following options: A: Massive pneumothorax, B: Pulmonary contusion, C: Bleeding more than 200m1/hr. in thoracotomy tube, D: Oesophageal rupture ### Response:

Indications of thoracotomy after chest trauma Cardiac arrest (resuscitative thoracotomy) Massive hemothorax (drainage of more than 1500 ml of blood when a chest tube is first inserted or continuous haemorrhage of more than 200 ml/hr for more than 3 consecutive hours). Brisk bleeding (> 100 ml/15 min) Penetrating injuries of the anterior chest with cardiac tamponade. Large open wounds of the thoracic cage. Rupture of the bronchus, aorta, esophagus or diaphragm. A non-emergent indication of thoracotomy Empyema not resolved with tube thoracostomy Clotted hemothorax Lung abcess Thoracic duct injuries Tracheoesophageal fistulas Chronic sequelae of vascular injuries (pseudo aneurysms & AV fistulas) Such an exhaustive list is prepared by mixing all the three books. (Shwartz, Sabiston, Bailey)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which is not an indication of thoracotomy -, with the following options: A: Massive pneumothorax, B: Pulmonary contusion, C: Bleeding more than 200m1/hr. in thoracotomy tube, D: Oesophageal rupture ### Response: Indications of thoracotomy after chest trauma Cardiac arrest (resuscitative thoracotomy) Massive hemothorax (drainage of more than 1500 ml of blood when a chest tube is first inserted or continuous haemorrhage of more than 200 ml/hr for more than 3 consecutive hours). Brisk bleeding (> 100 ml/15 min) Penetrating injuries of the anterior chest with cardiac tamponade. Large open wounds of the thoracic cage. Rupture of the bronchus, aorta, esophagus or diaphragm. A non-emergent indication of thoracotomy Empyema not resolved with tube thoracostomy Clotted hemothorax Lung abcess Thoracic duct injuries Tracheoesophageal fistulas Chronic sequelae of vascular injuries (pseudo aneurysms & AV fistulas) Such an exhaustive list is prepared by mixing all the three books. (Shwartz, Sabiston, Bailey) ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which egg does not float in a saturated solution of saline ?, with the following options: A: Ankylostoma eggs, B: Trichuris eggs, C: Unfeilized egg of Ascaris, D: Feilized egg of Ascaris ### Response:

Helminth eggs floating in saturated salt solution: Hell FATE Hell-Helminth,H.nana F-Feilised eggs of Ascaris A-Ancylostoma duodenale T-Trichuris trichiura E-Enterobius vermicularis

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which egg does not float in a saturated solution of saline ?, with the following options: A: Ankylostoma eggs, B: Trichuris eggs, C: Unfeilized egg of Ascaris, D: Feilized egg of Ascaris ### Response: Helminth eggs floating in saturated salt solution: Hell FATE Hell-Helminth,H.nana F-Feilised eggs of Ascaris A-Ancylostoma duodenale T-Trichuris trichiura E-Enterobius vermicularis ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Cholecysto-venacaval line seperates which of the following ?, with the following options: A: Gallbladder and IVC, B: Poa hepatis and IVC, C: Caudate lobe and quadrangular lobe, D: Right and left lobe of liver ### Response:

Cholecysto-venacaval line (cantlie line) seperates right and left lobe of the liver. Cantlie line is an imaginary line that divides the liver into two planes. It extends from the midpoint of the gallbladder fossa at the inferior margin of the liver back to the midpoint of the IVC and contains the middle hepatic vein. Ref: Gray&;s Anatomy 41st edition Pgno: 1162

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Cholecysto-venacaval line seperates which of the following ?, with the following options: A: Gallbladder and IVC, B: Poa hepatis and IVC, C: Caudate lobe and quadrangular lobe, D: Right and left lobe of liver ### Response: Cholecysto-venacaval line (cantlie line) seperates right and left lobe of the liver. Cantlie line is an imaginary line that divides the liver into two planes. It extends from the midpoint of the gallbladder fossa at the inferior margin of the liver back to the midpoint of the IVC and contains the middle hepatic vein. Ref: Gray&;s Anatomy 41st edition Pgno: 1162 ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Patient diagnosed with HIV and Tuberculosis. How to sta ATT and c-A.R.T, with the following options: A: Sta ATT first, B: Sta cA first, C: Sta both simultaneously, D: Sta cA only ### Response:

Ans. is 'a' i.e., Sta ATT first In a case when HIV and TB are diagnosed together ATT should be staed first. ATT staed first, because of IRIS (Immune Reconstitution Inflammatory syndrome). If A staed first, it may improve CD4 cells at first, but later a previously acquired infection (TB, Herpes), responds with an overshelming inflammatory response that paradoxically makes the symptom of infection worse. Therefore, staing of ATT-2 weeks before A, have shown to decrease the incidence of IRIS.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Patient diagnosed with HIV and Tuberculosis. How to sta ATT and c-A.R.T, with the following options: A: Sta ATT first, B: Sta cA first, C: Sta both simultaneously, D: Sta cA only ### Response: Ans. is 'a' i.e., Sta ATT first In a case when HIV and TB are diagnosed together ATT should be staed first. ATT staed first, because of IRIS (Immune Reconstitution Inflammatory syndrome). If A staed first, it may improve CD4 cells at first, but later a previously acquired infection (TB, Herpes), responds with an overshelming inflammatory response that paradoxically makes the symptom of infection worse. Therefore, staing of ATT-2 weeks before A, have shown to decrease the incidence of IRIS. ### 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 statements related to gastric injury is not true?, with the following options: A: Mostly related to penetrating trauma, B: Treatment is simple debridement and suturing, C: Blood in stomach is always related to gastric injury, D: Heals well and fast ### Response:

Ans. (c) Blood in stomach is always related to gastric injuryRef: Sabiston 19/e p461-462* Blood in stomach may come from esophageal injury, or from bleeding periampullary lesion can regurgitate, peptic ulcers etc.* MC mechanism of stomach injury is Penetrating injury

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 statements related to gastric injury is not true?, with the following options: A: Mostly related to penetrating trauma, B: Treatment is simple debridement and suturing, C: Blood in stomach is always related to gastric injury, D: Heals well and fast ### Response: Ans. (c) Blood in stomach is always related to gastric injuryRef: Sabiston 19/e p461-462* Blood in stomach may come from esophageal injury, or from bleeding periampullary lesion can regurgitate, peptic ulcers etc.* MC mechanism of stomach injury is Penetrating injury ### 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 originates from tibia, fibula and interosseous membrane?, with the following options: A: Popliteus, B: Flexor digitorum longus, C: Flexor hellus longus, D: Tibialis posterior ### Response:

TIBIALIS POSTERIOR:Origin: upper two-thirds of lateral pa of posterior surface of tibia below the soleal line.Posterior surface of fibula in front of medial crest Posterior surface of interosseous membrane.Popliteus: arises from lateral surface of lateral condyle of femur.origin is intracapsular.lateral meniscus of knee joint.Flexor digitorum longus: uppercut two third of medial pa of posterior surface of tibia below soleal line.Flexor hallucis longus: posterior surface of fibula and interosseous membrane.{Reference: BDC 6E pg no.106}

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: Which muscle originates from tibia, fibula and interosseous membrane?, with the following options: A: Popliteus, B: Flexor digitorum longus, C: Flexor hellus longus, D: Tibialis posterior ### Response: TIBIALIS POSTERIOR:Origin: upper two-thirds of lateral pa of posterior surface of tibia below the soleal line.Posterior surface of fibula in front of medial crest Posterior surface of interosseous membrane.Popliteus: arises from lateral surface of lateral condyle of femur.origin is intracapsular.lateral meniscus of knee joint.Flexor digitorum longus: uppercut two third of medial pa of posterior surface of tibia below soleal line.Flexor hallucis longus: posterior surface of fibula and interosseous membrane.{Reference: BDC 6E pg no.106} ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A severely ill patient was maintained on an infusional anaesthetic agent. On the 2nd day he staed detiorating. The probable culprit may be, with the following options: A: Etiomidate, B: Propofol, C: Opioid, D: Barbiturate ### Response:

A i.e. Etomidate; B i.e. Propofol Increased infection and moality in a group of patients sedated with etomidate infusion in an ICU was associated with low coisol levelsQ and is attributed to etomidate induced supression of adrenal coisal synthesisQ. Etomidate is a dose dependent but reversible inhibitor of 11 - hydroxylase in the adrenal coex and is more potent than metyrapone. This enzyme is required for both mineralocoicoid and coicosteroid production. Minor adrenocoical supressive effects (i.e. impaired response to ACTH) follow induction doses or sho infusion doses. Propofol is not recommended for sedation of critically ill pediatric patients in ICU. The drug has been associated with higher moality d/t propofol infusion syndrome. Its essential features are metabolic acidosis, multiple organ failure, hemodynamic instability, hepatomegaly, and rhabdomyolysis. Very rarely, it may occur in adults, and in patients undergoing long term propofol infusion (> 48 hours) for sedation at high doses (>5 mg/ kg/ hr).

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: A severely ill patient was maintained on an infusional anaesthetic agent. On the 2nd day he staed detiorating. The probable culprit may be, with the following options: A: Etiomidate, B: Propofol, C: Opioid, D: Barbiturate ### Response: A i.e. Etomidate; B i.e. Propofol Increased infection and moality in a group of patients sedated with etomidate infusion in an ICU was associated with low coisol levelsQ and is attributed to etomidate induced supression of adrenal coisal synthesisQ. Etomidate is a dose dependent but reversible inhibitor of 11 - hydroxylase in the adrenal coex and is more potent than metyrapone. This enzyme is required for both mineralocoicoid and coicosteroid production. Minor adrenocoical supressive effects (i.e. impaired response to ACTH) follow induction doses or sho infusion doses. Propofol is not recommended for sedation of critically ill pediatric patients in ICU. The drug has been associated with higher moality d/t propofol infusion syndrome. Its essential features are metabolic acidosis, multiple organ failure, hemodynamic instability, hepatomegaly, and rhabdomyolysis. Very rarely, it may occur in adults, and in patients undergoing long term propofol infusion (> 48 hours) for sedation at high doses (>5 mg/ kg/ hr). ### End

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The pharmacokinetics of Paroxetine include its ability to be easily absorbed after oral administration in healthy volunteers even after food is ingested. Which of the following is TRUE?, with the following options: A: Main poion of the medication resides in system circulation, B: Little of the medication is absorbed into the tissues, C: Less than 1% of the drug is in systemic circulation owing to extensive distribution in body tissues., D: Less than 25% is eliminated by the kidneys ### Response:

The major poion of paroxetine is distributed into the tissues and less than 1% if in systemic circulation while 64% if eliminated by the kidneys and 36% in the feces. The primary effect is believed to be on brain neurons because of its qualities as a selective serotonin reuptake inhibitor (SSRI). Ref: Pollock B.G., Semla T.P., Forsyth C.E. (2009). Chapter 63. Psychoactive Drug Therapy. In J.B. Halter, J.G. Ouslander, M.E. Tinetti, S. Studenski, K.P. High, S. Asthana (Eds), Hazzard's Geriatric Medicine and Gerontology, 6e.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Answer the following medical question: The pharmacokinetics of Paroxetine include its ability to be easily absorbed after oral administration in healthy volunteers even after food is ingested. Which of the following is TRUE?, with the following options: A: Main poion of the medication resides in system circulation, B: Little of the medication is absorbed into the tissues, C: Less than 1% of the drug is in systemic circulation owing to extensive distribution in body tissues., D: Less than 25% is eliminated by the kidneys ### Response: The major poion of paroxetine is distributed into the tissues and less than 1% if in systemic circulation while 64% if eliminated by the kidneys and 36% in the feces. The primary effect is believed to be on brain neurons because of its qualities as a selective serotonin reuptake inhibitor (SSRI). Ref: Pollock B.G., Semla T.P., Forsyth C.E. (2009). Chapter 63. Psychoactive Drug Therapy. In J.B. Halter, J.G. Ouslander, M.E. Tinetti, S. Studenski, K.P. High, S. Asthana (Eds), Hazzard's Geriatric Medicine and Gerontology, 6e. ### 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 follow ing are risk factors for carcinoma gall bladder, except -, with the following options: A: Typhoid carriers, B: Adenomatous gall bladder polyps, C: Choledochal cysts, D: Oral contraceptives ### Response:

Ans. is 'd' i.e., Oral contraceptives No risk of Ca G.B. has been noted with the use of oral contraceptiveso Risk factors for Ca Gall bladder are :i) Gall stonesApproximately 90% of patients with Ca GB have gall stonesSize of the stone has a direct relationship with development of carcinoma, the risk is ten times more for larger stones (3 cm in diameter) than for stones less than 1 cm in diameterThe risk is higher with symptomatic than asymptomatic stones.ii) Adenomatous gall bladder polyps (particularly polyps larger than 10 mm)Calcified (porcelain) gall bladderCholeduochal cystEstrogensAnomalous pancreaticobiliary duct junctionExposure to carcinogens (azotoulene, nitrosamine)Typhoid carriersSclerosing cholangitisCholecystoenteric fistula Ulcerative colitis o ASI Surgery mentions two other risk factorsChemicals used in rubber industryUse of adulerated mustard cooking oil in India

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 follow ing are risk factors for carcinoma gall bladder, except -, with the following options: A: Typhoid carriers, B: Adenomatous gall bladder polyps, C: Choledochal cysts, D: Oral contraceptives ### Response: Ans. is 'd' i.e., Oral contraceptives No risk of Ca G.B. has been noted with the use of oral contraceptiveso Risk factors for Ca Gall bladder are :i) Gall stonesApproximately 90% of patients with Ca GB have gall stonesSize of the stone has a direct relationship with development of carcinoma, the risk is ten times more for larger stones (3 cm in diameter) than for stones less than 1 cm in diameterThe risk is higher with symptomatic than asymptomatic stones.ii) Adenomatous gall bladder polyps (particularly polyps larger than 10 mm)Calcified (porcelain) gall bladderCholeduochal cystEstrogensAnomalous pancreaticobiliary duct junctionExposure to carcinogens (azotoulene, nitrosamine)Typhoid carriersSclerosing cholangitisCholecystoenteric fistula Ulcerative colitis o ASI Surgery mentions two other risk factorsChemicals used in rubber industryUse of adulerated mustard cooking oil in India ### End